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. Last Updated: 07/27/2016

The Crisis to Come

Almost 20 years have passed since AIDS was first identified. Since then, almost 14 million people worldwide have died from the disease. A further 33 million are believed to be living with HIV, the virus that causes AIDS. Life expectancy in some African countries has fallen by 20 years as a result of AIDS. In Zimbabwe, for instance, life expectancy has fallen from 65 years to 43 years — less than it was at the beginning of the 20th century. In South Africa, there are estimated to be 1,500 new infections daily, and in India 4 million people are HIV-positive. A recent UN report on AIDS in Africa noted the cost of treating victims, the loss of workers to the disease and restrictions on outside investment will restrict economic growth on the continent for decades ahead.

And now, on World AIDS Day, it appears such a crisis is looming for Eastern Europe and the former Soviet Union. In Russia, the growth in the number of HIV carriers has been alarming. In 1998, there were 15,569 officially registered cases. This month, Deputy Health Minister Gennady Onishchenko reported that the number had risen to more than 70,000. However, the actual number of cases is estimated to be between 300,000 and 400,000.

Earlier this year, the government declared AIDS an "epidemic," and in September, a United Nations representative in Moscow, Philippe Elghouayel, said Russia now has the highest HIV infection rate in the world. If current trends continue — and without concerted action, they certainly will — Russia will begin the new century crippled by the overwhelming social and economic costs of one of the world’s worst AIDS epidemics.

The solution to Russia’s AIDS crisis involves more than just money, although the amount of resources devoted to meeting this challenge is ludicrously inadequate. The government’s anti-AIDS program, which was designed more than four years ago, only began receiving funding last year. This year it received just $1.5 million, or 20 percent of the amount budgeted.

Just as important as the amount spent is the way it is spent. The solution to the AIDS crisis lies in honestly confronting many of society’s most vexing problems — drug use, prostitution, teenage sex and others. "We are living through a severe crisis of traditional values and a mistaken acceptance of a new culture that is influencing the younger generation," says Dr. Irina Savchenko, a leading AIDS researcher. "Social circumstances are extremely unstable, and economic hardships are also taking their toll. ...Young men, especially, are psychologically open to the idea of taking drugs."

The transmission of HIV in Russia is closely linked to the use of recreational drugs. Russian officials estimate that about 90 percent of HIV cases involve drug users, but that it is spreading rapidly through sexual contact. Widespread unemployment, poverty and a sudden relaxation of social and legal taboos — coupled with an influx of illegal drugs — has led to a rapid rise in the number of intravenous drug users, a rise closely shadowed by a sharp increase in the number of Russians who have contracted HIV.

Vladimir Yegorov, the leading drug expert at the Health Ministry, estimates there are nearly 1 million drug addicts nationwide; others believe about another 5 million Russians engage in occasional drug use. In parallel with the rise in drug use, instances of HIV infection have also spread. Once concentrated in Moscow and St. Petersburg, HIV/AIDS has spread aggressively to cities like Kaliningrad, Krasnodar, Tver, Nizhny Novgorod, Irkutsk and Samara.

In the past, anti-AIDS programs have targeted women, especially prostitutes. There are estimated to be about 80,000 women engaged in prostitution in Moscow alone. However, focusing on women may be a mistaken approach. Among the general population, it is most often men who dictate whether sexual relations will take place and what kind of birth control will be used. As a result, there are more opportunities for them to contract and transmit the virus.

Russian male drug users are more likely than women to share needles, research shows. Of drug users who are already infected with HIV, 80 percent are men. Studies also show Russian men continue to resist the use of condoms and demonstrate a dangerously cavalier attitude toward sexually transmitted diseases. Although condoms are widely available nationally, a survey by condom manufacturers revealed that only 10 percent of sexually active Russians use them regularly. Sociologists wonder whether young Russian men can change their widely held concepts of masculinity that lead them to take unacceptable risks.

The authorities are obviously aware of the extent to which injecting drugs facilitates the spread of HIV. But so far they appear unable either to reduce the number of individuals who take drugs or to limit the spread of the virus.

It is not too late for Russia to head off the AIDS crisis that is now looming over the country. But doing so will require, most of all, the active leadership of the authorities at all levels. The AIDS epidemic must be treated as a national security crisis of the highest order.

Kester Klomegah is an independent researcher and writer, whose recent work on HIV/AIDS in Russia appeared in a book titled "AIDS and Men: Taking Risks or Taking Responsibility?" He contributed this comment to The Moscow Times.