Pubdate: Mon 24 Apr 2000
Source: New York Times (NY)
Copyright: 2000 The New York Times Company
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Author: Michael Wines

HEROIN CARRIES AIDS TO A REGION IN SIBERIA

IRKUTSK, Russia, April 22 -- Thirteen months ago, a young man from this 
city's rough-and-tumble north side appeared at the government railroad 
workers' hospital complaining of a head wound suffered in a family fight. A 
blood work-up soon showed that it was the least of his problems: he was 
also infected with H.I.V., the virus that causes AIDS.

That was unusual. In the entire Irkutsk region, a Siberian expanse big 
enough to accommodate France and England in one gulp, health officials had 
recorded fewer than 200 H.I.V. infections since record-keeping began in 1991.

But when a second north-side man checked into another hospital for an 
operation a few days later, only to test positive for H.I.V., the officials 
decided to investigate.

What they found is still resounding through Irkutsk, a run-down river town 
of 650,000 just north of Mongolia. The two men, it turned out, both 
attended Vocational School 44, a training institute for river transport 
workers. Further tests uncovered six more H.I.V. cases among their classmates.

All eight shared another deadly trait: they were addicted to heroin, which 
first appeared in the city's drug subculture only six or seven months earlier.

Today a region that hardly heard of AIDS a year ago has recorded 5,000 new 
cases of H.I.V. infection and registered more than 8,500 drug addicts. 
Those are the official statistics: the true figures could be as much as 10 
times as great, officials say.

Perhaps nowhere else in Russia have H.I.V. infections grown so explosively. 
Heroin has proven the deadly catalyst in this epidemic. It has fueled a 
sharp rise in drug use and encouraged the needle sharing that helps to 
spread AIDS.

"It's a fire there," Arkadiusz Majszyk, the United Nations AIDS 
representative in Russia, said this week. "And nobody is paying attention."

If it is a fire, then the rest of Russia is surely smoldering. The number 
of H.I.V.-infected Russians is small so far -- 33,000 by official 
estimates, perhaps 300,000 by international ones -- but the potential for 
growth is huge.

The United Nations, which joined Russian officials on Friday to announce a 
new effort to halt the epidemic, says the virus's spread is accelerating 
and could move beyond drug users without preventive measures.

Already 40 per cent of Russian prostitutes, who often use drugs, are 
H.I.V.-positive. The growing prevalence of venereal diseases like gonorrhea 
make sexual transmission of the virus even easier.

And with the poverty and general breakdowns of law and mores that followed 
the Soviet Union's collapse, prostitution and drug use are thriving.

"The second wave of infection, which will come very soon, is heterosexual 
transmission," Mr. Majszyk said in an earlier interview. "It will go for 
the next two or three years, because the main measures which should be 
taken are connected with prevention. And to work, prevention needs time."

Time is in short supply in Irkutsk. Heroin and H.I.V. have already 
penetrated virtually every corner of this vast region, a farrago of 
pristine forest and permafrost, dying company towns and smoky industrial 
cities.

Heroin has surfaced in Bodaibo, a mountain-ringed gold mining outpost 
reachable only by small plane, and in Ust-Kut, a northern river port whose 
shipping business has all but dried up. There is H.I.V. in Mama, a moribund 
mica mining village some 400 miles north of here, and in Bratsk, a 
good-sized manufacturing center far down the north-flowing Angara River.

The Irkutsk region is home to about two million people. Simple math says 
the rate of H.I.V. infection is somewhere between 1 in 40 and 1 in 400.

"But you really have to measure it against the number of youth," because 
drug use and H.I.V. are largely confined to the young, said Yelena A. 
Lyustritskaya, who heads a government commission on drug abuse. "And in the 
Irkutsk region there are 300,000 people between the ages of 14 and 28. So 
it turns out that every third or fourth young man at age 18 or 20 takes drugs."

No one knows the infection rate among those users. But Dr. Maksim Medvedev, 
who screens addicts for a private rehabilitation program called Siberia 
Without Drugs, says roughly 3 of every 10 people he examines have the AIDS 
virus.

At the government's principal rehabilitation center, 40 of the 62 
inpatients are infected with H.I.V. Talk to some of the current and 
reformed addicts at that center, a tidy, but rundown and cheerless place, 
and those numbers do not seem so outlandish.

"We used to be the department for glue sniffers," one of the center's 
doctors said. "There is only one sniffer here now. There are no alcoholics. 
They are all drug addicts."

A buzz-cut 16-year-old who moved from opium to heroin said he believed that 
he had gotten H.I.V. by sharing his needle late last year. One 17-year-old 
with H.I.V. and hepatitis, who began using opium at 15 and switched to 
heroin about six months ago, offered a common theory to explain the 
epidemic: outsiders salted the heroin with the ground-up bones of African 
AIDS victims.

"The countries that supply us don't have anything, only fruits," he said. 
"Siberia's rich, and they want everybody here to die."

Natalya Kozhevnikova, a 27-year-old from a small diamond-mining town, said 
many addicts there began using drugs at ages 12 or 13. "There is nothing to 
do -- no movie theaters, no discos, nothing," she said.

