HIV Surge Among Addicts Catches Russia Unprepared

Under the chilly brick archways of the Right-Bank Market here, the Russian-style dance of death that experts say is bringing an AIDS epidemic to this huge country is in full swing.

Police patrol the market in this old imperial capital, watching for narcotics sales, eyeing the scared boys waiting for a fix. But right under their noses, Magomed, a grimy dealer with a mischievous grin, waves his hands in a conjurer’s gesture--and a dark opium lump, the size of a pingpong ball, appears and disappears. The police, widely viewed as corrupt in Russia, apparently see nothing.

“The police seem to protect the dealers, though every now and then they do pull in an addict,” said Grigory Latyshev, a doctor and coordinator of the Return Foundation, a grass-roots outreach group working with narcotics users in St. Petersburg. “We often compare their behavior to lions around a herd of antelope. They prowl, they growl, and occasionally they move in for the kill. But mostly what goes on here is an elaborate show.”

Since 1995, the human immunodeficiency virus that can trigger AIDS has started spreading into the large drug-taking community here, where there is little awareness of the dangers of infection from sharing needles and from the home-brewed “black” opiate mixed with human blood.

“The epidemic has begun,” Mikhail Narkevich, the Russian Health Ministry’s national AIDS program coordinator, proclaimed gloomily.

In the first half of this year, the number of officially registered HIV-positive Russians more than doubled, rising by 2,985 to 5,500. These figures are low by Western standards, but the steepness of the increase is startling.

“The new cases we’ve seen this year are almost all drug addicts,” said Yevgeny Voronin, head of the AIDS Center for Russia, outside St. Petersburg. “There are hardly any drug users with AIDS yet, because it’s still a young infection among them. But our specialists say AIDS will rip through the drug-taking population very fast. By the year 2000, 1 million Russians could have HIV, including 300,000 women and the 40,000 to 50,000 babies they’ll have.”

But officials seem unable, or unwilling, to deal with the explosive implications. Just as police do little to halt drug traffic, doctors, hospitals and government agencies squabble over who should treat HIV-positive drug users. Funding for medicine is in short supply. No state program has been created to treat the sick.

Narkevich said that Russia is working on prevention efforts and that he hopes the state will create an AIDS-fighting program. But it has no plans to equip hospitals with special wards or doctors with training ahead of the feared explosion of AIDS cases. He could give no breakdown of his budget, apart from saying “it’s too small.”

“The philosophy of our masters seems to be that the average drug addict dies within four or five years anyway, so what’s the point of treating him for AIDS when there are normal people needing treatment? They say the $10,000-a-year treatment cost is too high, although no one says it’s too expensive to pay $70,000 a year for [kidney dialysis]. But when it’s drug users with HIV, their only answer is that it’s too expensive,” Voronin said bitterly.

Latyshev observed that “in two or three years, when people who are HIV positive now start to get ill with AIDS, there’s going to be a huge crisis. But we get the impression so far that officials are shrugging the whole thing off.”

Even the number of people at high risk now that HIV has entered the drug world is hard to pin down.

In St. Petersburg, a port city of 5 million people where the first HIV-positive drug user registered only last fall, there are 5,000 drug users officially listed at hospitals. But some surveys indicate about 70,000 regular users and 600,000 occasional experimenters, and police figures, based on the amount of narcotics sold in the city, are pegged at 150,000 users.

“Naturally, this is a very acute problem today, because this vast army of drug addicts is just waiting for a huge explosion of AIDS,” said Leonid Shpilenya, the city’s head narcotics expert. “In 1996, we had the first seven HIV cases among drug addicts, but now hardly a week goes by without a drug addict turning out to have signs of HIV.”

Drug-related HIV has spread north through Russia, moving from Ukraine through southern cities such as Krasnodar to northern cities such as the Baltic port of Kaliningrad, where more than 1,500 drug users are now HIV positive.

Meantime, AIDS itself is little understood in Russia. Although the first official case--a gay man infected in Tanzania--was registered here in 1987, fewer than 1,000 people tested HIV positive until two years ago. Of these, 289 were children infected by dirty needles in state hospitals.

But the virus was still thought of as the exotic problem of Africa or the capitalist West and treated accordingly. A 1994 law made AIDS tests for foreigners compulsory, despite howls of protest that the legislation was xenophobic and illogical; the testing measure has since gone into legal limbo.

As for homosexuals, popular attitudes remain hostile, keeping one of the West’s major HIV-risk groups largely out of the public eye.

But U.N. statistics show that before last year--when drug-related HIV cases still amounted to only 0.3% of the total number of people infected here--28.6% of Russia’s HIV infections were linked to homosexual contact and 24.35% to heterosexual transmission.

