The number of Russians infected with HIV, the virus that causes AIDS, has doubled during the past eight years. It's an alarming trend that runs counter to AIDS-ravaged regions like Southeast Asia and sub-Saharan Africa, where infection rates dropped during the same eight-year period.
Health experts attending a three-day AIDS conference in Moscow have urged Russian officials to scrap existing, abstinence-based strategies for fighting the spread of HIV, saying needle-exchange programs and free condom distribution are the only way to prevent the country's epidemic from entering a devastating new phase.
Gennady Onishchenko, Russia's chief public-health officer, has dismissed such suggestions as encouraging illicit behavior. But Western health experts say it's time for the Russian leadership to seriously address AIDS and the myriad health threats facing the country, in order to help forestall a looming demographic catastrophe.
Yury Zhigalkin of RFE/RL's Russian Service spoke to Murray Feshbach, a Russian population expert and senior scholar with the Woodrow Wilson Center in Washington, D.C., about Russia's demographic crisis.
RFE/RL: The UN Human Development Report, which was issued earlier this month, projects that by 2050, the Russian population will have dropped from approximately 142 million to somewhere around 110 million. Much of the government's response has focused on bringing up the birthrate. But is there more to it than that?
Murray Feshbach: Hardly any emphasis has been placed on mortality, but the numbers are still outrageously high. Heart disease and cancer as a cause of death are three to four times higher per capita than in Western Europe and the United States. They have to reduce that to make up for the continuing decline in the number of births, as we get a drop in the number of women available to have children.
RFE/RL: What about the impact of infectious diseases like HIV/AIDS? Is there a sense that the government is adequately addressing this issue?
Feshbach: What I'm concerned with is that there is not enough concern by the [Russian] leadership about the impact of not only HIV/AIDS -- which I believe has wrongfully gotten less attention in Russia -- but also tuberculosis and hepatitis C.
All of this is related to injection drug use. And what's really complicated, which I don't think anyone has really accounted for, is the enormous number of cases of multi-drug-resistant tuberculosis, conventionally drug-resistant tuberculosis, and a big growth in the number of tuberculosis-HIV co-infections.
RFE/RL: What other health and demographic challenges are being overlooked?
Feshbach: We have to include smoking. We have to include other risk behavior. We have to include child health and reproductive health. You have a need to stop many other things and start solving these problems, which is not easy, because how do you turn this around?
How do you get people to drink less, or drink differently? Because, don't forget, in Russia, they mostly drink "do dna" (to the bottom) and all at once. And when you drink that way, it's not just the quantity, it also affects the ethanol level in the blood, which then brings other problems.
The World Heath Organization calculates that the number of liters of 100 percent alcohol begins to get bad if you drink more than 8 liters per capita per year. In Russia, that figure is somewhere between 16 and 18 liters.
RFE/RL: Can you envision a point at which the Russian nation will simply die out?
Feshbach: There are projections that by 2075 or 2100, the numbers will be down to 35-50 million. I don't know. I think it is going to be extremely difficult for them to maintain the economy, because the working-age population is declining by 1 million a year. Whether Russia will turn out to be a failed state....
I don't think so. But it won't be easy for it to assert its power, like it has in the past.