michael specter--times--aids in russia

the new york times at a western outpost of russia, aids spreads 'like a forest fire' november 4, 1997 KALININGRAD, Russia, Oct. 29 The young man sitting before the psychiatrist stared darkly at the wall and bit his lip to keep from crying. He had answered a dozen questions about his sexual habits and absorbed in silence a lecture about how AIDS would change his life. "Aleksei, everything now is up to you," the psychiatrist, Oleg Petroshuk, told him gently. "If you take care of yourself you can live a long time. I know how hard this is, but you have to believe me: nothing ends here." As if in answer, Aleksei stripped to the waist. He has three tattoos, but the one that draws the eye covers his left shoulder. It is a skull engulfed in huge batwings. Above the wings two English words have been burned into his skin: "No Future." Few words could apply more fully to Aleksei, who is 23, or to this odd and lonely city, which has suddenly become the center of what many experts say is the world's fastest-moving epidemic of AIDS infection. Kindled by a surge in the use of an easily contaminated liquid form of heroin, the epidemic has been fueled, as anywhere, by poverty and unemployment. But that is not why H.I.V., the virus that causes AIDS, is now tearing "like a forest fire through Russia," in the words of this country's chief AIDS official, Mikhail Narkevich. While the Soviet Union stood, official prudishness combined with totalitarianism to keep borders closed and sexual freedom to a minimum. The AIDS virus, on the other hand, thrives on drug abuse and the open road. And since the fall of Communism, both have been particularly plentiful here, in the vague borderland between Europe and Russia. Kaliningrad is unique, but it is not alone. A special economic zone that was supposed to become Russia's Hong Kong, it has floundered economically. But its status helped ignite the interlocking epidemics of drug addiction and AIDS that are now rolling across Russia. An isolated outpost lost between Poland and Lithuania, Kaliningrad is one of Europe's essential crossroads. The city -- called Konigsberg before Germany lost it to the Soviet Army in World War II -- doesn't quite look like Russia, and it doesn't quite feel like Europe. It is a giant warehouse. Everything here is cheaper than it is elsewhere in Russia. Beer and vodka are a third of what they cost in Moscow. It is the best place to get smuggled cars and discount narcotics. There are 5,000 prostitutes on the streets in Kaliningrad, and more in clubs and casinos. The syphilis rate -- a sign of sexual activity and a harbinger of AIDS -- is 3 times the average for Russia, and almost 100 times the rate in Germany. After more than 15 years of an epidemic that has infected tens of millions of people across the world, there are few places on earth where the H.I.V. infection rate has risen more rapidly. "All the conditions are there for a disaster," said Aleksandr Gromyko, the World Health Organization's regional adviser on H.I.V. and AIDS for Europe and Russia. "And nobody is remotely ready for it. The virus has spread so fast in Kaliningrad that even the few people who are trying to do something are lost. "I am afraid we can no longer pretend that Russia will somehow avoid the full force of the AIDS epidemic. What you see in Kaliningrad today is only the beginning for Russia." Russia's Pathway For an Epidemic Kaliningrad has now become the central pathway to Russia -- not just for cars or beer, but for disease as well. A year ago just 28 people here were known to have been infected with the AIDS virus. As of Oct. 15 there were at least 1,850, a far higher proportion in this city of 400,000 than anyplace else in Europe. From Kaliningrad, the truck routes -- and the epidemic -- head south through Belarus and Ukraine and north to St. Petersburg. It usually takes years for a person infected with H.I.V. to show clear signs of illness. But it only take minutes, and a quick contaminated dose of narcotics, to become infected at the park near the Baltika Stadium. "The thing that surprised me most about Kaliningrad," said Leo Kenny, a senior consultant for Unicef, "is that among dozens of drug users and prostitutes we have interviewed, not one had ever even seen a person who was sick. It has all happened that fast." He and officials here said that in a small sample of 200 prostitutes who agreed to be tested, 85 percent were infected with H.I.V. A year ago the figure was less than 5 percent. Unicef, the United Nations Children's Fund, is considering starting a major program here, in part because so many of those affected are in their teens. Today, Kaliningrad is filled with an odd mixture of fear and complacency. Posters suddenly appeared throughout the city this week: "Danger AIDS," they read, going on to