Lelia Starodumova, 23, was a swimming champion and model before she started 
opium four years ago. Now she and her husband are heroin addicts, and she 
carries H.I.V. "Ninety-nine percent of drug addicts have H.I.V.," she said 
blandly. "The only ones who aren't sick are the ones who haven't had their 
blood tested."

In a bleak two-room apartment across town, opposite the ramshackle factory 
that produces Russia's top fighter jet, the Su-30, Andrei Kurnosov, a 
30-year-old addict, said he had been on drugs for nine years.

When he began, he said, he was among the top five in his law class, aiming 
for a chance to study in the United States. Now he practices petty thievery 
and rolls small-time drug sellers for the 150 rubles -- about $5 -- he 
needs daily to finance his habit.

Mr. Kurnosov says he has avoided H.I.V. through blind luck. He has shared 
needles with other addicts, the last time three months ago, although he 
knows the dangers full well. "You don't care when you need a dose," he 
said. "The fear of remaining sober and in pain overwhelms any fear of 
sickness."

Heroin's death grip on its victims offers some explanation of why H.I.V. 
has raced through Irkutsk's addict population. Opium, whose less insistent 
craving grants a user some time to find a clean syringe, once was the drug 
of choice. But unlike heroin, which needs only water

to be injected, opium must be carefully cooked and mixed.

So when heroin suddenly appeared some 18 months ago, addicts switched en 
masse. It first came in liquid form -- in bottles or already-loaded 
syringes -- and groups of users foolishly filled their syringes from the 
same bottle, raising the odds that one infected addict would contaminate 
many others.

Today heroin comes as a powder wrapped in paper "checks," Russian slang for 
the cash-register tapes that they resemble. Fifty-ruble and 100-ruble 
checks are sold almost brazenly, from newsstands and bread kiosks and by 
loitering dealers, in any number of open-air drug markets around town.

Addicts say many police officers have been bought off, and they may be 
right: in one muddy north-side market named Treity Posylok, or Third 
Settlement, a militia jeep cruised past knots of dealers and addicts twice 
in 10 minutes one afternoon this week.

The police, meanwhile, say the heroin trade is ballooning despite their 
best efforts to stop it. The drug comes by truck from Afghanistan and 
Tajikistan, far to the west of Irkutsk, and is distributed throughout 
Siberia from the southern Russian city of Novosibirsk.

Irkutsk's militia seized about 400 pounds of drugs last year, well ahead of 
previous years but a pittance in comparison with the total traffic. 
Smugglers vacuum-pack heroin or hide it in shipments of rotting onions to 
deter drug-sniffing dogs.

More and more, the trade has shifted from individual free-lancers to 
organized crime.

"It's difficult to control the flow," the deputy chief of the eastern 
Siberia militia, Pyotr Kobalchok, said this week. "We've even arrested 
members of the Tajikistan special services who were escorting the 
smugglers. It's that well-organized."

Beneath such frustration over Irkutsk's plight runs a subtle but pointed 
undercurrent: this region never had such problems when the Soviet Union 
existed. Addiction and AIDS are among the consequences of freedom and 
capitalism that Westerners neglected to mention when Communist rule ended a 
decade ago.

Law-enforcement officials unanimously blame the drug problem on the opening 
of Soviet borders and the loosening of government control over ordinary people.

"Back then, there were no charter flights," said Nikolai Pushkar, chief of 
the eastern Siberia transport militia, which battles drug smuggling. 
"Everything was state-owned, and it wasn't possible to negotiate with the 
state. In the past only the president could have his own plane. Now anyone 
with money can have a plane.

"No matter how much we criticize the Soviet system, there was a certain 
ideology. We were educated in an absolutely different way. Of course, there 
were abuses when the state interfered with family life. But there were 
standards then."

Irkutsk has declared its own war on both of its epidemics, hiring new 
narcotics police, printing educational brochures and changing the school 
curriculum to promote what officials call "the healthy way of life." But 
beyond telling people to just say no to drugs, officials have done little 
to prevent the spread of H.I.V. among addicts and have no immediate plans 
to do so.

Proven AIDS preventive measures, like providing drug addicts with sterile 
needles or bottles of virus-killing bleach, remain on the drawing board -- 
in part, some critics say, because politicians believe that they amount to 
an endorsement of drug use.

"We had contact with different people last year, including people from 
foreign countries where such programs are implemented," Dimitri Piven, the 
Irkutsk region's deputy head of health care, said in an interview this 
week. "Since there are different schemes, we are choosing an optimal one 
for ourselves." Mr. Piven said officials would try to put new preventive 
measures into effect among addicts before year's end.

The addict Mr. Kurnosov, his gaunt, rheumy face a contrast to hands swollen 
grotesquely by repeated injections, said that would be too late for many 
addicts. For many others, it already is.

"The generation of the 70's is dying," he said. "The generation of the 80's 
is already dead -- not all, not 100 percent. But 50 percent are killing 
themselves before a natural death."
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