Pubdate: Sun, 25 Aug 2002
Source: Seattle Times (WA)
Copyright: 2002 The Seattle Times Company
Contact:  http://www.seattletimes.com/
Details: http://www.mapinc.org/media/409
Author: Alex Rodriguez, Chicago Tribune

AS HIV SPREADS, OFFICIALS ARE STILL LOOKING THE OTHER WAY

MOSCOW - Since she began using heroin at 12, Oksana Mitrofanova has been to 
drug-abuse clinics twice - once before she was told she was infected with 
the virus that causes AIDS, once afterward. Each time they flushed the drug 
out of her body but not the craving for it.

"As far as counseling, they said, 'Here, take this medicine,' " said 
Mitrofanova, now 19. "And they suggested I see a psychologist. That's all."

Nowhere in the world is HIV spreading faster than in the former Soviet 
Union, an ominous trend that so far has been driven almost exclusively by 
the young embracing experimentation.

And yet Russia has devoted little if any attention to the prevention and 
treatment of drug abuse, AIDS experts say. Now, as Russia begins to see the 
first signs that transmission among non-drug-using heterosexuals is on the 
rise, experts worry that the nation once again will react far too slowly to 
a health crisis that threatens to explode.

At a global AIDS conference in July in Barcelona, Spain, the director of 
the Russian Federation AIDS Center, Dr. Vadim Pokrovsky, said the 
proportion of Russia's new HIV cases linked to heterosexual transmission 
jumped from 4 percent in 2001 to 8.4 percent during the first three months 
of this year.

About 200,000 Russians are registered as HIV-positive, but Pokrovsky and 
other leading AIDS researchers in Russia estimate the actual number is 
closer to 1 million. The figure is expected to grow to 5 million by 2005.

Pokrovsky has said as much as $65 million is needed immediately to slow the 
spread of HIV infection in Russia and to treat the thousands of infected 
people who soon will begin suffering the symptoms of AIDS. This year, the 
Russian government budgeted just $5.1 million to combat the disease, Health 
Ministry officials said.

The government could have tapped into a new global fund for nations facing 
huge increases in AIDS cases in coming years but did not submit a proposal. 
That fund could have produced as much as $27 million for Russia this year, 
experts believe. Ukraine, which is facing a crisis of its own with 1 
percent of the population HIV-positive, was awarded $9 million from the 
fund this year and is to receive $92 million over 10 years.

Alexander Goliusov, head of the Russian Health Ministry's HIV infection and 
treatment department, said Russia contributed $20 million to the fund but 
chose not to request aid like Ukraine, "which like a beggar has stretched 
out a hand for help."

AIDS experts believe that behind Russia's reluctance to employ even basic 
preventive measures such as drug-abuse counseling and needle exchanges is a 
glaring underestimation of how severe the crisis could become.

Ninety percent of the Russians infected by HIV are intravenous drug users. 
More worrisome, though, are estimates from researchers that two out of 
every five intravenous drug users already are infected with HIV, said 
Andrei Kozlov, director of the Biomedical Center in St. Petersburg and one 
of Russia's leading AIDS researchers.

And in cities such as Rostov-on-Don, Krasnodar and Kaliningrad, experts are 
seeing evidence that the spread of HIV is beginning to take hold in the 
general heterosexual population, said Arkadiusz Majszyk, the Russian 
Federation's representative to the United Nations Program on HIV and AIDS.

"We are going from this high-risk group, intravenous drug users, to the 
general population," Majszyk said. "The young generation is experimenting 
with everything, including sex and drugs. Having these two combined, the 
danger is much higher."

Other former Soviet republics faced with rapid increases in the spread of 
HIV, including Kyrgyzstan and Belarus, have begun methadone programs to 
help reduce the incidence of intravenous drug use. In Russia, however, 
methadone is illegal.

Needle-exchange programs benefit about 5 percent of the country's 
intravenous drug users, Majszyk said. But to make a significant dent in the 
spread of HIV among that group, at least 60 percent coverage is needed.

Russia has had myriad other problems to confront, from an ailing economy to 
the ongoing civil war in Chechnya, but experts argue that the explanation 
for the country's inaction toward the AIDS crisis goes beyond priority-setting.

"In Russia there has been a lack of understanding of new social problems 
and a tendency to look at drug users as a marginalized group," Majszyk 
said. "And today, that drug user could be your son, or the son of a 
government leader. For now, however, the average Russian citizen is saying, 
'No, it will not come to me.' "

That denial courses through every tier of Russian society, experts say. 
Foundations that fund AIDS prevention and treatment programs have begun to 
spring up in Moscow and throughout Russia, but they are largely 
foreign-based groups, Kozlov said.

"We have so many rich people in Russia now. Why don't we have an AIDS 
foundation here?" Kozlov said. "This means society doesn't understand the 
scope of the problem yet."

Support groups for people who are HIV-infected exist, but on a shoestring. 
Mitrofanova's group meets in the basement of a large, dilapidated apartment 
building in Moscow's industrial northeast sector.

Heroin users in the group say they realize their predicament is the product 
of their own actions. But they recount how when they sought help at Russian 
drug-abuse clinics, the experience was impersonal, almost mechanical. The 
sole purpose was detoxification, and it usually was carried out through a 
daily regimen of vitamins and painkillers.

Mitrofanova said that before her diagnosis, she and 19 other teenagers 
spent their evenings huddled around a small spoon of heroin outside an 
apartment building. They shared syringes. Her two visits to drug-abuse 
clinics ended the same way: She walked out the door and began using again 
later that day. "It was of no help," she said.

She said when she learned she was HIV-positive, "there was no fear of being 
ill or doomed to die. What really frightened me was the fact that I knew 
people were going to turn their backs on me."
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