warn residents that a disease "worse than plague" is upon them. Like a Repetition Of the 80's in the U.S. "In the last week alone, 30 new cases of this deadly illness have appeared among people between the ages of 18 and 30," the notice states. It then points out that every daughter on the way to a disco is under threat, as is every boy who might choose this as the day to stick a needle into his arm. The poster suggests that if things do not change soon, the only money in the city's slim health budget will have to be spent on AIDS. "Think about your children, parents and loved ones," it ends. "Don't die of ignorance." But ignorance -- or perhaps more accurately, denial -- is the affliction that threatens Kaliningrad today more than any other. Some people here would call it an ignorance that should never have come to pass. "Today is 1981 in New York or San Francisco," said Dr. Oleg Mormot, referring to the dark years when the AIDS epidemic first took hold in the United States. Dr. Mormot is director of Kaliningrad's only AIDS center, a small nest of offices tucked behind the aging edifice of the city's ancient infectious disease hospital. The hospital itself has six H.I.V. patients -- all it can handle right now. But because methadone use is illegal in Russia, the doctors there let them leave their beds and buy narcotics on the street once a day. Each time they leave the hospital, they take the virus back onto the street. "We are repeating the history in those cities as if they never happened anywhere before," Dr. Mormot said. "As if Russia can learn nothing from the West. You cannot convince a young drug addict or prostitute here that they are in danger, because most of them have never seen AIDS. They have no jobs, and a shot of heroin costs less than $5. That's the reality of it. Nothing else matters." You cannot talk about AIDS in Kaliningrad unless you talk about drug addiction. Dirty needles have always been the most efficient way to spread the AIDS virus. The way drugs are prepared in Kaliningrad has increased the efficiency to a grim science. Hymka, a liquid opiate that the addicts often mix with their blood to help it settle, is the drug of choice here. A glassful-- usually three doses -- goes for less than $20. In 1995 the number of people who tested positive for H.I.V. here would not have filled a small classroom. Less than 1 percent of them were drug abusers. Last year, 20 percent of those infected got that way by using dirty needles. This year, as in much of Russia, the shift has been fundamental. "The official figures are that 75 percent get infected with H.I.V. through dirty needles," said Aleksandr A. Dreizin, the chief physician at the regional Narcology Hospital. "The real number is more like 96 percent. The only people here who get AIDS any other way are prostitutes who have sex with infected drug addicts and children who are born to them." Dr. Dreizin says that there are about 10,000 addicts in the city and that many of them by now are probably infected with H.I.V. Homosexual intercourse so far has played only a minor role in the spread of H.I.V. here. The reasons for drug use in Kaliningrad are not novel. Unemployment among the young is close to 50 percent, said Irina Vershinina, deputy chairman of the city council. There are few opportunities to advance and few avenues of escape. Throughout the day young men with stringy hair and dark jackets exchange what cash they have for their fix in front of the Polytechnic Institute or one of the local theaters. Late at night the prostitutes add their commerce to the mix. There are no needle exchange programs. Money for Prevention And Treatment Scarce Although the local Governor, not a political radical by any means, has called for a closer look at legal prostitution and an end to Russia's long prohibition of methadone treatment of drug addicts, neither is likely. There will be just $5 million in the AIDS budget for the coming four years, and that money includes the construction of a hospital. The idea of spending public health money on a methadone program for drug users is politically impossible in Russia at a time when there is not even money for the most basic programs of childhood vaccinations. "Hey, I know all about AIDS," said Yevgeny, 21, a computer student at the Technical Institute who spoke on condition that his full name not be used. "I don't use drugs much. But when I do, I don't buy the Gypsy drugs." Most people here attribute the habit of mixing blood with the opiates to Gypsies -- although there seems to be no truth to the idea. "I buy it clean," Yevgeny said, "and I buy clean needles. So I'll be O.K. I don't do it that much, anyway." Oddly enough, the official who appears to recognize most clearly what Kaliningrad is up against, and is the most eager to do something about it, is Valery