#7
The Star (Toronto)
July 10, 2002
HIV engulfs former Soviet Union with a fury
By Rosie DiManno

BARCELONA -- FREE ... to die of AIDS.

This isn't what the democratic movement had in mind for the former Soviet Union when communism collapsed and the world seemed shiny new, rich with possibilities. But along with the economic chaos that subsequently wrought havoc, Russia and its one-time vassal states -- nations that lurched out from behind the Iron Curtain -- are now infested with HIV and AIDS contamination.

Out of nowhere, out of the immediate socio-cultural past, HIV and AIDS have arrived with a fury in Eastern Europe and Central Asia. For the past three years HIV, the virus that causes AIDS, has been on a rampage there, although few have paid attention.

Indeed, UNAIDS reports that HIV is growing faster in Eastern Europe and the former Soviet Union than anywhere else in the world. Faster than in India, with an HIV/AIDS population of 4 million, the second-largest afflicted population on the globe for sheer numbers. Faster than in China, where the disease has established a worrisome foothold and where only one in six has ever even heard of the disease. Faster than in Thailand, with its rutting fields of pubescent prostitutes and indentured sex slaves.

It's Africa all over again, 10 years later. The same bleak trends, the same dire predictions, the same writing on the wall -- after The Wall came tumbling down.

"The world celebrated with us when the Berlin Wall fell," a leading Eastern European activist chided the international community at yesterday's plenary session of the 14th International AIDS Conference. "And then left us alone to deal with the consequences."

Polish-born Kasia Malinowska-Sempruch, who is director of the New York-based International Harm Reduction Program -- which has pioneered HIV/AIDS projects across Eastern Europe -- also provided a grim warning: "If the world is unable or unwilling to turn its attention to this region and offer help with this looming disaster, the consequences will be horrific."

These words are hauntingly similar to the warnings issued more than 10 years ago, that AIDS had circumnavigated the globe and was back whence it originated, about to explode with a vengeance in sub-Saharan Africa. But North America and Europe were preoccupied with the disease in their own backyards, still portraying AIDS as an affliction besetting the gay community. The gaining of wisdom came hard and too late for millions of Africans, where the disease is now more prevalent in girls and women, and where 2.2 million died last year alone.

"Not only is this an economic and social disaster, but a moral one," Malinowska-Sempruch reminded. "No matter how much attention donor nations give to Africa now, it will never be forgotten that the world fell brutally short of meeting its human obligations."

AIDS brought Africa to its knees. The huge fear is that Eastern Europe will buckle next; is in fact already sagging.

In the year 2000, more new HIV/AIDS cases were registered in Russia than in all previous years combined. In Ukraine, where fewer than 100 cases were registered between 1989 and 1994, an estimated 300,000 are now living with HIV. Estonia's infection rates tripled last year, catapulting the country to one of the highest prevalence rates in Europe. The former Soviet republics are hopelessly unprepared to deal with the pandemic, with few people having any access to antiretroviral treatment, the triple combination therapy considered standard care by the World Health Organization.

But most disastrously, and with little resistance, the pandemic is sweeping across Russia, purportedly one of the most industrialized nations in the world, where brilliant minds pushed the boundaries of science and assembly lines churned out hundreds of thousands of nuclear warheads.

According to the Imperial College in London, an estimated 5 per cent of Russians will be infected within five years and 4 million will have developed full-blown AIDS.

Yet this has not been a phenomenon propelled by sexual activity, despite an international sex trade that is significantly controlled by the Russian mafia, with prostitutes forcibly migrating across Central Asia, Eastern Europe and even into Western Europe. Instead, the primary culprit in Russia, which straddles the main heroin trafficking routes originating in Afghanistan, is injected drug use: 93 per cent of known HIV/AIDS cases have been attributed to this cause.

Ironically, as a source of HIV/AIDS, injected drug use should be more easily interdicted than trying to alter deeply ingrained sexual attitudes. But this is far from reality on the ground, where drug users are viewed as unworthy of helping and, further, incapable of maintaining a strict antiretroviral drug regiment even if it were available. Malinowska-Sempruch snorts at this perverse reasoning: "One thing drug users know how to do well is to take drugs."

Instead, similar to the American model of dealing with drug "criminals" (and the Canadian model too, for that matter), intravenous drug users are arrested and warehoused in atrocious prisons where they're at even further risk of HIV/AIDS contamination from sharing dirty needles. Sharply increasing rates of pre-trial incarceration in overcrowded cells has further fuelled jailhouse use of shared syringes. And Malinowska-Sempruch tells of parents who would rather watch their teenage children die of AIDS than seek help for a drug problem, because they fear police harassment afterward.

Twenty-three thousand Russian prisoners have tested positive and the main killer of all Russian prisoners is tuberculosis, another disease returning with fervour and closely associated to HIV/AIDS infection.

The picture is grim, grim, grim. And it's a picture pre-screened in Africa. But will the lessons learned in the sub-Sahara be applied to Russia and Eastern Europe while there's still time, if there's still time? Or will millions of preventable deaths be the legacy of freedom?

"My father was sentenced to life in prison at age 18 for political activity," said Malinowska-Sempruch. "He spent 12 years in prison and died before Poland became a truly independent country again in the late '80s. There are hundreds of thousands of men and women who, like my father, sacrificed their lives opposing communism.

"None of them did that to now watch their children, or their children's children, or their neighbour's children, be locked up in prison for drug use or die of AIDS."

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