#5 - JRL 7276
Newsday
August 4, 2003
Generation Afflicted
HIV spreads quickly in Russia, particularly among the young
By Liam Pleven
RUSSIA CORRESPONDENT
Togliatti, Russia

The poster reads like the roster for a high school reunion, yet the top line explains why nobody named below - Vovka, 27, Andryukha, 21, Tanya, 26 - will ever make it to the party: "They died from drugs."

Svetlana Terentyeva survived. But years of shooting up heroin and other narcotic cocktails in this bleak factory town landed the 28-year-old mother on another grim list, of Russians with the virus that causes AIDS.

It was a short list a few years ago, when the diagnosis led Terentyeva to end a pregnancy. "What's the point of giving birth to a baby who would die 10 years later, or even sooner?" said Terentyeva, who had her first child at 18, though she doesn't look much older than that in her light blue coat and jeans, a plain metal barrette clasping light brown hair.

But since the start of 2000, the number of registered HIV cases in Togliatti has leapt from 16 to about 8,300 - more than 1 percent of the city's population - and many belong to what one local called the Lost Generation. More than 80 percent of Russians known to carry the virus were diagnosed between ages 15 and 29, a proportion more than twice that of Western Europe and the United States.

HIV in Russia, in other words, mostly afflicts the young. In a country where the population is declining and the economy is struggling to its feet, the deadliest virus of this era is overwhelmingly concentrated among the people most essential to solving those problems.

"A part of that young generation - and everyone knows they're a strategic resource for any country - the prospects for them are very grim," said Elvira Zhukova, Togliatti's deputy public health director.

Togliatti is scrambling to contain the damage. Svetlana now works out of a city-run needle exchange center that holds the roll call of drug deaths, and travels the city distributing clean syringes to junkies and giving prostitutes condoms that don't burst as easily as the cheap sleeves sold in street kiosks.

But Russia is likely to suffer the consequences of its AIDS epidemic, one of the fastest growing in the world, for years. While President Vladimir Putin has called for doubling the gross domestic product over 10 years, a World Bank study predicted that HIV and AIDS could shave off half a percentage point of any growth annually by 2010.

Yet even as much of Russia's future lines up to die prematurely - half a percent of Russians ages 15 to 29 are infected with HIV - the crisis draws little attention. Putin made only a passing reference to AIDS in his annual state-of-the-nation address this year. And when he fielded roughly four dozen questions in a nearly three-hour news conference recently, not one focused on HIV.

The epidemic burst among young Russians in large part because of a wave of drug abuse following the collapse of the Soviet Union over a decade ago, and the wave hit Togliatti hard. Named after an Italian Communist and built up starting in the 1960s with the construction of a massive car factory - General Motors launched a joint venture in the city last year - Togliatti is marked by rows of uniform apartment blocks.

As an industrial center, Togliatti is relatively well-off by Russian standards, locals say. And disposable income - along with the city's location, about 600 miles southeast of Moscow, along a drug-smuggling route between Central Asia and Europe - helps explain why drug use spread so rapidly.

And deeply. A 2001 study led by Togliatti officials and University of London researchers concluded that 56 percent of the city's intravenous drug users were HIV-positive, and about three-quarters of those infected didn't know it.

As elsewhere in Russia, HIV is also spreading increasingly through sex. "Because they are so young, they tend not to have regular partners," said Henning Mikkelsen, the coordinator for Europe for the United Nations' AIDS agency, UNAIDS. "That's why we have such a fast growth."

A Togliatti native, Terentyeva was married and a mother while still a teenager and divorced before she turned 21. She worked in an assortment of jobs - stints as a sales clerk and a waitress - and, in the 1990s, started doing drugs.

Terentyeva believes she got the virus from sharing a needle at a party attended by a man who later tested positive in prison. Heroin is a favorite in Togliatti, but homemade concoctions are also popular, drugs with names like "jeff" and "vint" and "hanka," the last made from opium and, Terentyeva said, sometimes cut with ground-up bricks.

"And we were stupid enough to inject it into our blood. My dirty blood," Terentyeva said.

