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. Last Updated: 07/27/2016

'Elista Incident' Gives Birth to AIDS Horror

ST. PETERSBURG -- At the Leningrad Republican Infectious Disease Hospital, located in the countryside near this city of 4.5 million, many of the dynamics -- and much of the history -- driving the HIV explosion in Russia can be seen at once at a Salvation Army prayer meeting.


A 10-year-old girl demurely bows her head, a large pink bow in her hair as she prays. Beside her, a 9-year-old girl, her hair filled with carefully entwined artificial flowers, shifts impatiently in her seat. And across from them, two tough-looking men in their mid-20s nibble on the free meal, only half-listening to a Bible reading.


In all, nearly 30 people sit around a large lunch table. Ranging in age from 6 to 50, they represent a cross section of Russian society. And they're all infected with the human immunodeficiency virus.


"See little Misha over there? The 12-year-old boy?" whispers Svetlana, 32, a Salvation Army volunteer, who is also HIV-positive. "He says, 'It's OK. I'll get married when I grow up, and my HIV will go away.'"


Some of the adults in the room, like Svetlana, got HIV through heterosexual intercourse. Others -- probably the majority -- were infected through contaminated needles they shared with fellow opium users. And one, Nikolai, got the virus through homosexual sex.


But the children were all infected in Russian hospitals in a series of transmissions known within the health-care system as the "Elista incident."


While drug-related HIV can be blamed on gangsters and the region's growing pains, the tragedy that occurred in the city of Elista signifies for many a substantial rip in the fabric of basic health care.


In conversations over several months in Russia, Georgia and Ukraine, many people spoke vehemently of avoiding minor surgery and dental visits because they feared getting AIDS via reused or contaminated instruments. And physicians told of the dangers they fear in caring for high-risk patients.


The chain of tragic events known as the Elista incident began around 1982, when a Russian sailor who had worked in Africa unknowingly acquired HIV. He passed it on to his wife, and she, in turn, unknowingly infected her fetus.


In May 1988, the child was admitted to Elista's pediatric hospital with a variety of intractable infections, all with no apparent causes. The baby died soon afterward, still undiagnosed. Meanwhile, the baby's mother, now 23, began to develop the same type of unusual infections.


The mother went to Moscow for treatment, where she ran into a woman with similar symptoms, who also had lost a child at Elista. When the two mothers compared notes, they determined that their children had been in the neonatal ward at the same time and had suffered the same type of infections.


The result? Doctors finally added up the coincidences and gave both an HIV test, determining that one of the country's first HIV outbreaks was under way. A joint Russian-UN investigation later determined that by the time the last mother and child in the chain were infected in 1994, about 250 cases had occurred. The children were infected through hospital injections with recycled syringes and catheters, the mothers via bites from breast-feeding babies.


Follow-up investigations determined that the problems at Elista were not unique: Pediatric practices in hospitals, clinics and doctor's offices throughout Russia were astonishingly backward.


Healthy babies, or those suffering minor ailments, routinely received up to 300 injections yearly of vitamins and antibiotics that were given with needles used on one patient after another all day long. Babies who were very sick routinely received implants of recycled, poorly sterilized catheters.


"There was just one case to begin with," said Dr. Saladin Osmanov of the UNAIDS agency. "But the terrible medical practices were enough to create an outbreak."


The outbreak did not end at Elista, investigators said. Some of the HIV-positive babies were shipped to other hospitals in the Russian cities of Rostov-on-Don, Volgograd and Stavropol before their diagnoses were clear. Doctors in those facilities, repeating the same practices, passed the virus around their pediatric facilities, as well.


How was the outbreak tracked? It proved easy, Osmanov said: Everyone connected to the outbreak was infected with the same strain of HIV, an unusual strain known as subtype G, which had never previously made its way out of East Africa.


After Elista, Soviet authorities panicked, stepping up mandatory HIV testing to levels unheard of elsewhere, and allowing doctors to screen patients without consent. But experts on world health say this policy was a mixed blessing historically.


They could, indeed, use the testing to isolate individual infections. But since the rate of infection remained tiny, the Russians felt no pressure to follow up with an expensive infection-control effort that would have ensured adequate supplies of sterile syringes and protective equipment, not to mention extensive retraining of caregivers. That, the experts agree, did nothing to prepare the country for the maelstrom it now faces.


At a clinic in Kiev, Alexander, 46, a television repairman by trade, sits in the converted 17th-century Ukrainian monastery that serves as that country's primary AIDS hospital. He speaks of his room as his "cage," but says he appreciates the kindness of the staff.


One of the nurses, a woman who has treated HIV patients for more than two years, rolls up Alexander's sleeve and begins to take a blood sample. Although she is not wearing protective latex gloves, she uses her forefinger to apply pressure on the site of injection after she removes the needle. Then, still bare-handed, she injects the blood into a test tube, manually removing the needle from the syringe.


When her supervisor, Dr. Alla Vouk, is questioned about the incident later, she flatly denies that any of her staff ever performs blood-related procedures without appropriate precautions. Her denial is unaltered by a reporter's insistence that these events were witnessed and photographed.