MOSCOW -- With his glassy pale-blue stare, missing teeth, and emaciated frame, Igor knows all too well the damage heroin can do. But after a decade of using the drug, the 27-year-old Muscovite can't imagine himself quitting.
The descent into addiction began before Igor was even a teenager. His mother died when he was 12 and he found himself on the streets. Within a year, he was drinking up to two liters of vodka a day; within two, he was shooting up heroin.
"Everyone starts out saying 'I can manage,' 'I know what I’m like,' 'I trust myself,'" Igor says. "And so I tried it in 2001, and here we are in 2013. Twelve years. To this day I tell myself the same: 'I can manage,' 'I know what I’m like,' 'I trust myself.'"
To support his habit, Igor learned to steal. He lost his childhood friends. He spent three years in jail. He developed trails of scabby abscesses on his inner thigh. And he hints he is now impotent and incapable of intimacy with a woman.
Igor, who declined to give his last name, is open, warm, and jovial. But he darkens and sways compulsively as he reflects on how he ended up here, stumbling over his words.
"I'm a good, sociable person who likes to work," he says. "You know, it was just a difficult period in life. You won’t understand -- I was searching for something to save me, some way to relax, something I can’t even explain. And that’s how I ended up in this, you know, vileness. I fell into this swamp, this swamp."
Igor isn't alone. The Federal Antinarcotics Service estimates that there are some 1-1.5 million heroin users in Russia. Independent observers say the figure could actually be twice that. It is part of a subculture of drug use that claims an estimated 100,000 lives a year, while endemic needle-sharing among addicts is feeding an HIV epidemic that -- unlike countries even in sub-Saharan Africa -- is growing rather than abating.
The Kremlin has branded the flow of heroin into Russia from world heroin producer Afghanistan a threat to national security and blamed NATO coalition forces in the war-torn republic for presiding over a boom in heroin production. Gennady Onishchenko, Russia's top public-health official, warned darkly last year
that the withdrawal of troops from Afghanistan could trigger an upsurge in heroin flowing into Russia.
Yet despite this, the Russian government has done little to help addicts like Igor get off the drug.
There are no state needle-exchange programs that would curb the spread of HIV. There is no methadone substitution program that would help wean addicts off heroin. And heroin users -- many of whom need treatment for hepatitis, HIV, or tuberculosis -- are regularly mistreated and given inferior medical care. Sometimes they are turned away entirely.
Malyshev is a volunteer with the Andrei Rylkov Foundation, an NGO that assists addicts. He says addicts find themselves in a "vicious circle" and face stigmatization and discrimination in society:
"They can't get standard medical care, first of all because of a prevailing fear of drug addicts," he says. "A person turns up at the hospital and he's told: 'but, no, you're a drug addict -- what do you want here? Why should we treat you, you'll die anyway.'"
Civic groups like Malyshev's, which try to work with addicts, are chronically underfunded and often face hostility from the state. The Rylkov Foundation seeks to help drug addicts at the grassroots level by providing them with medical tests
for diseases like HIV and hepatitis as well as medicine and clean needles.
It also lobbies for methadone to be legalized. The World Health Organization calls methadone-substitute therapy to wean heroin users off the drug "the most promising way" of combating addiction. But the substance is banned in Russia. In February 2012, the Rylkov Foundation’s website was temporarily shut down by the authorities for promoting the use of methadone.
Recently, when Malyshev and his colleagues were assisting addicts -- including Igor -- in Marino, a rough-and-tumble Moscow suburb, police threatened them with arrest and ordered them to disperse. Unfazed, they moved up the street to a bus stop to assist more addicts -- this time heroin-addicted prostitutes.
The Rylkov Foundation's methods differ sharply from more famous antidrug organizations like Yekaterinburg’s controversial vigilante group City Without Narcotics, which is notorious for forcing addicts to go "cold turkey" by handcuffing them to beds. Yevgeny Roizman, the group's firebrand founder, was elected mayor of the Urals mining town in September.
Malyshev, himself a recovered heroin addict, says he understands the work his foundation does is a "drop in the ocean." But he insists it is worth it.
"We believe we have to do this -- despite the fact that there are few of us, despite the fact that we cannot dramatically change the drug policies," he says. "Nonetheless, we still do this."
For his part, Igor knows only too well how marginalized addicts are. Police regularly detain him because, as a conspicuous drug addict, he can be easily coerced into admitting to petty offenses.
Nevertheless, he has managed to find work repairing the shuttle buses that make up part of Moscow's public-transportation network.
"If it wasn't for work, honestly, I'd have been in jail a long time ago," he says. "Drugs require financial investment. If you don't work, you can't get any [money]. You have to go out, rob, pinch, and steal. You set out on that crooked path that sooner or later leads to jail. And it's usually sooner because you’re never on the run for long."