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. Last Updated: 07/27/2016

AIDS: Spreading the Message, Not the Disease

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Much attention has been paid to the rapid increase of AIDS in Russia, the growing prevalence of heterosexual intercourse as the means of infection, and the spread of AIDS through urban centers of both European Russia and Siberia. But not much attention has been paid to the small towns.

In the year I've spent working as a teacher in a southern Siberian town of 15,000, I didn't hear AIDS mentioned at all. I worried that my students were not being educated on matters vital to their health, but wasn't sure when and how to approach the subject. In the run-up to World AIDS Day on Dec. 1, I decided both to do some public AIDS education and to study the issue locally myself. I assembled a group of 16- and 17-year-old students in a special public school for bright students and gave them a short quiz, later giving the same interview to several young people in the community. What is AIDS? I asked them. How is it spread? How can you protect yourself?

Most of the 16 students in the group knew that AIDS can be acquired through sex, although only 50 percent mentioned blood and 23 percent mentioned needles as modes of transmission. Likewise, in terms of protecting themselves, 90 percent knew that condoms would reduce their risk, but less than 35 percent mentioned avoiding used needles or practicing abstinence, and only 13 percent knew to avoid touching blood.

When asked about the prevalence of AIDS in Russia and in the local region, they estimated only about a fifth of the actual numbers. Sixty-three percent said the statement, "Russia has one of the fastest-rising AIDS infection rates in the world," was false; and half believed that children with AIDS should not be allowed to attend public schools.

The youth in this small town had clearly heard of the disease, but they didn't consider it a problem in their region or their country. And their knowledge about the modes of transmissions and means of protection was spotty. Yet, their desire to learn was clear. Several hours later, another teacher asked me to give the lecture to several more groups of students. "You can come during my class periods," she said. The demand for knowledge exists, only no one wants to talk about it.

The local epidemiological office told me that they used to have someone on staff who gave lectures at schools and handed out free condoms at the discotheque. But she left a year ago and no one has replaced her. Only one of my students has seen a demonstration of how to use a condom.

Together with several students, I visited the local polyclinic to ask questions about the problem of AIDS locally. We were directed to a doctor of skin and venereal diseases.

"We have one case in this area," the doctor responded. "And that person doesn't have AIDS, but only HIV."

"And how many people in our area have been tested?" a student asked.

"We don't keep figures on such things. I can tell you that the person who has HIV came from another region, another place." The implication seemed to be: This is not something that affects our local population.

"In my opinion, as an expert," she continued, "there are four causes of AIDS. The first is drug use. The second is running around and sleeping with lots of people. Third is alcoholism."

"Alcoholism?" I asked, surprised.

"Yes, when you drink a lot you don't remember what you've done. And fourth," she continued on, "is the social and economic situation. There are lots of kids who want to study but who aren't able to, children whose parents don't take care of them."

She didn't mention either needles or the exchange of blood as a cause of AIDS. And she didn't convey a need for the 16-year-olds accompanying me to have to worry. AIDS is something that affects other people, her manner seemed to say: Those who use drugs, who are profligate, poor and drink too much.

I later visited other health officials and was often told, "It's not a problem here," "We don't have AIDS," or "We only have one case."

When even the experts don't seem clear on the causes and dangers of AIDS, the local population has little chance of being well-educated.

Only the epidemiologist was able to give me hard facts. She showed me the books, indicating the risk groups that had been tested.

She told me that the first local case of HIV infection was registered in 2000. I asked about the conflicting reports about the number of cases, or whether there were any at all.

"Well, you know this is a small area and when people heard that there was one case, they probably would have confronted everyone to see who it was. So for one year afterward, we spread the information that that individual had left the region."

"But that wasn't true? He still lives here?"

"Yes."

So far this year, three more AIDS tests have come back positive.

"Are you worried about AIDS becoming a problem here?" I asked.

"Yes, because we have a very high rate of Hepatitis B infection and other STDs, which indicates low condom use."

It's not easy for young people to buy condoms in a place where everyone knows each other. A 26-year-old divorced woman said, "I would feel ashamed buying condoms at the pharmacy. I would be better off going several hours to the city to buy them." If a mature woman finds it difficult to buy condoms, it cannot be any easier for students.

It's been a Russian practice over the past few years to try to deny the existence of AIDS, to deny the fact that it can spread beyond social pariahs, to see it as something brought from and affecting the outside world. Local governments and citizens seem to think it is a problem for other cities, other regions, people different from themselves. Yet it's here, even in this rural, cattle-breeding area with little drug use and no visible prostitution.

Until these perceptions are shattered and Russians wake up to the threat in their midst, it will be difficult to curb the spread of AIDS. It's a matter for the federal and local governments to finally recognize the social, health and economic effects that continued increases in the HIV infection rate will have on Russia.

The first and easiest step to take is to earmark more of the federal AIDS budget for education, increasing the "few kopecks," First Deputy Health Minister Gennady Onishchenko indicated are spent on education per person. Second, young people need access to safe and confidential places where they can obtain condoms and ask questions about AIDS and STDs. Only when the health officials and the average citizens of Russia are educated can they take the necessary steps to protect themselves.



Jessica Jacobson, a graduate student of international development at Princeton University, has lived in southeastern Siberia for the past year. She contributed this essay to The Moscow Times.