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Tatarstan: Kazan Clinic Is Bold Exception In Russia's HIV Battle

By Albina Zaynulla and Claire Bigg An examination room at the Simona center (RFE/RL) KAZAN, August 10, 2006 (RFE/RL) -- Every day in Russia, hundreds of thousands of women go out onto the streets to work as prostitutes. For most, health care and other forms of support is nonexistent. But Kazan, the capital of Tatarstan, has launched a unique campaign to protect commercial sex workers against the spread of HIV and other sexually transmitted diseases.

Irina, 33, has been injecting heroin for the past six years.

When her husband died earlier this year, Irina found herself unable to pay for her addiction. That's when she turned to prostitution.
"It's actually a pleasure to come here. At the hospital I used to go to, they treated me like a dog." -- Irina

It's not an easy life. But Irina is luckier than many commercial sex workers in Russia.

She is able to receive regular medical screening from the Simona clinic in Kazan, one of the only support centers for prostitutes in the country.

Open Dialogue

Arriving at Simona for a routine test for sexually transmitted diseases, she is met by a female doctor who asks about her health and her work.

The questions are frank, but not judgmental. Irina answers openly. How long has she been involved in commercial sex? Four months. Does she take drugs? Yes. Does she have hepatitis? Yes.
"If a person has chosen this path, it is her right, it is her choice. Our job is to offer help and support."

The Simona center opened in the Tatar capital in January. Run jointly by local authorities and nongovernmental organizations, it is the only one of its kind in Russia.

Irina's tests, like all medical services offered at this clinic, are free. Free condoms are also available.

Kochetkova says her job is not to fight prostitution, but its consequences (RFE/RL)

The center does not provide drug treatment for HIV-positive clients, but it does help direct patients to find the drugs they need. The clinic also carries out prevention work and trains health specialists to work with prostitutes.

Fighting The Odds

Simona's venereologist, Albina Zaripova, says "around 80 percent" of prostitutes in Tatarstan are infected with at least one sexually transmitted disease. "Most of them are drug addicts and have hepatitis as well," she adds. "One out of four is HIV-positive."

By treating this high-risk group, Kazan hopes to curb the spread of sexually transmitted diseases -- in particular HIV/AIDS -- into the mainstream population.

The Kazan center doesn't wait for prostitutes to drop in. It reaches out to them in the street, distributes flyers throughout the city, and tries to persuade escort services to send their sex workers in for regular health checks.

Moral Support

The clinic has been quick to gain the trust of sex workers -- today, it receives an average of eight patients a day.

Like many of Kazan's sex workers, Irina says she now sees the center as a source of comfort. "I like it here. The people, the doctors, are very nice, very kind. They support me morally. I want to give up drugs, so they're also helping me with that," she says.

"It's actually a pleasure to come here. At the hospital I used to go to, they treated me like a dog. It was dirty, there were cockroaches everywhere, the doctors were bad," she adds.

Country At Risk

Russia has one of the fastest-growing HIV infection rates in the world. The country's federal AIDS center estimates Russia has as many as 1.5 million HIV carriers.

And though fighting HIV/AIDS has been labeled a "national priority," response to the crisis remains sluggish.

Russia's budget allocation for HIV/AIDS is 20 times higher than last year. But activists -- many of whom will be attending the 16th annual International AIDS Conference, which begins in Toronto on August 13 -- say embarrassment and hostility regarding the issue continue to present a barrier.

Staff at Simona work hard to lower such barriers. The clinic owes much of its popularity to the fact that it does not attempt to talk these women into quitting the sex business.

Acceptance, Not Prejudice

Svetlana Kochetkova, a manager at Simona, stresses that its job is not to combat prostitution itself, but its consequences. "Our task is not to prevent the spread of prostitution, although this is also important. Our work focuses on dealing with what has already happened," Kochetkova says.

"I don't have any prejudices against women working in the sex business. We just accept the situation as it is. If a person has chosen this path, it is her right, it is her choice. Our job is to offer help and support."

A New Way Of Life?

The much-needed moral support and human warmth that the sex workers find at the clinic, however, can ultimately help these women find an alternative to prostitution.
Russia's budget allocation for HIV/AIDS is 20 times higher than last year. But activists say embarrassment and hostility regarding the issue still present a barrier.

Alfia Novikova, the clinic's administrator, refers to the women who come to Simona as "society's outcasts." But for her, she adds, they are "like daughters who have veered from the correct path."

"Most of them are very young, some of the girls are 16 or 17," Novikova says. "Recently I spoke to a girl, she's 17. We sat here and discussed where she could go and study, what profession she wanted to pursue. We discuss things like that, like a mother and a daughter would do."

Irina also has bright ambitions. If she succeeds at giving up drugs and gets a clean bill of health, she says she hopes to marry her new boyfriend, a taxi driver whom she has known for over 10 years.

Simona, too, has big plans for the future. The staff there hopes its success will inspire other regions to set up, with their help, similar structures in other Russian cities.

(RFE/RL's Tatar-Bashkir Service contributed to this report.)



The United Nations has issued its annual report on the AIDS epidemic. Here are some of its findings:

  • There are currently an estimated 40.3 million people living with HIV, the virus that causes AIDS. Of those, 17.5 million are women and 2.3 million are children under the age of 15.
  • There were an estimated 4.9 million new HIV infections in 2005, including 700,000 children under the age of 15.
  • An estimated 3.1 million people, including 570,000 children, died of AIDS in 2005.
  • According to the report, more than 25 million people have died of AIDS worldwide since the disease was recognized in 1981.
  • In Eastern Europe and Central Asia, the number of HIV-positive people reached 1.6 million in 2005, up from 1.2 million in 2003. The bulk of people living with HIV in the region are in the Russian Federation and Ukraine. "Ukraine's epidemic continues to grow, with more new HIV infections occurring each year, while the Russian Federation has the biggest AIDS epidemic in all of Europe," the report states. A private Russian survey cited in the report found "no postive changes in sexual behaviour, with condom use decreasing slightly among people in their twenties."
  • In Central Asia, Uzbekistan and Kazakhstan have seen the most dramatic increases of HIV infections. In the Caucasus, the situation is described "relatively stable."

See also:

Central Asia: AIDS Project Seeks To Avert Epidemic

Eastern Europe: European Commission Warns Of 'Resurgent' HIV/AIDS Epidemic

Listen to a short interview by RFE/RL's Tajik Service with Gregory Henning Mikkelsen, director of EU team for a joint EU/UN AIDS initiative. In the November 21, 2005, interview, Mikkelsen describes the epidemic in Central Asia.
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