As Vladimir Putin proudly shows off his holiday vacation spot – Sochi – to the world and proclaims it clean, safe, and accepting of homosexuals (“just don’t tell the kids”); there is a considerably darker side to Russia that he would very much like the outside world not to know about. As Bloomberg reports, hidden from the outside world and abetted by policies that critics say promote infections rather than curbing them, the HIV scourge plaguing Russia is one that even the poorest countries have begun to subdue. With an estimated 2.4 million users of injected drugs and 1.3 million of Putin’s countrymen with the life-threatening virus that causes AIDS; among the top 20 global economies, only India, with a population almost nine times bigger than Russia’s 143 million, has more people living with HIV.
At the root of Russia’s woes is an unchecked outbreak among addicts: 21 percent of the world’s HIV-positive injecting-drug users live in the country, compared with 15 percent in the U.S. and 10 percent in China, the UN Office on Drugs and Crime says.
Russia’s surging epidemic runs counter to the global trend. Worldwide, annual HIV infections dropped by almost a third to 2.3 million in 2012 from 2002.
Russia trails in curtailing HIV infections because it forbids or refuses to fund approaches that have worked elsewhere, says Michel Kazatchkine, the UN secretary-general’s special envoy on HIV/AIDS in Eastern Europe and Central Asia.
The country bans methadone, a treatment the World Health Organization recommends to curb heroin use and thus prevent infection from contaminated needles, under a 1998 law that prohibits addictive drugs.
“There is a climate of suspicion about everything that comes from the West — and the U.S. particularly,” Kazatchkine says. “I don’t see much progress coming in Russia unless it changes quite radically. It’s so shocking. The nation’s HIV policies result in death and suffering that could be avoided.”
Instead of funding heroin-substitution and clean-needle programs, Russia is trying to curb HIV with measures designed to fight drug use and addiction.
Pokrovsky, the Russian AIDS center director, disagrees. He says anti-drug efforts don’t stem HIV… efforts to stop heroin abuse in the 2000s prove his point. A government crackdown pushed addicts onto intoxicants such as krokodil, which users inject more frequently than heroin, increasing infection risks. The concoction is based on the pain reliever codeine mixed with gasoline, iodine, acid and phosphorus, according to the New York State Office of Alcoholism and Substance Abuse Services.
Russia has also stymied international aid groups that fight HIV.
“Suddenly, everything was wrong,” recalls Cantau, who says the challenge was ideological, not medical. “Everything that the Global Fund had supported was not good; harm reduction didn’t work. We ran into a closed door.”
Putin enraged AIDS and gay-rights activists in June when he signed a law that prohibits distributing to minors “propaganda” on homosexuality. While no more than 2 percent of reported HIV cases in Russia originate from gay sex, the law will make it harder to prevent infections among gay men, Pokrovsky says.
As the following graphic images suggest:
“The situation is really serious,” Pokrovsky says softly. “We have no effective prevention measures. We can only expect the most negative scenario.”
On the outskirts of Yekaterinburg is a grim illustration of the unchecked consequences of Russia’s AIDS epidemic: a hospital on Kamskaya Street for HIV and TB patients that locals call the Last Way.
“It doesn’t have this name for nothing,” says Ivan Zhavoronkov, a consultant with local charity Chance Plus. “Every day, someone dies.”
A drug user prepares a batch of krokodil in the Russian city of Yekaterinburg.
Irina Maptynenko, an HIV-positive drug user in Ukraine, shows a wound from injecting krokodil.
Russian youth watch television in a rehabilitation center in Yekaterinburg called City Without Drugs.
Ruslan Rotar became addicted and infected with HIV in Russia. He fled to Ukraine in 2012 to seek treatment
So, while Putin assures the West that Russia is all fresh pow-pow and snow-bunnies… it appears reality is somewhat different.