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Montreal Gazette
November 24, 2002
Red-hot Russians party on
But AIDS epidemic could cool the fever
By MICHAEL MAINVILLE
Freelance
It's a Friday night at the Hungry Duck, the most infamous of Moscow's hedonistic night clubs. It's crowded with young Russian women plied with free alcohol and male strippers. Men aren't allowed in until 11 p.m., but when the doors open they rush in, eager to pounce.
By 1 a.m., the Hungry Duck is a madhouse. Pounding music drowns out all talk, topless women dance on tables and couples grope openly in every corner of the club. On the bar in the centre of the room, two male strippers empty bottles of champagne over the naked body of a young female patron.
For many young Russians, a night at the Hungry Duck - or any of the dozens of similar clubs scattered across Moscow -- embodies the freedom they enjoy since the fall of communism.
Unfortunately, it's clubs like these that experts say are the next breeding ground in a growing AIDS epidemic sweeping across Russia.
"The next wave is coming and it's coming soon," said Arkadiusz Majszyk, the UNAIDS representative in Russia.
"And it's going to hit the heterosexual community, because in Russia sex is freedom and safe sex is unknown."
AIDS experts say Russia's epidemic, so far mostly confined to the country's intravenous drug users and small gay community, is crossing over to the heterosexual population.
In a country where the young have embraced sex as a symbol of their freedom and the government has done little to raise awareness of the dangers of AIDS, they fear Russia is facing a crisis of horrendous proportions.
"People do not understand that HIV and AIDS are a real danger," said Vadim Pokrovsky, director of the Moscow-based Centre for AIDS Prevention and Treatment and the country's leading AIDS researcher.
"But if nothing changes, Russia will be facing the same scenario as Africa.
"Some of the drug users are very active sexually, and sex is also the main way for woman drug users to get money for their drugs," Pokrovsky said. "And this is acting as a bridge to the heterosexual community."
And now that the bridge has been crossed, the epidemic is expected to balloon.
If current infection rates continue, Pokrovsky said, millions of Russians will have AIDS within two decades.
"The best scenario would be 2 million deaths in 15 years," he said. "The worst is that up to
7 million deaths are possible in the next 15 to 20 years."
Experts see few reasons for optimism because Russians have so far shown little interest in taking AIDS seriously.
The misperception is that this is a problem only for injecting drug users, said Vinay Saldanha of the Canada AIDS Russia Project.
"You very often hear an average Russian saying: 'I sleep around, but none of my partners are drug users, so I have nothing to worry about.' "
Experts say the government bears much of the blame for this attitude.
The Russian government has allocated a meagre 185 million rubles ($9 million) to combat HIV and AIDS this year - slightly more than one ruble (5 cents) per Russian citizen.
Most of that money goes into treatment, but still only 500 AIDS sufferers - mostly in the Moscow region - are being treated with retroviral drugs. Only a pittance is spent on prevention programs, and efforts to introduce sex education and AIDS awareness into the high-school curriculum have failed.
"The argument the Russian government gives is simple: if there are not enough syringes in hospitals to treat young children, if the old babushka who has lived through so much is without support, why should we spend money on drug users?" Majszyk of UNAIDS said.
"The arguments are strong, but they are also shortsighted."
In fact, most of the money being spent on HIV and AIDS in Russia is coming from international sources, such as UNAIDS and the Canada AIDS Russia Project, which has received $2.1 million in funding from the Canadian International Development Agency.
The three-year project is aimed at raising AIDS awareness among officials, developing local non-governmental organizations and improving medical techniques.
And experts say more money is available from international sources, if only Russia were interested in claiming it.
The World Bank has offered Russia a five-year, $50-million (U.S.) loan to combat HIV and AIDS, but the government has refused to take on any more foreign debt.
It has also refused to apply for money from the UN Global AIDS Fund, which Saldanha said could provide up to $100 million U.S. to fight AIDS in Russia with few strings attached.
"The problem," he said, "is that Russia doesn't want to be seen to be begging to the international community."
Pokrovsky has been particularly critical of the government's spending priorities, such as when it spent $200 million U.S. last year to raise the sunken Kursk submarine.
"When the government had to find money to raise the Kursk - no problem - but not when it comes to AIDS," he said. "In my opinion, the millions of people who are going to be affected by AIDS are much more important than one submarine."
There are some signs that Russian society is starting to grasp the full scope of the problem.
This month, 5,000 people turned out for a Live Aid-style pop concert in Russia's western enclave of Kaliningrad to raise money and awareness in the struggle against AIDS.
Among those in attendance was Russian first lady Lyudmila Putin.
Still, experts said it's unlikely her husband, President Vladimir Putin, other top officials and the Russian public will wake up to the epidemic before it's too late.
"Russians are still far from the point of view that this epidemic affects them, even if it hasn't infected them," Saldanha said.
"And, unfortunately, that isn't going to change until the epidemic spreads more widely among the heterosexual population and more members of society actually start getting ill."
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AIDS in Russia
Because of the isolation its citizens suffered under communism, AIDS came late to Russia. As recently as 1994, no country in the former Soviet Union had registered more than a few cases of HIV infection.
The Russian Federation has the fastest-growing rate of HIV infection in the world. There are officially 218,000 HIV cases, but experts estimate the real number is closer to 1 million. About 41,000 new cases have been registered this year.
In less than a decade, Russia's HIV infection rates have surpassed those in North America and western Europe. Nearly one per cent of Russians age 15 to 49 are believed infected, compared with 0.3 per cent in Canada and 0.6 per cent in the U.S.
Most of those infected are in the country's growing community of intravenous drug users. As the main route from opium-producing countries like Afghanistan to western Europe, Russia has become a dumping ground for cheap heroin. With needle-exchange programs rare and methadone treatment illegal, HIV is rampant among drug users. In 1999, 95 per cent of cases of HIV infection were among intravenous drug users.
But that proportion is slowly falling, and experts are worried. In 2000, only 3 per cent of HIV transmissions were from heterosexual sex. In the first eight months of this year, that jumped to 11 per cent.
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