At last, Russia faces AIDS

SUN JOURNAL

Epidemic: Amid prejudice and government indifference, a disease that once mainly infected addicts has spread quickly.

October 16, 2003|By Douglas Birch | Douglas Birch,SUN FOREIGN STAFF

MOSCOW - Most days, 33- year-old Alexander Alexandrov lies curled on the cot in his hospital ward, listening to the drone of the radio, the chatter of the television, staring out at the gray fog that so often shrouds the city. Once in a while, when he's feeling restless, he will pick up his worn copy of his favorite novel and reread the story of how the devil came to Moscow.

The former aeronautics machinist is the gaunt face of Russia's maturing AIDS epidemic.

HIV, the virus that causes AIDS, came late to Russia, arriving only with the economic and social collapse of the 1990s. And it came mostly as an infection passed among intravenous drug users, through the sharing of needles.

For a decade, the disease incubated silently, all but ignored by authorities. But in recent years, Russia has begun seeing its first significant number of AIDS cases. And the disease has burst from the netherworld of drug users.

Hundreds of HIV-infected children are born to infected mothers each month. And the human immunodeficiency virus is increasingly being transmitted through sexual contact, often between heterosexuals. (In 2001, only one out of 25 new cases was sexually transmitted. Last year, the figure jumped to one in eight.)

AIDS experts here estimate that 1.5 million people are infected - about 1 percent of Russia's population - and that this figure could more than quadruple, to more than 7 million, in the next five years. The number now infected is about 650,000 more than in the United States, which has twice the population.

Many experts blame the threat on government indifference to the spread of acquired immune deficiency syndrome among drug users such as Alexandrov.

He shares a seventh-floor hospital room with five other patients. His green tartan bathrobe hangs open to reveal pale flesh pasted to ribs. He has lost 40 pounds in the past 18 months and suffers from enlarged lymph nodes and fungal infections.

Alexandrov is still on the cusp of AIDS. His weakened immune system has avoided the life-threatening infections. But he can't take the new anti-viral drugs to halt the progress of the disease because of liver damage from alcoholism and a hepatitis C infection.

He has spent more than a year on this ward, waiting for his liver to recover, curled in his small, white cot, racked by headaches and stomach pain.

When he's feeling melancholy, which is often, he picks up Mikhail Bulgakov's classic Russian novel The Master and Margarita, an anti-Stalinist fantasy about the devil's appearance in Moscow in the 1930s.

The novel savagely satirizes society's petty cruelty and bureaucratic indifference. But Alexandrov says he never felt discriminated against when he was living outside the hospital. Like most AIDS sufferers here, he was careful to keep his illness secret from everyone but his closest relatives.

"This is not talked about," he says.

After the fall of the Soviet Union, Alexandrov lost his prestigious job building experimental jet fighters at a Moscow institute. He discovered the bitter joys of heroin just as tons of the stuff started flooding out of Afghanistan and across Russia in the early 1990s.

Two years ago, he says, he suffered a long bout of pneumonia. Doctors told him that a test showed he was HIV-positive.

"I really find it difficult to describe my feelings," he says. "Of course, this news was painful in the beginning. But I got used to it somehow."

Alexander E. Barannikov, a member of the State Duma and a leading anti-AIDS campaigner, says the disease has spread so quickly in Russia because of prejudice, pride and a certain willful blindness on the part of the authorities. In the beginning, its victims were society's outcasts.

"Ninety-eight percent of the diseased were drug addicts," says Barannikov, "which sort of didn't bother state officials or politicians at all."

Many Russian government officials, he says, believed that because there was no way to stop heroin use, there was no way to stop AIDS. (Needle exchange programs are rare. Under federal law, methadone is prohibited.)

"Some even believed that AIDS would eliminate all drug addicts in a natural way," Barannikov says. "And this blind, and I should say even criminal approach - criminal in the sense that it is a crime against humanity - resulted in the fact that the authorities didn't even notice when the virus broke through the borders of the drug addict group and went outside."

That jump to the population at large occurred about two years ago as the disease spread among Russian prostitutes.

"About 70 percent of the women in prostitution are also drug addicts," he says. "The vast majority of prostitutes are infected with HIV."

These women have passed the disease to their customers and to their children as well. About 1,500 HIV-infected babies were born in Russia in the first six months of this year. Many Russian officials regard the problem as a law-enforcement issue rather than a public health emergency.

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