AIDS in Russia: conservatism may kill millions


By Renfrey Clarke

MOSCOW — In cities and towns throughout Russia, repressive official policies have helped create a huge pool of narcotics users infected with the HIV virus. The infection is now poised to spread swiftly among young people who are sexually active, but to whom prudish authorities deny proper sex education. Millions may die.

This holocaust is looming even though HIV had a late start in the Soviet Union, and officials had time to study western experience and devise effective counter-measures. The virus was not recorded in the USSR until 1987 — six years after it was first identified in the US, and at a time when its nature was already well understood. But the Soviet and Russian authorities blew their chance to keep the disease tightly controlled.

The first HIV victims in the USSR were mostly hospital patients, many of them children, infected through the re-use of syringes and through transfusions of contaminated blood. These dangers were eventually minimised, though not ended. But no effective moves were made in the early 1990s to stop sexual transmission of the disease.

Health officials, suffering from Soviet-era sexual prudery, did little to spread the word that condoms provided good protection against the virus. The efforts at HIV control that were mounted were focused largely on prostitutes and male homosexuals, stigmatising the infection and creating a false belief that the wider population was not at risk.

Parliamentarians, convinced that the blame lay with foreigners, passed a law compelling applicants for long-term Russian visas to prove they were free of the virus. Not surprisingly, the number of confirmed cases of HIV infection grew steadily, from a few hundred to several thousand.

As late as 1995, the rate of infection in Russia remained low compared to many western countries, and mass education campaigns might have stopped it growing further.

Infection rates soaring

Illegal drug use had become commonplace in Russia by the mid-1990s. "Among my acquaintances, every second student has tried some kind of narcotic at least once", a young journalist wrote in the Moscow daily Nezavisimaya Gazeta in 1997. "One in 10 uses it regularly."

Without the money for high-grade drugs, Russian users improvised, developing habits that would be viewed as suicidal in the west. Today a typical "hit" consists of cheap boiled opium, mixed with chemicals such as veterinary anaesthetics. This mix is often shared between users, each dipping a needle in the brew. Frequently, narcotics when bought are already in this form — and thick with bacteria and viruses. The drugs may well have been "purified" using a process that involves human blood, which is considered to remove toxins as it coagulates.

Of Russians diagnosed as HIV-positive between 1987 and 1995, only 0.3% were injecting illegal drugs. But among new HIV sufferers registered in 1996, the proportion was already 60%. In 1997, the figure was almost 90%.

Taking wing on the drug epidemic, HIV was soaring to new heights. By late in 1998, the English-language Moscow Tribune reported, more than 10,000 people in Russia were registered as infected, up by 40% on the 1997 figure. "Experts claim the real level of infection may be up to five or six times this amount", the paper stated.

The developing catastrophe with narcotics and HIV did little to change the thinking of Russian legislators and law enforcement chiefs. These people still regarded illegal drug use — as they had in Soviet times — first and foremost as a crime to be punished. In April 1998, new drug legislation was introduced. Doctors trying to slow the spread of HIV found that if they taught addicts how to take drugs safely, they would themselves be open to prosecution. Handing out clean syringes was also an offence. Non-state clinics were banned from treating drug addicts who agreed to receive treatment rather than go to prison, even though the state health system had few resources with which to help such people.

Armed with expanded powers to detain and test drug users — or anyone they thought looked like a drug user — Russian police stepped up their arrests. No meaningful distinction was made in the new law between dealers, addicts and casual users. People could be jailed for seven years for possessing quantities of heroin too small to see with the naked eye.

Narcotics use nevertheless continued to spread. A United Nations report late in 1997 estimated that Russia had 350,000 regular users; little more than a year later, the Moscow Times was citing a figure of 1 million. Hundreds of thousands of these people, it seems certain, will sooner or later contract HIV.

If HIV in Russia were to remain mostly an affliction of illegal drug users, the growth in the number of its victims would slow relatively soon; in any society, most people are happy to abstain from shooting up. Abstaining from sex, however, is different.

Spread during its first years in Russia mainly through sexual contact, HIV now seems destined to return to its old vector — but on a vastly bigger scale. Illegal drug users tend also to be highly active sexually. And among young Russians in general, there are alarmingly few barriers to sexually transmitted diseases being passed on freely.

Unsafe sex

In Russia, safe sex has never been widely understood, much less practiced. Proof of this is to be found in the incidence of syphilis. Though this disease is now rare in the west, recorded cases among 15- to 17-year-olds in Russia multiplied by a factor of almost 70 between 1990 and 1996, to the near-epidemic level of 389.9 per 100,000.

Young people in Russia are no more suicidal than in most countries, and are unlikely to ignore information on safe sex practices if it is given in an open, non-condescending fashion. But the chances of the latter seem remote.

"Under pressure from social conservatives and the Russian Orthodox Church", the Moscow Times reported on February 2,"the Education Ministry has dropped plans to introduce sex education classes nationwide". A program of training teachers as sex educators is under way, but a senior education official told the paper's reporter: "We are not [proposing] using the word condom even once in our schools."

For Russians who contract HIV, the long-term chances of surviving are close to nil. The state health system cannot help; the 1998 budget assigned the equivalent of only US$8 million for the fight against AIDS, and by December only about 5% of this sum had been disbursed. Full treatment for HIV costs at least US$20,000 per person per year, more than 20 times the average Russian income.

The victims of AIDS in Russia in the coming years will certainly number in the hundreds of thousands, perhaps millions. Most of these people will be young, many of them children. Their deaths will be a steep price to pay for the hypocrisy of the old system, given lethal force by the barbarities of the new.