A. Zaborovsky, a colonel in the Russian Interior Ministry who overseas the region's prison system. The head of the regional health department, Larisa Melchenko, refused in an interview to discuss any aspect of the AIDS epidemic or divulge the regional health budget. "Do you give out such information in the West?" she asked, seemingly unaware that such information is given out readily in Moscow. But Colonel Zaborovsky answered every question put to him and granted a reporter and photographer total access to a special prison ward for people infected with the AIDS virus. "What are we going to get from lying and hiding here?" the colonel asked. Unlike most of his colleagues across Russia, he believes in making prostitution legal, opening methadone clinics and maybe even closing the AIDS ward at Special Prison 216. That is the locked quarters where 117 H.I.V.-infected men, all drug abusers, are kept in isolation from other prisoners. Their gray barracks looks like any other but comes at the end of a long row of prison housing not far from the city. The first four dorms have wooden picket fences in front of them and prisoners strolling aimlessly in the yards. The last dorm is hidden behind a locked concrete gate. "We put these men in prison because it is against the law to use drugs," Colonel Zaborovsky said. "I am not going to tell you that it helps them or us to have them there, but I must obey the law." He said the isolation ward was a protection for the inmates-- those who are infected and those who are not. Rape is at least as common in the Russian prison system as it is in the United States. The ward itself is depressing, but no more so than its neighbors. Hot water is rare, medical treatment more so. Most of the men are in their early 20's. They want aid, hospital rooms and fancy new drugs that next to no one in Russia can afford. "I have a deadly disease," said one young inmate with burning blue eyes who insisted on being identified only by his prison number, 738437. "I'm going to die here because I made a few mistakes. Is that fair? Shouldn't I get a better break than that?" About an hour earlier, Colonel Zaborovsky made the same point. "What we have now is a huge problem we are facing with a system that doesn't work and isn't fair," he said. "If we lock up every person who gets infected from drugs here, we surely are going to need a lot of prisons. They cost money too, you know."



			the new york times at a western outpost of russia, aids spreads 'like a forest fire' november 4, 1997 KALININGRAD, Russia, Oct. 29 The young man sitting before the psychiatrist stared darkly at the wall and bit his lip to keep from crying. He had answered a dozen questions about his sexual habits and absorbed in silence a lecture about how AIDS would change his life. "Aleksei, everything now is up to you," the psychiatrist, Oleg Petroshuk, told him gently. "If you take care of yourself you can live a long time. I know how hard this is, but you have to believe me: nothing ends here." As if in answer, Aleksei stripped to the waist. He has three tattoos, but the one that draws the eye covers his left shoulder. It is a skull engulfed in huge batwings. Above the wings two English words have been burned into his skin: "No Future." Few words could apply more fully to Aleksei, who is 23, or to this odd and lonely city, which has suddenly become the center of what many experts say is the world's fastest-moving epidemic of AIDS infection. Kindled by a surge in the use of an easily contaminated liquid form of heroin, the epidemic has been fueled, as anywhere, by poverty and unemployment. But that is not why H.I.V., the virus that causes AIDS, is now tearing "like a forest fire through Russia," in the words of this country's chief AIDS official, Mikhail Narkevich. While the Soviet Union stood, official prudishness combined with totalitarianism to keep borders closed and sexual freedom to a minimum. The AIDS virus, on the other hand, thrives on drug abuse and the open road. And since the fall of Communism, both have been particularly plentiful here, in the vague borderland between Europe and Russia. Kaliningrad is unique, but it is not alone. A special economic zone that was supposed to become Russia's Hong Kong, it has floundered economically. But its status helped ignite the interlocking epidemics of drug addiction and AIDS that are now rolling across Russia. An isolated outpost lost between Poland and Lithuania, Kaliningrad is one of Europe's essential crossroads. The city -- called Konigsberg before Germany lost it to the Soviet Army in World War II -- doesn't quite look like Russia, and it doesn't quite feel like Europe. It is a giant warehouse. Everything here is cheaper than it is elsewhere in Russia. Beer and vodka are a third of what they cost in Moscow. It is the best place to get smuggled cars