For much of the 1990s, Russia believed itself immune from the global AIDS crisis, registering a handful of cases per year while numbers steadily grew in Western states and mushroomed in parts of Asia and Africa. Three years ago, everything changed. Although the government has barely acknowledged it, Russia now faces what is believed to be the world's fastest-growing infection rate of HIV, the virus that causes AIDS. Since 1998, the number of registered HIV cases in Russia has jumped almost twentyfold, from 11,000 to 200,000. St. Petersburg alone has experienced a fortyfold increase.
St. Petersburg, 30 September 2002 (RFE/RL) -- In many countries, doctors call AIDS a "silent killer." Governments do not acknowledge it, carriers of the disease know little about it, and health workers have few resources to combat it -- ideal conditions for the spread of an epidemic.
And an epidemic of the HIV virus that causes AIDS, according to scientists from the World Health Organization and the United Nations, is what Russia now faces.
The country diagnosed its first HIV case in 1987. Despite the fact that the year coincided with Soviet leader Mikhail Gorbachev's new campaign of glasnost, or openness, little publicity was given to the matter. Over the next decade, fewer than 1,000 cases were registered, out of a population of 150 million. The hypothesis that HIV and AIDS would not take hold in Russia seemed to have been confirmed, until 1996, when a major barrier was breached.
Alla Davydova, head of the city-funded AIDS Center in St. Petersburg, explained: "The first documented case [of HIV] was in 1987. Until 1996, the HIV virus was spread primarily through sexual contact, but there was no mass spread of the virus into the general Russian population. In 1996, when the virus began to hit the intravenous drug-using population, the number of HIV infections started to rise dramatically. And now, since 1996, we have developed a genuine epidemic of HIV infections among drug users. It is a concentrated epidemic, but recently we have seen a new trend and we are seeing a growing number of sexually transmitted HIV infections."
In 1996, the authorities in St. Petersburg registered 43 HIV-positive patients. The next year, that number nearly doubled to 82. And then, the numbers went off the scale. By 2000, 5,400 new diagnoses of HIV were recorded in St. Petersburg, 20 times as many cases as the previous year. In 2001, the St. Petersburg AIDS Center registered 10,000 new HIV patients.
Statistics have a tendency to numb, but these numbers tell a clear and chilling story: For years, the HIV virus lay dormant in Russia. That began to change in 1996, with the appearance of the first HIV cases among intravenous drug users. Five years later, the vast majority of intravenous drug users in St. Petersburg, as well as many other Russian cities, have HIV. And the disease is now spreading, primarily through sex and blood transfusions, to a largely unaware general population.
There is another category of victims. At St. Petersburg's Botkin Hospital, doctors recently set up a special maternity ward for HIV-infected mothers. Head obstetrician Tatyana Penchuk said 149 HIV-positive women gave birth here last year. Nine months into this year, the number has tripled to more than 400.
Penchuk and her team work long hours, delivering babies that are often underweight, anemic, and with a weakened immune system. The medical staff faces extra risks dealing with these babies but take as many precautions as possible. "We work in gloves, we have special glasses, special liquid-proof gowns, all of that," Penchuk said.
Funds are short. A sign at the entrance to the ward tells patients they may have to purchase some of the medicines they need at a private pharmacy and bring it to the doctors.
Penchuk said many of the mothers her team cares for do not understand how sick they are. "They don't even understand what kind of illness this is. It seems to me society has underestimated the disease, and many patients don't understand the state they're in, how it's going to end for them, and how serious it all is," Penchuk said.
Once the babies are born, most are abandoned. No one wants HIV-positive children in Russia, it seems. No one except Olga Kim, who runs Orphanage No. 10, which is for HIV-positive children in central St. Petersburg. When the orphanage opened in October 2001, it was the first institution of its kind in Russia. With its 35 places for HIV-infected children between 7 days and 4 years of age, it remains the only state-run shelter for such children in all of St. Petersburg. Kim explained that it takes several months to determine whether a child born to an HIV-positive mother is a permanent carrier of the virus. "All children born to HIV-infected mothers carry HIV antibodies in their blood. Unfortunately, because of this, it is impossible to establish an immediate diagnosis as to whether a child is HIV-positive or not. The first medical tests are conducted between the child's first and second months of age. A blood sample is analyzed to determine the quantity of the virus in the blood. The second test is done at six months of age," Kim said.
