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. Last Updated: 07/27/2016

Tver Looks to Cope With Surge in HIV

TVER, Central Russia — He's thin and smiles easily and, at 20, does not look like someone who has already spent three years in prison for robbery. But Sasha Volgin is determined to be a tough guy even though the AIDS virus now runs through his veins — and those of his 16-year-old pregnant girlfriend.

"HIV is like a cough," he says dismissively.

He sees no need to take medicine. He does not need friends. He does not fear death. He did not react when he learned of his condition. Or so he says. "I'm not expecting any help. We will die here, and our kids will die here."

This brand of fatalism terrifies Alexander Kolesnik, head of the AIDS clinic in Tver, a mid-size industrial city 200 kilometers north of Moscow, and it terrifies the international health care community as well. The AIDS epidemic that once bypassed the East has now begun to ravage Russia and some of its neighbors, and only slowly is the world's largest country awakening to the potential threat.

While the numbers remain small compared to those in Africa, the Caribbean and the United States, HIV infection is growing at a faster rate in Russia and the rest of Eastern Europe than anywhere else in the world, according to UNAIDS, the consortium of international agencies fighting the disease. Nearly 50,000 people in Russia tested positive for the virus since January, a 60 percent jump in just six months. Because official statistics generally reflect only the tip of the story, specialists estimate that the 129,261 cases registered by the Health Ministry probably translate to as many as 750,000 in reality.

The escalation might only grow worse. Until now, the infection has been largely confined to intravenous drug users in Russia, but doctors believe it is about to break out into the general population through sexual transmission, meaning that Russia is heading down the same road already traveled by the countries with the world's worst AIDS problems.

"If you just extrapolate from what we have seen in the last decade, it's going to be a disaster," said Armin Fidler, the European health care sector manager for the World Bank. "It has the potential to become a huge tragedy."

"This is of great concern. This requires immediate action," said Stefano Lazzari, an epidemiologist at the World Health Organization in Geneva. "When the numbers increase so dramatically, you know an epidemic is going on."

At the moment, the total infected population in Russia remains a fraction of the HIV/AIDS cases in countries that have suffered from the disease for many years. As a proportion of the population, the number of infected Russians was just one-third that of the United States, according to 1999 data from UNAIDS.

The spread of disease is tied in part to the burgeoning drug problem that has developed since the fall of the Soviet Union. The government reports that drug addiction has multiplied 12 times over the past decade and attributes 80 percent to 90 percent of the HIV infections to dirty needles. Hepatitis B and C, which are transmitted through blood and sexual activity, have risen rapidly as well. "Basically these epidemics are feeding each other," Fidler said.

In Tver, a provincial city on the scenic Volga River between the giant metropolitan centers of Moscow and St. Petersburg, the growth of HIV infections has baffled local officials struggling to get a handle on the epidemic before it gets out of control.

Until 1997, there were just eight known cases of HIV infection in Tver, six attributed to heterosexual contact and two to homosexual activity. But this struggling factory town experienced economic problems and the influx of drugs in the mid-1990s, with opium and later heroin becoming readily available for roughly the cost of cigarettes.

As of July 1, Tver had registered 2,342 people with the infection, with many more thought to be carrying the virus without knowing or notifying authorities.

The enemy is not only the disease but Russian culture and prejudices. "Our population has certain stereotypes and that is that you will get the infection only if you are a drug user," said Kolesnik, the head doctor at the local AIDS clinic. "On the contrary, we keep saying the infection is spreading and it's not just about drug use."

Kolesnik cited studies showing that 60 percent of drug users here say they have sexual relations with nondrug users. "Maybe when people start to die, then it'll have an impact on them," he said. "We are losing time now."

At Kolesnik's clinic, however, even the patients seem almost blithe about the situation. Natasha Ivanova was 15 when she started using heroin. A friend offered it to her and she decided to try it. She came from an economically stable home with a father who worked as a logger and a mother who worked as a teacher.

"I didn't have a clue," she said, sitting in Kolesnik's office the other day, wearing a blue turtleneck sweater and bobby pins in her hair. "I didn't have any idea what the consequences would be. I was so small at the time."

Then she got pregnant by her boyfriend, who was also a drug user, and in March when she went for a blood test discovered that she had HIV. Her baby was born on May 24, but it is too early to know whether little Katya is infected as well. Natasha now is just 17 and living with the boyfriend.

"I'm not scared," she said. "Now it's more or less normal because my friend also has HIV, so people know about it. We all know that we can use drugs and get AIDS."

Sasha Volgin said he did not know much about AIDS either before learning last winter that he had the virus. He said he got it from a one-night stand with a young woman shortly after getting out of prison last fall and learned about it when another woman he impregnated got a blood test. But he acknowledged that it could have been from the needles he shared while using heroin.

The disease has spread, he said, because of the lack of order in Russia. "People do not have any way out. … People just don't know what they're doing. They start to steal, they use drugs, they drink. They don't know what to do."

As for him, "I'm not afraid. I'm alive. If I die, then I die."