Russia's gathering epidemic

July 02, 2002

THE VIRUS that causes AIDS is spreading faster in Russia than anywhere else in the world.

Throughout most of the 1990s, while drug use and sexually transmitted diseases mushroomed, the level of HIV infection there remained negligible - but the long-expected outburst finally took hold about three years ago.

Last year, the number of officially registered cases of HIV infection doubled. That's a 100 percent annual increase - about three times higher than the rate in Baltimore's most hard-hit neighborhoods.

From about 10,000 infected people in 1996, Russia recently surpassed the United States in the number of cases of HIV, though it has only half the population. There are probably between 800,000 and 1.2 million infected Russians, registered and nonregistered, out of a population of 140 million.

And now a trend that is just starting to develop is causing serious alarm among Russian health officials. Previously, HIV was almost entirely restricted to intravenous drug users, but researchers have begun to see an upsurge in cases of heterosexual transmission.

This means that HIV is leaping out of the shadowy society of heroin users and into the general population. In places such as Kaliningrad, sexual transmission now accounts for as much as 25 percent of new cases. "A big heterosexual epidemic is quite possible," says Vadim Pokrovsky, Russia's leading expert on HIV. "It's an alarming situation."

Few people in Russia have paid much attention to HIV, for two essential reasons. As long as it was confined to the world of narkomani, or addicts, Russians both in and out of the government found it hard to care very much about the course of the infection. And, because the spread of HIV is so recent, hardly anyone has actually contracted AIDS; there's no visible evidence that HIV does much harm.

Last year, the Russian government spent at least $150 million to raise the sunken Kursk, and $5 million on HIV treatments. The public cared, adamantly, about the stricken submarine and its 118 sailors. HIV, on the other hand, is spreading so quietly, and its effects are still so latent, that ordinary Russians feel no sense of alarm at all.

That inevitably must change - and, as far as Mr. Pokrovsky is concerned, the sooner the better. It's the only way that inertia and resistance within the government toward taking HIV seriously can be overcome.

In Baltimore, the rule of thumb is that one-third of those infected with HIV are unaware of it. In Russia, it's more like four-fifths. Of those who know they have the virus, only half are getting any kind of treatment.

That's a large reservoir of HIV among people who are ignorant of the condition and ignorant of the consequences, many of whom practice unsafe drug use, and the vast majority of whom engage in unsafe sex. In another year, if the infection rate exceeds 2 percent of the population, Mr. Pokrovsky fears that HIV will have become untamable in Russia. It's a public health catastrophe, and it's just around the corner.

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