By 18 months of age, 65 to 70 percent of children born to HIV-infected mothers test negative for the virus. They are moved to "regular" orphanages or, if they are lucky, they are adopted by a foreign family. Those who test positive will remain under Kim's care until their fourth birthday. After that, the future is uncertain. "This problem is being examined at the city level. Unfortunately, there have not been any directives yet at the ministerial level. This orphanage is a first experiment. It's the first time such an orphanage has opened in Russia. Now, other regions are starting to follow suit, because the problem unfortunately is not shrinking but growing," Kim said.
Kim said HIV leaves no visible trace on her young charges. And indeed, a tour of the orphanage reveals its occupants to be as lively and lovable as "normal" kids. The only difference in the daily regime at this orphanage is the extra attention given to hygiene to avoid the spread of any infection. Staff also spend extra time with the children to reinforce essential learning skills.
Nurse: "Masha sat down to eat her meal, right? And then came along...Who came to see Masha? Try to remember. No, that's not the one, Irochka, it's another one. Try to remember, who came to see Masha after she sat down to eat? Vitya, who came to see Masha?"
Nurse: "Masha. And who came to see Masha?"
Nurse: "A dog. Say: 'dog' [sobaka]."
Nurse: "And Liza, do you remember the dog's name?"
Kim: "Liza remembers everything, she's a smart little girl."
Nurse: "That's right, Liza knows. You know, right? Tell us the poem you know."
Kim's cheerfulness buoys the children as well as the staff. But back in her office, she acknowledges that she has her moments of quiet despair. Here too, funds are short and the surrounding community has often been less than supportive. "There was, initially, a lack of understanding from our neighbors. Next to our orphanage is a kindergarten and, of course, the parents of the children there at first were upset that HIV-infected kids were living next door. They considered it a health threat for their own children. We had to talk to the parents and explain and I would say we've reached a measure of understanding. There has been progress," Kim said.
Back at the AIDS Center, Davydova said educating people about what HIV is and how it can be transmitted and how it cannot has to be Russia's most crucial task. The authorities do not have the resources to treat even a fraction of those already ill. Out of St. Petersburg's 17,000 officially registered HIV patients, only 100 are currently receiving expensive antiretroviral therapy, which helps postpone the onset of AIDS. Davydova's staff frequently visit schools and have prepared a range of study materials, from brochures to computer programs aimed at different age groups.
The reason is simple. "Most of those infected in St. Petersburg are under 30 years of age -- under 30, young people between the ages of 15 and 30," Davydova said.
But so far, the message does not seem to be getting across to those at risk. "We examined the behavior characteristics of people who come to our anonymous testing unit after a five-year interval. The first study was conducted in 1997, when there was still no mass epidemic. And the second study was conducted in 2001, when we were already dealing with an epidemic. What we determined was that these people did not change their behavior in the slightest. We surveyed 2,000 people who came to be tested -- it's quite a large sample -- and neither the men nor the women had changed their high-risk behavior," Davydova said.
Nor, it seems, has the Russian government, which reduced national spending on AIDS and HIV last year from an already paltry $6 million to $5 million.
Russian society has yet to acknowledge that it is facing a crisis with HIV. And people have not been receptive to measures such as needle-exchange programs, which have been proven to cut HIV infection rates among drug addicts and, by extension, the general population in other countries. One such pilot program, sponsored by the French nongovernmental organization Medecins du Monde (Doctors of the World) came to an abrupt halt after mini-buses used to transport clean needles to addicts were set on fire.
Unlike in the United States or South Africa, no famous personalities have taken up the cause of AIDS in Russia. President Vladimir Putin has never devoted a speech to the disease. If nothing is done, within eight years, the World Bank estimates that at minimum, 2 percent of the Russian population will be infected with HIV. Hundreds of thousands of people will have developed full-blown AIDS. Several thousand of them will be dying each month -- the victims of a silent, but very potent killer.