Russia Sees an AIDS 'Explosion'
Government Slow to React To Five Years of Warnings
By Peter Baker
Washington Post Foreign Service
Sunday, June 13, 2004; Page A01
IRKUTSK, Russia -- Andrei Artyomenko can pinpoint the day he believes he became infected. He was 21 years old, a product of a broken family, a school dropout, a junkie living in this Siberian city. By his own account, he looked awful, wearing dirty clothes and weighing just 128 pounds. His mother wouldn't let him come home because he kept stealing from her to pay for his habit.
One day he and a friend retreated into the darkened stairwell of a nine-story apartment building where no one would bother them. "He had just one syringe," Artyomenko recalled. "He warned me. He said, 'I'm not sure, but I think I got bombed,' " meaning infected. But the warning went unheeded.
"All I could think about was the needle," Artyomenko said. "I had to have it."
That spring of 1999 would introduce HIV not only into his own veins but into the Russian national bloodstream as well. It was the spring of "the explosion," as it is called here, the spring this remote Siberian outpost suddenly was no longer so cut off from the rest of the world.
As Afghan liquid heroin arrived, so did AIDS. When a student from a technical school tested positive for HIV, the virus that causes AIDS, panicked local officials began checking his classmates and discovered a hidden epidemic that was just beginning to break out in other cities and would transform Russia.
In the five years since, the country's leadership has done little to stop the infection as it has raced across the country. While international organizations are now rushing to offer assistance and holding back-to-back conferences on how to address the problem, President Vladimir Putin has mentioned AIDS only once in a major speech to the Russian people and then only in a fragment of one sentence. There was no reference to AIDS in his state of the nation address last month.
Russia once was largely free of a disease ravaging the United States, Europe and Africa, but the rate of infection in recent years has been growing faster here than anywhere else in the world, according to the United Nations and other international organizations.
A country that had just a few thousand HIV-positive people before 1999 now has more than 280,000 officially registered cases, and U.N. and Russian experts estimate that 1 million Russians actually have the virus -- more than in the United States, which has twice the population and a much longer history of the disease. Proportionately, the virus has infected six times as many people in Russia as in China, according to current statistics.
Now the infection has broken out of Russia's drug-using community into a society with hidden sexual promiscuity that no one likes to talk about. And with the state still not providing antiretroviral treatment to people like Andrei Artyomenko, the first generation of people infected will soon start dying off in large numbers.
The death toll remains small by the standards of sub-Saharan Africa, where close to 20 million people have succumbed to AIDS. But by 2010, under the most optimistic World Bank forecast, 250,000 Russians will be dying as a result of AIDS each year; under the most pessimistic scenario, the annual toll will reach 650,000, more than all those who have died with AIDS in the United States since 1981.
In Russia, AIDS is striking the world's only major nation where the population is already falling so drastically. Even before AIDS became a factor, the death rate in Russia had soared far beyond the birth rate, reducing the population faster than in any other major industrialized nation in the world. For every 100 babies born in Russia today, 173 people die. The population has already fallen by 5 million since the collapse of the Soviet Union 13 years ago, to 145 million, and government forecasts say it will fall to 102 million or, in the worst case, 77 million by 2050, without accounting for AIDS.
The reasons are myriad. Russians drink more, smoke more and commit suicide more often than practically any other people on earth. They suffer from some of the world's highest rates of heart disease, accidental death, tuberculosis, hepatitis and syphilis. The average lifespan for a Russian man recently fell to 59, below that in Bangladesh, Guatemala or Bosnia.
The advent of AIDS in such an environment threatens to swamp a health system that is already in crisis and, according to some experts, poses a long-term threat to Russia as a nation. The people the disease will afflict will be predominantly young men and women in their child-bearing years, the backbone of a dwindling labor force and the hope for replenishing the population.
"The totality of all this is . . . potentially devastating for the society, economy and social stability," said Murray Feshbach, a specialist at the Woodrow Wilson International Center for Scholars in Washington. Or as Steven L. Solnick, director of the Moscow office of the Ford Foundation, put it, "If you don't stop it now, it'll destroy the country."
© 2004 The Washington Post Company
Rosa Varnakova, head of a clinic that houses 48 abandoned HIV-infected children in Irkutsk, Russia, holds up an infant born to an HIV-positive mother.
(Peter Baker -- The Washington Post)