COLUMN ONE : Russia’s Epidemic of Shame : As venereal diseases rise, Moscow tries to convince citizens that treatment is now humane. Fearing the spread of AIDS, officials must undo mistrust created by a harsh Soviet system and gulag of VD hospitals.

The young woman’s face blushed the color of borscht.

Her chin disappeared into the high collar of her fur coat as she looked furtively around the hospital waiting room making sure no one she knew was there. Then she whispered that she had caught “it” from her husband.

The woman could not bring herself to speak the name of her ailment: syphilis.

“Nobody cares how she got it; it’s still considered a disgrace,” said Valery V. Kuznetsov, chief doctor at the Skin and Venereal Disease Clinic No. 7.

In today’s Russia, where a new sexual permissiveness coexists with the old Soviet puritanism, venereal disease is still seen as shameful and revolting. Above all, patients feel it must be kept secret from a prying and punitive state.

Until about a year ago, confidential treatment for venereal disease was unknown here--and most syphilis patients were still being locked up in a little-known gulag of high-security hospitals.

Now Russia is facing an epidemic of sexually transmitted diseases--an ominous indicator that a serious AIDS problem could be looming, although so far the former Soviet Union has largely been spared that scourge. Syphilis rates have shot up eightfold since 1988 and are at twice U.S. levels, according to the Russian Ministry of Health. The incidence of gonorrhea is also climbing. The rise of these diseases indicates widespread unsafe sexual habits that invite HIV transmission, said Mikhail I. Narkyevich, who heads the ministry’s national AIDS prevention program.

“I have no illusions,” Narkyevich said. “Syphilis is rising in the young. In two years, it will be AIDS.”

A delayed sexual revolution is under way in Russia. Political liberalization begat an explosion of pornography, prostitution and provocative advertising. Authorities complain that the public has interpreted democracy as a license for promiscuity.

But before doctors can heal the sick--let alone preach prevention--they must undo the legacy of decades of mistrust created by the frightening, coercive, punitive Soviet system for treating sexually transmitted disease.

Take the case of Alexander O., who spent two weeks in a Soviet prison hospital in 1973. His crime: contracting gonorrhea.

As soon as he realized he was infected, Alexander went to a local VD clinic for treatment.

“I expected them to help me, but instead the doctor subjected me to a real interrogation,” Alexander said. “At the end of it, I felt like a criminal.”

The doctor opened a dossier on Alexander that included his passport number and information about his family and workplace. She demanded that he disclose his sexual contacts. When he demurred, not wishing to subject his girlfriend to the same treatment, the doctor threatened to lock him up.

Ultimately, Alexander was sent to one of the 42 high-security VD hospitals the Soviet Union continued to run decades after the discovery of antibiotics that could cure most syphilis and gonorrhea cases with a single injection.

Treatment at the hospital where Alexander was sent was not gentle, and the place was so filthy he was afraid to eat in the cafeteria for fear of catching an even worse malady.

“Doctors examined us very seldom and spoke to us like scum and criminals,” he said. “There were very few nurses. And you really had to chase a nurse around the hospital to get the prescribed medicine”--usually, up to a month of injections of weak Soviet penicillin.

If a patient was docile, his ailment was listed on his papers as eczema or another non-contagious skin disease, sparing him further humiliation. If he was uncooperative, doctors threatened to prolong his hospital stay, or write his true condition on the sick leave form he would have to give his employer to explain his absence.

Five years after his release from the hospital, Alexander contracted gonorrhea again. Determined to stay out of the clutches of the “VD police,” he did what privileged or well-connected Soviet citizens had done for years. He sneaked off for a private consultation with a doctor recommended by a friend and paid a steep bribe for a prescription. Alexander was able to buy penicillin. Then he bribed a nurse recommended by the doctor to give him injections.

“I have been lucky ever since, but if I get sick again, nothing will make me get official treatment, even though they claim you can be treated anonymously now,” he said. “I just don’t trust the system.”

Changing that attitude is an urgent priority for the Russian Ministry of Health, which is determined to convince citizens that treatment today is humane, dignified and confidential.

The ministry is gradually closing the VD hospitals, about half of which have already been shut down. And anonymous treatment for sexually transmitted diseases, although not for AIDS, has recently become available in some areas.

But the message is traveling slowly, while the maladies are spreading fast.

The rate of reported syphilis shot up from 4.4 per 100,000 people in 1988 to 13.4 in 1992 and 32.3 in 1993.

In some areas, syphilis has spread even faster. In the city of Cheboksary, for example, about 350 miles east of Moscow, the syphilis rate has jumped 20-fold since 1990.

Gonorrhea is even more prevalent, with 211.4 cases per 100,000 people. And chlamydia, a disease with few symptoms that remains difficult to diagnose because most Russian clinics do not have the necessary laboratory equipment, is so widespread it has become a leading cause of infertility among Russian women, as it is in the West, public health officials said.