and discount narcotics. There are 5,000 prostitutes on the streets in Kaliningrad, and more in clubs and casinos. The syphilis rate -- a sign of sexual activity and a harbinger of AIDS -- is 3 times the average for Russia, and almost 100 times the rate in Germany. After more than 15 years of an epidemic that has infected tens of millions of people across the world, there are few places on earth where the H.I.V. infection rate has risen more rapidly. "All the conditions are there for a disaster," said Aleksandr Gromyko, the World Health Organization's regional adviser on H.I.V. and AIDS for Europe and Russia. "And nobody is remotely ready for it. The virus has spread so fast in Kaliningrad that even the few people who are trying to do something are lost. "I am afraid we can no longer pretend that Russia will somehow avoid the full force of the AIDS epidemic. What you see in Kaliningrad today is only the beginning for Russia." Russia's Pathway For an Epidemic Kaliningrad has now become the central pathway to Russia -- not just for cars or beer, but for disease as well. A year ago just 28 people here were known to have been infected with the AIDS virus. As of Oct. 15 there were at least 1,850, a far higher proportion in this city of 400,000 than anyplace else in Europe. From Kaliningrad, the truck routes -- and the epidemic -- head south through Belarus and Ukraine and north to St. Petersburg. It usually takes years for a person infected with H.I.V. to show clear signs of illness. But it only take minutes, and a quick contaminated dose of narcotics, to become infected at the park near the Baltika Stadium. "The thing that surprised me most about Kaliningrad," said Leo Kenny, a senior consultant for Unicef, "is that among dozens of drug users and prostitutes we have interviewed, not one had ever even seen a person who was sick. It has all happened that fast." He and officials here said that in a small sample of 200 prostitutes who agreed to be tested, 85 percent were infected with H.I.V. A year ago the figure was less than 5 percent. Unicef, the United Nations Children's Fund, is considering starting a major program here, in part because so many of those affected are in their teens. Today, Kaliningrad is filled with an odd mixture of fear and complacency. Posters suddenly appeared throughout the city this week: "Danger AIDS," they read, going on to warn residents that a disease "worse than plague" is upon them. Like a Repetition Of the 80's in the U.S. "In the last week alone, 30 new cases of this deadly illness have appeared among people between the ages of 18 and 30," the notice states. It then points out that every daughter on the way to a disco is under threat, as is every boy who might choose this as the day to stick a needle into his arm. The poster suggests that if things do not change soon, the only money in the city's slim health budget will have to be spent on AIDS. "Think about your children, parents and loved ones," it ends. "Don't die of ignorance." But ignorance -- or perhaps more accurately, denial -- is the affliction that threatens Kaliningrad today more than any other. Some people here would call it an ignorance that should never have come to pass. "Today is 1981 in New York or San Francisco," said Dr. Oleg Mormot, referring to the dark years when the AIDS epidemic first took hold in the United States. Dr. Mormot is director of Kaliningrad's only AIDS center, a small nest of offices tucked behind the aging edifice of the city's ancient infectious disease hospital. The hospital itself has six H.I.V. patients -- all it can handle right now. But because methadone use is illegal in Russia, the doctors there let them leave their beds and buy narcotics on the street once a day. Each time they leave the hospital, they take the virus back onto the street. "We are repeating the history in those cities as if they never happened anywhere before," Dr. Mormot said. "As if Russia can learn nothing from the West. You cannot convince a young drug addict or prostitute here that they are in danger, because most of them have never seen AIDS. They have no jobs, and a shot of heroin costs less than $5. That's the reality of it. Nothing else matters." You cannot talk about AIDS in Kaliningrad unless you talk about drug addiction. Dirty needles have always been the most efficient way to spread the AIDS virus. The way drugs are prepared in Kaliningrad has increased the efficiency to a grim science. Hymka, a liquid opiate that the addicts often mix with their blood to help it settle, is the drug of choice here. A glassful-- usually three doses -- goes for less than $20. In 1995 the number of people who tested positive for H.I.V. here would not have filled a small classroom. Less than 1 percent of them were drug abusers. Last year, 20 percent of those infected got that way by using