In 1996, as the shift toward intravenous drug use as a cause of HIV infection took hold, 61.2% of those testing positive were found to be users. The homosexual and heterosexual rates of HIV infection then shrank drastically as a proportion of the whole; however, the percentages of infection linked to heterosexual conduct (5% of cases) and homosexual activity (5.6%) continued to be similar.

A very few television programs have discussed AIDS, but they have tended to reinforce the view that the most important issue is attaching blame. For example, a recent report on women and children with AIDS, made by the NTV commercial channel, showed Anastasia--a profile in shadow--discussing her discovery three days before she was to deliver a child that she was HIV positive. Her child was born with HIV and syphilis, transmitted when Anastasia shared needles with other drug users. “It’s my fault, my mistake, that it turned out like this,” she said.

More legislation being worked out in the conservative-led parliament--a law forcing drug users to take an HIV test or go to prison--has been condemned by experts as authoritarian, inept and almost certainly counterproductive.

“If this law is passed, God forbid, then the drug scene will go underground,” Voronin said.

Russian society has become more permissive since the Soviet collapse. But Russians do little to protect themselves from the harmful consequences of their experiments with sex and substances.

Although theirs is the second most sexually active nation after the United States, according to a recent survey by London International Group, a condom manufacturer, Russians are hostile to the notion of such prophylactics and ranked 12th among the populations of 15 countries in how often they used them. And, indeed, syphilis infection rates today are more than 50 times higher among Russian teenagers than they were five years ago.

That hardly seems surprising given the comments of, say, Masha Karpova, a rebellious 16-year-old St. Petersburg student. She has spent the last two years running away from home, switching from school to school, getting into trouble with the police.

She also has been experimenting with drugs with groups of friends and lovers. She says she has tried everything from swallowing Ecstasy tablets to injecting heroin.

But she takes no precautions when dabbling with narcotics or sex. She only grinned when asked what contraceptive she used and gave a devil-may-care answer: “The Holy Spirit.”

Such skeptical post-Soviet shrugs--common reactions from a people tired of being told what to do by bossy bureaucrats--undermine what few official attempts have been made to deal intelligently with the risk of AIDS.

Even so, Latyshev said, addicts who came to exchange their needles for clean ones at the Return Foundation a few months ago did not react at all to the idea that they could get infected with HIV. But now they are asking for disease-prevention information.

AIDS test centers have been set up in Russia’s 89 regions and republics. Small, privately funded programs are trying to raise Russians’ awareness about using condoms and clean needles to protect themselves from HIV infection.

In Moscow, the charitable group Doctors Without Borders launched a safe sex program this summer to alert teenagers about using contraceptives. The United Nations opened an AIDS office in Moscow in December to give information about prevention. The Return Foundation is running three AIDS-prevention programs in St. Petersburg, helped by the medical charity Doctors of the World: One is a bus that visits the Right-Bank Market every day to swap free clean needles for dirty ones and distribute condoms. Russian officials are watching these programs uneasily.

More fundamentally, a big problem remains: For those who test HIV positive, there is little hope or care. “All we can give is a diagnosis,” Voronin said.

Drug users from all over Russia who have tested HIV positive in their home clinics are sent on to his specialty site.

“I think it’s criminal,” said the Return Foundation’s Latyshev. “When there’s an infection, it’s a doctor’s duty to localize it rather than let it spread. But here you get HIV-positive people coming from all over Russia to St. Petersburg, including addicts who then go to the market in town and shoot up with our local kids. As soon as an HIV-positive person is sent to our city, the risk here grows. It’s illogical.”

In any case, all that most drug users can hope for at the clinic is four more days of tests. Then they are simply sent home. There is enough money in Voronin’s budget to treat 10 patients with the combinations of drugs that have helped many of those infected in the West.

But for the unhappy staff, there is only a struggle with the bulk of the youthful and infected addicts.

“A kid of 17 or 18 gets told he’s HIV positive and can’t be treated,” Voronin said. “Naturally, when he gets this scary diagnosis, he realizes there is absolutely nothing left for him to be scared of. He disappears. What does he care after that whether he’s using clean needles? The situation will only get worse until we start offering drug addicts something in return.”

For now, most of the drug users who come to the Return Foundation’s bus, parked near the Right-Bank Market, are too overwhelmed by their current miseries to care about any new threat from AIDS.

Yura, 29, a former soldier whose drug habit has cost him his wife and daughter, is talking blurrily inside the bus. The blond 29-year-old with intelligent eyes waves a syringe filled with “black,” the impure opiate sold outside.

“Why would I bother with an AIDS test?” he asks bleakly. “Even if I have it, so what? The effect will be exactly the same either way: death.”