Following one days-long marathon on vint, an ephedrine derivative that stirs up strong sexual urges, Terentyeva ended up in a hospital, hallucinating. "I couldn't recognize my mother," she said. "I saw devils."

But HIV wasn't a major concern. "Before 1998, we didn't have an HIV problem here. Maybe there was one guy," Terentyeva said. November 1999 - around the time when Terentyeva tested positive - was the first time city officials recorded more than one infection in a single month.

The diagnosis came as a shock. "They were looking at us like we were wild animals," she said of workers at the facility where she got her test result. Doctors induced labor five months into her pregnancy.

"I lost my child because I didn't know anything," said Terentyeva, whose mother helps care for her previous child, a 9-year-old daughter who is HIV-free, in a nondescript apartment complex not far from Terentyeva's own.

"At that time, there was no antiretroviral therapy," said Terentyeva, and without such medical intervention to reduce the risk of passing on the virus, it didn't seem possible to her that her new baby would emerge uninfected.

And at first, Terentyeva started using drugs more and more. "I didn't care about my life," she said. "I told everybody I had HIV - I had my own needle, and I told everybody they should be careful."

But the cycle of drug abuse - chasing after cash, shooting up, crashing down - soon proved unbearable, and then a doctor told her that by shedding drugs and alcohol, she could live longer, even with HIV. She checked into a hospital again and stayed for 21 days.

That proved to be the turning point. By March of 2001, Terentyeva found a job with the city of Togliatti as part of a team of outreach workers passing out free needles and condoms, and she later worked on the study co-led by researchers from the University of London.

The local lingo - heroin is buckwheat, and a syringe is an accordion - is familiar to her, just like the spots along Moskovsky Prospekt where prostitutes might be working, even on a day of persistent rain.

When one woman emerged from a car that pulled up at the curb, Terentyeva and a fellow outreach worker dashed through the wet weeds to give her needles, condoms, sanitary wipes and vitamins. They had only a few brief moments to make the handoff before another car pulled up and the woman disappeared again.

"If you're not quick enough, she's gone," Terentyeva said.

Terentyeva guessed that the woman was 27 or 28 and might have HIV. "If she's a drug addict, it's very possible. And she's a drug addict. You can see that."

Terentyeva now favors cigarettes and beer, and she said she doesn't shoot up anymore or spend too much time worrying about the virus in her veins. "The doctors themselves say the less you think about it, the better," she said. "For the next 10 years, I can avoid thinking about it."

Striking Russia's Young

Young Russians are being hit particularly hard by the AIDS epidemic, with more than 80 percent of the people known to carry the virus having been diagnosed between the ages of 15 and 29. By comparison, about one-third of HIV-positive Americans are in a similar age group. The statistics below include those diagnosed with HIV, but exclude those already diagnosed with AIDS and show just how different the demographics of HIV are in the two countries:

United States

Total population 288.4 million Total infected 174,017*

Through December 2001

Russia

Total population 144 million Total infected 228,245

Through December 2002

Ages Number of HIV infected / (Percentage of infected population)

United States 0-12 3,923 (2.3%)

Russia 0-14 5,712 (2.5%)

United States 13-29 59,178 (34%)

Russia 15-29 186,379 (81.7%)

United States 30-49 99,079 (56.9%)

Russia 30-49 34,188 (15.0%)

United States 50-64 10,429 (6%)

Russia 50-69 1,798 (0.8%)

United States 65 and older 1,408 (0.8%)

Russia 70 and older 168 (0%) (less than one-tenth of 1 percent)

*Includes only data from parts of United States that have confidential HIV reporting. Also excludes nine cases where the sex of the person infected is not known.

Newborn Vulnerability

As Russia struggles to reverse a decline in its population over the past decade or so, the spread of HIV among women of child-bearing age is showing up already. The number of children born to HIV-infected mothers in Russia last year was 10 times higher than the number four years ago.

Children born to HIV-infected mothers

1999 211 of 2.1 million births

2000 390 of 2.2 million births

2001 1,139 of 2.3 million births

2002 2,777 of 2.3 million births

SOURCES: U.S. Centers for Disease Control and Prevention, U.S. Census Bureau; Russian Federal AIDS Center, Russian State Statistical Committee