The New Face Of an Epidemic

When Moscow photographer Serge Golovach decided to present portraits of beautiful women for an HIV/AIDS awareness project, he was revealing a startling truth about AIDS in Russia today -- it is quickly becoming a problem with a woman's face.

At the beginning of the AIDS epidemic in Russia, those infected were predominantly male. Unlike in much of the rest of the world, the vast majority of AIDS cases in Russia and the CIS were the result of intravenous drug use -- a behavior usually associated with men. But of the 415,000 people infected with AIDS in Russia today, 135,000 of them -- 32 percent -- are women, according to the latest figures from the Federal Consumer Protection Service. A higher percentage of cases among women can be found only in Moldova or in African countries. In Moscow, the situation is even worse. Out of the 28,000 cases of HIV registered in Moscow as of January 2008, more than a half were women -- up 14 percent from last year, according to the Moscow branch of the consumer protection service. More disturbing, most of the newly infected women are young and in their best reproductive years, from ages 20 to 29. Around 5,000 of these women found out that they were infected while undergoing blood tests as part of prenatal care.

The ongoing feminization of the AIDS epidemic in Russia will no doubt affect the health and future of the nation. An increasing number of HIV-positive children born to these women are the predictable result. But there remains the disturbing question of why more Russian women are becoming part of this epidemic. Experts say it is a result of both the changing nature of HIV transmission in Russia and changes in gender-based social norms and sexual customs. While officials say intravenous drug use remains the main way of transmitting the virus, contracting HIV as a result of heterosexual intercourse is rising. The Moscow AIDS Center's web site says 86 percent of new cases of HIV are the result of intercourse. This change suggests that HIV is now affecting the general population rather than the marginalized elements of society, such as prostitutes or drug addicts, who have long been considered at high risk for acquiring HIV.

Of course, it remains true that mass unemployment and economic insecurity in the depressed regions of Russia sometimes force women into commercial sex work, which contributes to the rising numbers of HIV-positive women. Surveys of regional Russian cities show that most sex workers are between the ages of 17 and 23 and that condom use among these prostitutes is erratic at best.

But what makes the changing situation alarming is that ordinary women are increasingly at risk in a country where sexual coercion and gender inequities are tolerated, and double standards make it acceptable for men to have multiple sexual partners. While using condoms could be a solution in many cases, condoms have traditionally been extremely unpopular among Russian men. This is especially the case among the segments of the population with lower income and educational levels, where HIV is spreading most rapidly. The economic dependency of some women on their husbands and sexual partners leaves them with little bargaining power when it comes to negotiating condom use.

"Some women suspect their husbands have many sexual partners but fear to be abandoned or beaten if they resist their husbands' sexual demands," says Maria Ivannikova, the head of the informational department of the nongovernmental association AIDS Information Service.

Viktor Ribas / for MT
Writer Maria Arbatova posing by her portrait with photographer Serge Golovach.

Since women are biologically more vulnerable to acquiring HIV, it is two to four times more likely that a woman will contract HIV from a man than a man from a woman. The explanation is that women have a large surface area of reproductive tissue that is exposed to their partner's secretions during intercourse, and semen infected with HIV typically contains a higher concentration of the virus than a woman's sexual secretions. Specialists say young women are especially at greater risk, because their reproductive organs are immature and more likely to tear during intercourse, specialists say. Women also face a high risk of acquiring other sexually transmitted diseases, which increases the risk of contracting HIV 10-fold when left untreated.

The female condom could be a solution, since it is the only safe and effective HIV prevention option available that is completely controlled by women, but at the moment the method is mostly unknown in Russia. And even when women are familiar with female condoms, they have a hard time finding them. Pharmacies do not stock them because of their relatively high cost and a lack of demand, according to Igor Peskarev, the director of Humanitarian Action, a UNAIDS partner NGO in St. Petersburg.

"You may find women's condoms only in sex shops in our city, and the price will be around 3 or 4 euros, more than 100 rubles. It's relatively expensive for a one-time use item," he said.

Microbicides, which can be applied in the vagina for the prevention of HIV and other STDs, are still in the developmental stage, although Russian scientists are working along with others around the world to develop an effective one.

Every day, more than 100 new cases of HIV appear in Russia, and if current trends continue, women will soon make up a majority of the victims. And the fact that Russia is currently in the midst of a serious demographic crisis compounds the problem. According to data from the Center for Strategic and International Studies, the combination of falling birth rates and rising death rates from chronic and infectious disease means that by 2025, Russia's population will fall from about 144 million to about 125 million. Add to that 5 million to 15 million excess deaths from AIDS, and the country may lose 20 percent of its citizens over the next 20 years.

In an attempt to raise awareness of this problem and help lift the stigma of people with AIDS, UNAIDS recruited 25 famous women from Russia and Ukraine who agree to be photographed. By displaying the photographs of women who are well-known and in the news, the organization hopes encourage both public and private discussions about HIV/AIDS, particularly among women. The exhibit, which will run for two weeks in Moscow, will then tour the country, and a selection of the photographs will be published as a 2009 calendar to be launched on Dec. 1, World AIDS Day.

The photo exhibit "Stars Against AIDS" opened on May 15 and will run until May 29 at Stella Art Foundation, 7 Skaryatinsky Per., M. Barrikadnaya, 291-3407,