Elena Yaskevich hunches over her desk and lights up another cigarette. Her office phone, one of Moscow's few drug-addiction hot lines, rings once again. She begins yet another round of questions, the same as the last. "How old is your daughter?" Pause. "I see, 17. Vich?" the Russian word for HIV. Solemnly, she nods as she gets the mother's expected reply.
Even pros like Yaskevich have been blind-sided by the tidal wave of HIV that's hit Russia over the past two years. "This is a serious threat," she says, likening it to a "neutron bomb." That bomb has already exploded among intravenous drug users. The question is when it will go off in the general population. Officially, Russia has diagnosed 129,261 new cases of HIV over the past year and a half, including this July. That's the highest rate of infection in Europe, making Russians seven times more likely than their Western counterparts to contract the virus. And the real number of new cases could be anywhere from five to 10 times higher, according to experts. "This is a catastrophe," says Dr. Alex Gromyko, an HIV adviser to the World Health Organization. "Within the space of two years, Russia has gone from the bottom of the list to No. 1."
Infection rates are increasing almost exponentially. More than 63,000 cases have been counted during the first five months of this year, three times the rate of two years ago and double the total for the 12 years between 1987 and 1999. That's modest compared with Africa, where 17 million people have already died. But Russia's HIV-watchers feel like people preparing for a hurricane: they can close the shutters, but that won't save their home. Dr. Gromyko makes no predictions, except to say he is sure that within two or three years several million Russians will be infected. "When the deaths will be counted in the millions," he says, "then we will start to understand the tragedy."
HIV can quickly spread to the general population in a country like Russia, where standard protections against the sexual transmission of the disease are often not used and abortion is still a popular form of birth control. And clearly, few of the dramatic steps needed to combat a general epidemic are being taken. This April, Russia refused a $150 million World Bank loan for treating tuberculosis and AIDS. Reason: Health Ministry officials were reportedly "not satisfied" with certain conditions of the loan. And while Russia plans to commit $5 million on the fight against AIDS this year, that's a pittance next to what the United States and Europe spend to combat the disease--and utterly inadequate for the challenge. Russia has opened AIDS awareness centers in each of its 89 regions, and many hospitals now have AIDS wings. But few have adequate supplies of the drugs needed to treat HIV, and their cost is beyond the means of most patients. According to Dr. Gromyko, only about 500 are receiving effective treatment. "Russia cannot afford to treat that many infected persons," he says. "It's a generation lost."
Now comes the influx of heroin to the former Soviet Union. Ever since the 1980s, the drug of choice in former republics like Belarus has been cherny, a cheap form of raw opium. Shooting drugs into your arm is still the best way to get a strong hit for the least amount of money. Needle sharing has always been common, and remains so. Add to this the general disregard for contraception and a surge in drug-related prostitution and you've got a deadly recipe for an epidemic. Just ask 26-year-old Lena, who walks the halls of the AIDS ward at a hospital in Rostov, in southern Russia, a crumbling edifice populated mostly by addicts with HIV. She wears blue pajamas and clutches her stomach, not knowing why it hurts all the time. But she knows she got her disease from sharing needles. "I never stole, I never became a prostitute," she says. "Most narcomanki became prostitutes for kopeks. They will serve clients right by the roadside. They are the most lost of all."
At Rostov's Center for AIDS Prevention, heroin addicts Oleg and Vasily wait to get their test results. The doctor has already told them they are almost certainly HIV-positive, and the silence in the room testifies to their nervousness. Oleg explains the deadly rules of the game. It's almost a given, he says: "When you get the drugs, you don't have a clean syringe. Sometimes you just don't have the money, other times the pharmacy is closed." So you shoot up anyway. Vasily, too, talks about the full-time job of obtaining the drugs, cooking them up, injecting and keeping away from the cops. It gives him something to do in what he sees as his otherwise useless existence. "Why does it matter what you die of, AIDS or drugs? One of them will kill you, but there's no reason to live anyway. We spit on society, and we spit on ourselves." That attitude is surprisingly prevalent, in itself a harbinger of worse to come.