Pubdate: Sun, 21 Jul 2002
Source: New York Times (NY)
Copyright: 2002 The New York Times Company
Section: International
Author: Steven Lee Myers


KALININGRAD, Russia, July 14 - As the cafes and clubs began to course with 
night life one recent evening, Andrei V. Bykovsky and Yuliya B. Sokolova 
cruised around in a white van, patrolling the newest front of Russia's AIDS 

They stopped first near the Mother of Russia statue, then along Moskovski 
Prospect, then beneath the Cosmonauts Memorial. They easily found what they 
were looking for: young women, many in their teens, most racked by drugs or 
desperation, selling themselves on the street for a trifle - less than $7.

Mr. Bykovsky and Ms. Sokolova passed out condoms from a green backpack and 
tried to coax the women to visit their basement clinic, which offers exams 
and advice to slow the spread of H.I.V., the virus that causes AIDS.

In Kaliningrad, as in all of Russia, the virus has spread almost entirely 
through the use of intravenous drugs. But the next step in the disease's 
march across Russia, which has one of the fastest-growing AIDS epidemics in 
the world, is starting to be documented here: a sharp increase in H.I.V. 
infections through sex.

"The figures began to grow in the last year," said Yelena Y. Kozhenkova, a 
doctor who rides along in the van on its nightly missions. "But we could 
see it coming even earlier."

What makes Kaliningrad's experience significant is what it forebodes for 
Russia as a whole. This region of more than 900,000 people, isolated from 
the Russian mainland and plagued by the social and economic ills that came 
with the Soviet Union's collapse, was the first hit hard by an explosion of 
cases among drug addicts and has been a harbinger of the disease's spread 
ever since.

In 2001, the percentage of new H.I.V. infections in Kaliningrad attributed 
to sexual contact jumped to nearly 30 percent of the total, compared with 
only 4 percent when the epidemic struck here with a vengeance in 1996, 
regional officials said. Prostitution appears to have been the primary 
source of these infections, but officials now fear that the trend signals 
the spread of H.I.V. beyond the shadowy world of drugs and criminality.

Tatyana N. Nikitina, the director of the Kaliningrad region's government 
AIDS center, attributed the increasing numbers to men contracting the virus 
from prostitutes and then spreading it to their wives and girlfriends.

"The disease has reached beyond the circle of the consumers of sexual 
services," she said.

In all of Russia, sexually transmitted H.I.V. infections accounted for a 
little more than 5 percent of new cases last year. But if previous patterns 
hold, officials warn, the number will rise, as it has here.

"The processes under way in Russia now could be observed in the Kaliningrad 
region five years ago," said Vadim V. Pokrovsky, the country's leading AIDS 

AIDS came belatedly to Russia, a fact attributed to the Soviet Union's 
nearly closed society. The first case was reported in 1987, but infections 
did not reach epidemic proportions until the mid-1990's, with an explosion 
of intravenous drug use.

In the last year alone, the total number of registered H.I.V. infections 
more than doubled to 177,354, from 87,177 in 2000. With screening still 
fairly limited, officials estimate that the total number of Russians 
actually infected may have already reached one million.

Dr. Pokrovsky has begun to warn, with some alarm, that AIDS could spread in 
Russia the way it has in Africa, infecting broad swaths of the population.

For now, drugs remain the leading cause of H.I.V. infections, particularly 
in Russia's notoriously overcrowded, drug-infested prisons. Some estimates 
suggest that the country has more than a million hardened drug users, most 
of them young men, but increasingly young women, as well.

They are also among the most sexually active age group, in which rates of 
other sexually transmitted diseases, like syphilis, are also high.

"Given the high odds of transmission through needle sharing, the fact that 
young people are also sexually active, and the high levels of sexually 
transmitted infections in the wider population, a huge epidemic may be 
imminent," a report by the United Nations program on H.I.V. and AIDS, or 
Unaids, warned in December.

In Kaliningrad, the spike in infections through sex has overshadowed some 
of the progress the region has made in slowing the disease's spread.

The number of new cases each year has dropped from a high of 1,109 in 1997 
to 491 last year and only 215 in the first six months of this year, 
according to the region's AIDS center. To date, there have been 3,763 cases 
of H.I.V. infection.

Although its rate of infections per capita is higher than in Western 
Europe, Kaliningrad no longer has the highest rates in Russia, having been 
surpassed by the regions of Irkutsk and Khanty-Mansi, in Siberia. Officials 
here have attributed the slowing of the growth to greater awareness of the 
risks, stricter policing of drugs and to one of the unintended consequences 
of the United States campaign in Afghanistan: a drop in drug exports that 
has driven up prices for heroin.

Officials also cite the increased use of clean disposable syringes, which 
are distributed by the basement clinic, run by a psychologist named 
Aleksandr A. Dreizin, that sends out the van teams each night.

With the number of cases involving sexual contact increasing, the clinic's 
mission has evolved from an exclusive focus on addicts, although drugs and 
prostitution are inseparably intertwined.

Dr. Dreizin has hired a gynecologist to offer women free exams. With money 
from the World Health Organization and private donors, the center also 
distributes condoms and pamphlets on safe sex.

An estimated 3,000 women work as prostitutes in Kaliningrad. Dr. Dreizin 
noted that new clusters of prostitution have appeared on Kaliningrad's 
borders with Poland and Lithuania, where they serve long lines of motorists 
waiting to cross. A French organization has donated a bus to help the 
clinic reach those women more easily.

Of the prostitutes who are reached, Dr. Kozhenkova said, many remain wary 
even of health authorities. "It's a complex of guilt and shame," she said. 
"They are afraid even of a gynecological clinic."
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