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. Last Updated: 07/27/2016

Kaliningrad: Russia's AIDS Gateway

KALININGRAD, Western Russia -- The young man sitting before the psychiatrist stared darkly at the wall and bit his lip to keep from crying. He had answered a dozen questions about his sex habits and absorbed in silence a lecture about how AIDS would change his life.

"Alexei, everything now is up to you," the psychiatrist, Oleg Petroshuk, told him gently. "If you take care of yourself, you can live a long time. I know how hard this is, but you have to believe me: Nothing ends here."

As if in answer, Alexei stripped to the waist. He has three tattoos, but the one that draws the eye covers his left shoulder. It is a skull engulfed in huge batwings. Above the wings two English words have been burned into his skin: "No Future."

Few words could apply more fully to Alexei, 23, or to this odd and lonely city, which has suddenly become the center of what many experts describe as the fastest-moving epidemic of AIDS infection in the world.

Kindled by a surge in the use of an easily contaminated liquid form of heroin, the epidemic has been driven, as anywhere, by poverty and unemployment.

But that is not why HIV, the virus that causes AIDS, is now tearing "like a forest fire through Russia," in the words of this country's chief AIDS official, Mikhail Narkevich.

In the Soviet Union, official prudishness combined with totalitarianism to keep borders closed and sexual freedom to a minimum. The AIDS virus, on the other hand, thrives on drug abuse and the open road. And since the fall of communism, both have been particularly plentiful here, in the vague borderland between Europe and Russia.

Kaliningrad is unique, but it is not alone. A special economic zone that was supposed to become Russia's Hong Kong, it has floundered economically. But its status helped ignite the interlocking epidemics of drug addiction and AIDS that are now rolling across Russia.

An isolated outpost lost between Poland and Lithuania, Kaliningrad is one of Europe's essential crossroads. The city, called Konigsberg before Germany lost it to the Soviet army in World War I, doesn't quite look like Russia, and it doesn't quite feel like Europe.

It is a giant warehouse. Everything here is cheaper than it is anywhere else in Russia. Beer and vodka are a third of what they cost in Moscow. It is the best place to get smuggled cars and discount narcotics.

There are 5,000 prostitutes on the streets in Kaliningrad, and more work in clubs and casinos. The syphilis rate, a sign of sexual activity and a harbinger of AIDS, is three times the average for Russia, and almost 100 times the rate in Germany.

After more than 15 years of an epidemic that has infected tens of millions of people around the world, there are few places on Earth where the HIV infection rate has risen more rapidly.

"All the conditions are there for a disaster," said Alexander Gromyko, the World Health Organization's regional adviser on HIV and AIDS for Europe and Russia. "And nobody is remotely ready for it. The virus has spread so fast in Kaliningrad that even the few people who are trying to do something are lost.

"I am afraid we can no longer pretend that Russia will somehow avoid the full force of the AIDS epidemic. What you see in Kaliningrad today is only the beginning for Russia."

Kaliningrad has now become the central pathway to Russia -- not just for cars or beer, but for disease as well. A year ago, just 28 people here were known to have been infected with the AIDS virus. As of Oct. 15, there were at least 1,850, a far higher proportion in this city of 400,000 than anyplace else in Europe.

From Kaliningrad, the truck routes -- and the epidemic -- head south through Belarus and Ukraine and north to St. Petersburg.

It usually takes years for a person infected with HIV to show clear signs of illness. But it only takes minutes, and a quick contaminated dose of narcotics, to become infected at the park near the Baltika Stadium.

"The thing that surprised me most about Kaliningrad," said Leo Kenny, a senior consultant for the United Nations Children's Fund, or UNICEF, "is that among dozens of drug users and prostitutes we have interviewed, not one had ever even seen a person who was sick. It has all happened that fast."


He and officials here said that in a small sample of 200 prostitutes who agreed to be tested, 85 percent were infected with HIV. A year ago the figure was less than 5 percent. UNICEF is considering establishing a major program here, in part because so many of those affected are in their teens. Today, Kaliningrad is filled with an odd mixture of fear and complacency. Ominous posters suddenly appeared throughout the city this week: "Danger AIDS," they read, going on to warn residents that a disease "worse than plague" is upon them. "In the last week alone, 30 new cases of this deadly illness have appeared among people between the ages of 18 and 30," the notice states. It then points out that every daughter on the way to a disco is under threat, as is every boy who might choose this as the day to stick a needle into his arm.

The poster suggests that if things do not change soon, the only money in the city's slim health budget will have to be spent on AIDS. "Think about your children, parents and loved ones," it ends. "Don't die of ignorance."

But ignorance -- or perhaps more accurately, denial -- is the affliction that threatens Kaliningrad today more than any other. Some people here would call it an ignorance that should never have come to pass.

"Today is 1981 in New York or San Francisco," said Dr. Oleg Mormot, referring to the dark years when the AIDS epidemic first took hold in the United States.

Mormot is director of Kaliningrad's only AIDS center, a small nest of offices tucked behind the aging edifice of the city's ancient infectious disease hospital.

The hospital itself has six HIV patients, the most it can handle right now. But because methadone use is illegal in Russia, the doctors there let them leave their beds and buy narcotics on the street once a day. Each time they leave the hospital, they take the virus back out onto the street.

"We are repeating the history in those cities as if they never happened anywhere before," Mormot said. "As if Russia can learn nothing from the West. You cannot convince a young drug addict or prostitute here that they are in danger because most of them have never seen AIDS. They have no jobs, and a shot of heroin costs less than $5. That's the reality of it. Nothing else matters."