dirty needles. This year, as in much of Russia, the shift has been fundamental. "The official figures are that 75 percent get infected with H.I.V. through dirty needles," said Aleksandr A. Dreizin, the chief physician at the regional Narcology Hospital. "The real number is more like 96 percent. The only people here who get AIDS any other way are prostitutes who have sex with infected drug addicts and children who are born to them." Dr. Dreizin says that there are about 10,000 addicts in the city and that many of them by now are probably infected with H.I.V. Homosexual intercourse so far has played only a minor role in the spread of H.I.V. here. The reasons for drug use in Kaliningrad are not novel. Unemployment among the young is close to 50 percent, said Irina Vershinina, deputy chairman of the city council. There are few opportunities to advance and few avenues of escape. Throughout the day young men with stringy hair and dark jackets exchange what cash they have for their fix in front of the Polytechnic Institute or one of the local theaters. Late at night the prostitutes add their commerce to the mix. There are no needle exchange programs. Money for Prevention And Treatment Scarce Although the local Governor, not a political radical by any means, has called for a closer look at legal prostitution and an end to Russia's long prohibition of methadone treatment of drug addicts, neither is likely. There will be just $5 million in the AIDS budget for the coming four years, and that money includes the construction of a hospital. The idea of spending public health money on a methadone program for drug users is politically impossible in Russia at a time when there is not even money for the most basic programs of childhood vaccinations. "Hey, I know all about AIDS," said Yevgeny, 21, a computer student at the Technical Institute who spoke on condition that his full name not be used. "I don't use drugs much. But when I do, I don't buy the Gypsy drugs." Most people here attribute the habit of mixing blood with the opiates to Gypsies -- although there seems to be no truth to the idea. "I buy it clean," Yevgeny said, "and I buy clean needles. So I'll be O.K. I don't do it that much, anyway." Oddly enough, the official who appears to recognize most clearly what Kaliningrad is up against, and is the most eager to do something about it, is Valery A. Zaborovsky, a colonel in the Russian Interior Ministry who overseas the region's prison system. The head of the regional health department, Larisa Melchenko, refused in an interview to discuss any aspect of the AIDS epidemic or divulge the regional health budget. "Do you give out such information in the West?" she asked, seemingly unaware that such information is given out readily in Moscow. But Colonel Zaborovsky answered every question put to him and granted a reporter and photographer total access to a special prison ward for people infected with the AIDS virus. "What are we going to get from lying and hiding here?" the colonel asked. Unlike most of his colleagues across Russia, he believes in making prostitution legal, opening methadone clinics and maybe even closing the AIDS ward at Special Prison 216. That is the locked quarters where 117 H.I.V.-infected men, all drug abusers, are kept in isolation from other prisoners. Their gray barracks looks like any other but comes at the end of a long row of prison housing not far from the city. The first four dorms have wooden picket fences in front of them and prisoners strolling aimlessly in the yards. The last dorm is hidden behind a locked concrete gate. "We put these men in prison because it is against the law to use drugs," Colonel Zaborovsky said. "I am not going to tell you that it helps them or us to have them there, but I must obey the law." He said the isolation ward was a protection for the inmates-- those who are infected and those who are not. Rape is at least as common in the Russian prison system as it is in the United States. The ward itself is depressing, but no more so than its neighbors. Hot water is rare, medical treatment more so. Most of the men are in their early 20's. They want aid, hospital rooms and fancy new drugs that next to no one in Russia can afford. "I have a deadly disease," said one young inmate with burning blue eyes who insisted on being identified only by his prison number, 738437. "I'm going to die here because I made a few mistakes. Is that fair? Shouldn't I get a better break than that?" About an hour earlier, Colonel Zaborovsky made the same point. "What we have now is a huge problem we are facing with a system that doesn't work and isn't fair," he said. "If we lock up every person who gets infected from drugs here, we surely are going to need a lot of prisons. They cost money too, you know."

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