Some of the surge in sexually transmitted diseases (STDs) may be explained by better reporting as public health officials spread the word that patients need no longer fear coming forward. Many of the “new” syphilis patients have in fact been infected for some time, said Lilia I. Tikhonova, who heads the Health Ministry’s syphilis prevention program.

Still, judging by the number of newspaper advertisements hawking confidential treatment for STDs and the ease with which antibiotics can be bought without a prescription, a private underground treatment network persists. This raises the possibility that the disease rate may be higher than official statistics indicate.

So far, the old Iron Curtain appears to have spared Russia the ravages that HIV infection has wreaked on the West. The first AIDS case was not reported here until March, 1987. By then, information about the disease had already reached Russia.

To date, 717 Russian citizens have tested HIV positive, and 83 people have died, according to the Health Ministry’s Narkyevich. AIDS activists say these infection and death statistics are vastly understated.

“Those are only the people who have been traced,” said Irina Savalyeva of the AIDS prevention group AESOP. “There were lots of people who might have been (HIV) positive but avoided all testing sites because they were afraid their anonymity would not be preserved--and rightly so.”

Public health officials blame the huge increase in STDs on the lifting of restrictions on travel into and out of Russia; on a marked rise in prostitution that has been accelerated by skyrocketing unemployment among women, and on large migrations of refugees and settlers from the Caucasus, Tajikistan and other war-torn areas of the former Soviet Union.

The old political controls were somewhat effective in uncovering and isolating VD outbreaks. Patients who had been cured had to report back for blood tests each year. Teachers, day care providers and food service workers were routinely tested, and all Soviet citizens had to be certified syphilis-free before they could travel abroad. In Soviet times, sailors were not allowed to prowl foreign ports without a KGB minder in tow, Narkyevich said; today, many Russian sailors come home with syphilis, and some later test positive for HIV.

Still, many infected people simply avoided treatment or paid bribes to doctors who may not have been trained to treat STDs. Others consulted faith healers or bought antibiotics on the black market and tried to treat themselves. Some syphilis sufferers managed to mask the symptoms of the disease but not cure it, so it progressed in those patients with ghastly consequences such as blindness, Tikhonova said.

“That is why we finally decided to change our ways,” Tikhonova said. “Now, under democracy, people have more freedom, and every citizen has the right to keep his private life to himself.”

But sex education lags. Although state and private AIDS prevention programs exist, they have not yet penetrated the public consciousness--let alone begun to erode the bias against condoms, even imported ones. That bias is partly left over from the Soviet era, when thick, unreliable domestic-made condoms were long the object of black humor.

People who catch STDs continue to be viewed as lepers.

And AIDS patients are often shunned. Even doctors’ attitudes can be slow to change.

As late as 1992, about 80% of syphilis patients at Kuznetsov’s clinic were being hospitalized for 20 to 30 days, the doctor said. Yet a dose of penicillin from UNICEF costs about 39 cents. This wildly cost-ineffective system persisted partly because the Soviet Union neither manufactured nor imported long-lasting antibiotics, and to eradicate syphilis using weaker Soviet antibiotics could require injections for several weeks.

Today, Kuznetsov’s clinic is one of only four in Moscow that are allowed to offer outpatient treatment with imported antibiotics. The clinic hospitalizes only about 10% of patients, mainly those with complications, said the doctor.

The clinic also offers anonymous VD and HIV testing. The service is so popular that by word of mouth alone, the clinic has overflowed with people from Moscow and beyond, Kuznetsov said.

Those who test positive must give their names if they wish to receive treatment, but now that the process has been decriminalized, most are willing to do so, the doctor said.

“We convince people that we are not going to tell anyone, we are not going to report them and we are not going to lock them up,” Kuznetsov said.

AIDS activists say the process is moving too slowly.

“There’s still the Soviet psychology that people should be directed and should not be allowed to choose their own lifestyle,” Savalyeva said. “I’m not very optimistic about government agencies being able to change their lifelong attitudes.”

Tikhonova and her colleagues are trying to re-educate medical personnel to take a non-judgmental approach to sexually transmitted diseases. Patients are told that treatment is voluntary and are encouraged--not ordered--to bring their sex partners for testing.

In an even more radical step, 200 anonymous treatment centers have been opened across Russia, though none in Moscow. This program is considered experimental, and the results will be re-evaluated in two years, Tikhonova said.

A 1971 law that established criminal and civil sanctions on VD patients who refused to submit to treatment or reveal their sexual contacts has been repealed. Authorities, however, want to retain criminal penalties for anyone who knowingly infects an unsuspecting sex partner with syphilis or the HIV virus, Tikhonova said. That is in keeping with a trend toward criminalization of conscious transmission in some U.S. states and many other countries, according to the World Health Organization.

But Russian officials have concluded that coercion ultimately won’t work. “All our propaganda used to consist entirely of bans and prohibitions,” Kuznetsov said.

“But it’s impossible to ban sex. So now our task is to educate.”

Sergei L. Loiko of The Times’ Moscow Bureau contributed to this report.