The New York Times

Wednesday, November 24, 1999

Needle Use Sets Off H.I.V. Explosion in Russia

By MICHAEL WINES

MOSCOW -- Needle sharing among intravenous drug users has set off an explosive increase in HIV infections, with the number of new cases reported in Moscow so far this year more than four times greater than in all of 1998, the World Health Organization said Tuesday.

The U.N. agency's principal AIDS expert in Russia, Arkadiusz Majszyk, said the sharp increase was quite likely to continue for at least two or three more years, spreading to sexual partners before it levels off.

"It's a real epidemic picking up," Majszyk said in an interview Tuesday. "A critical mass of injecting drug users is coming to the picture, and because of this, one or two cases of HIV" -- the virus that causes AIDS -- "coming from outside the region is enough to start a very quick wave" of infections.

The total number of Russians officially registered as HIV-positive -- 23,509 -- remains low, Majszyk said, and only 445 deaths from AIDS have been reported nationwide. But the Russian government estimates the actual number of HIV cases at five times the reported number. Majszyk added, while, as a rule of thumb, Western specialists generally use a factor of 10.

Whatever the true number, he said, the steep rise in the rate of infection is alarming -- and sometimes astounding -- all by itself.

So far this year, the WHO report states, 12,425 new cases of HIV infection have been recorded in Russia -- an increase of 358 percent over the total for all of 1998, and more than the total number of cases reported in all preceding years.

The Moscow region recorded more than 4,000 new cases so far this year. In Irkutsk, a city of some 670,000 buried deep in southern Siberia, the number of reported cases leapt from 68 as of last January to 2,191 today.

Three-quarters of the reported infections occur among men, the report states. The greatest rate of infection is among people between the ages of 18 and 25. Improved reporting methods may account for a small portion of the increase in known cases, Majszyk said. But the evidence points overwhelmingly to an epidemic borne by drug addicts, who he said comprise about 90 percent of the new cases.

Nobody knows the true number of drug users in Russia, a nation of 146 million people, but experts place the total at about 2.5 million, with 2 million of them needle users. HIV can be spread among drug users not just by sharing needles, but by methods used widely in the former Soviet Union to prepare drugs for injection, which can contaminate the drug solution.

The WHO report states that the rise is equally alarming in Ukraine and parts of eastern Europe, where drug use and prostitution have promoted the spread of HIV.

Majszyk said he bases his projections of a widening epidemic in part on the experience in Kaliningrad, a tiny, disconnected outpost of the Russian Federation located on a Baltic Sea peninsula north of Germany. Poverty-stricken and isolated, Kaliningrad suffers a serious drug-abuse problem, which early on encouraged the spread of HIV.

It is being increasingly transmitted by prostitutes, or "commercial sex workers" in UN parlance. Half the region's prostitutes are HIV positive, Majszyk said, including 9 in 10 of those work who work on the streets. "The second group and second wave, which will come very soon here, is heterosexual transmission," he said.

"It will go for the next two or three years because the main measures which should be taken are connected with prevention," he added. "And prevention, to work, needs time."

Majszyk said the Russian government is awakening to the scope of the HIV problem and that officials are preparing an intensive effort, involving seven government ministries and 12 populous regions, to raise public awareness of the epidemic.

The spokesman for the Russian Ministry of Health and a press officer in the ministry division that deals with AIDS declined to comment Tuesday on the report, which they said they had not seen.

An accurate accounting of the nation's HIV problem, they said, must await a government news conference next week.