AIDS Program Reaches Out to Prostitutes

MTRadik Gubaidullin, a Simona doctor, displaying images of patients with STDs.
KAZAN -- Alfia Novikova nears the women selling themselves by the side of the road. "Is Lena coming today, the chubby one?" Novikova says. "Tell her I have her HIV test results, and she's clean."

Novikova hands out condoms, brochures and business cards from Simona, the health center where she's the administrator.

As the nation's first full-service center for prostitutes -- providing medical, legal and psychological care -- Simona is breaking new ground in a country reluctant to confront AIDS head-on.

The center has a decidedly Western bent, reaching out to heroin addicts moonlighting as hookers and their pimps.

Many patients lack the insurance or documents to go to a regular clinic. They pay nothing for the services, and they enjoy anonymity.

And when they come into the four-room clinic, housed in a center for dermatological and venereal diseases, they are treated like human beings. No one tries to arrest or lecture them; no one is looking to abuse them. Coffee, tea and cookies are readily available.

"Here, doctors work not as they would with regular patients, but rather, with an eye toward encouraging safer behavior," said Yulia Kuznetsova, who oversees the clinic at AIDS-Infoshare. AIDS-Infoshare is a Moscow organization that has been working with prostitutes, drug users and homosexuals for a decade.

Simona has two kinds of clients: the prostitutes employed by escort agencies and the streetwalkers.

On her most recent trip to the city outskirts, a trip she makes four times per month, Novikova met 14 streetwalkers.

The prostitutes are stationed along the road in groups of two and three. There's a rhythm to their work: The cars slow down, the drivers haggle with the girls, the girls get in the cars, the cars drive away. Later, the girls emerge from the cars farther down the road, a few hundred rubles richer.

As Novikova doles out her materials, a young woman in black pants and a black, zip-down sweater runs up to her, a silver SUV waiting nearby. "What's he want?" another young woman asks. The first replies: "A blow job for 300 rubles." She gets her condoms and scurries back to the SUV.

Nearly all the women who work the street are drug addicts and only service enough clients each day to get one dose, or fix, of heroin, Simona employees say. The prostitutes do not disagree.

"We're all addicts here," said a young woman wearing bright pink lipstick and pigtails. "This is the only place where we can make money honestly, without stealing."

Most women Novikova meets have heard of Simona, though not many have visited. One said she wanted to visit sometime, because she'd heard of the cordial treatment at the center.

Novikova asks the women to fill out a short questionnaire testing their knowledge of HIV. She routinely answers a barrage of questions: Can you really help me get a hospital stay? What if I don't have a passport? Can I come get tested and bring my husband, too?

Anastasiya Lebedev / MT
Alfia Novikova, left, dispensing condoms, brochures and business cards to streetwalkers selling their wares in Kazan.
Novikova eyes a woman whose face is covered with reddish scabs. "What's that on your face?" she says. "You've got something." The woman cheerfully waves her off, saying it's nothing.

The scabs look suspiciously like those in the photographs that Radik Gubaidullin, one of Simona's two doctors, likes to show patients. The photographs -- depicting ulcers, rashes, scabs and other disfigurations -- are all of patients he's treated with sexually transmitted diseases.

"Girls who've worked the road for ten years look at these, and their eyes pop out," Gubaidullin said. "They get a completely different understanding of these diseases."

After they learn that some sexually transmitted diseases, or STDs, can also be transmitted orally and that a few, including syphilis, can be transmitted through everyday contact, some women bring in their children to be checked out, he said.

The center's work has been greatly helped by the cooperation of Tatarstan health officials. The republic provided Simona with its facilities, doctors and free STD tests.

"What's most critical for us is that infections spread no further," said Guzel Vafina, a doctor employed by the republic at the STD and venereal disease clinic where Simona is housed.

Tatarstan authorities have been looking to curb HIV infection rates among prostitutes for 15 years, Vafina said. While there is no official data, she said, unofficial estimates put the number of prostitutes at 1,500. She added that the rates of STD infection among prostitutes are exponentially higher than those in the general public.

Still, Simona has confronted some trouble with the police. Even though the higher-ups are generally supportive of the center, cops on the street have sometimes given the center's employees a hard time when they try to meet with prostitutes.

There has also been some trouble prodding pimps into sharing information about the center.

While pimps have been eager to get their prostitutes treated, they have been less eager to let other pimps know about Simona, marketing their women as safer than those at other escort agencies.

"One guy told me, 'I'm not telling the other agencies about it. Let their girls get sick and mine stay healthy,'" said Svetlana Kochetkova, the center's deputy director. "So coming here actually gives them an extra competitive edge."

The center nevertheless has managed to reel in many patients. Since opening at the beginning of this year, Simona has seen 150 patients, has had 252 visits total and has distributed more than 11,800 condoms.

One of the center's most effective patient recruiters has been a former male prostitute, Artyom, Novikova said. Artyom, who declined to give his surname, has brought in 37 of the center's patients.

Artyom also gives prostitutes seminars about AIDS prevention and handling dangerous or disagreeable clients.

Even though getting prostitutes to find other, safer work is not one of the center's stated goals, many have quit after coming to Simona, Kochetkova said.

Liza, who would only give her street name, came to Simona to get tested and to get help in starting drug rehab. She could have gone to rehab on her own, she said, but that would have meant registering as a drug addict, which could hamper her job prospects later.

Simona offered critical information that, she said, wasn't available so long ago. "I don't understand people who began injecting two or three years ago," Liza said. "There's so much information about drugs now. And back then we didn't know anything."