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. Last Updated: 07/27/2016

An Award for Staying Alive

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I needed a favor done the other day. I waited for a friend's nickname to appear in the instant-messenger window and sent him the request. He agreed. I thanked him and then felt momentarily embarrassed: I hadn't even asked how he was. So I did -- planning to sign off in another couple of minutes.

"Just now," he wrote back so slowly that it seemed the letters were actually shaking, "I am opening my test results. My viral load is over 180,000."

My friend has known for a couple of years that he is infected with HIV. In this time he has learned that 55,000 copies of the virus per 1 millimeter of blood is the critical level -- the moment when one should start receiving treatment. It is a difficult moment for anyone with HIV, the time when one becomes a lifetime patient, the point of no return. But for my friend and tens of thousands of people like him, it is even more difficult: His chances of getting treatment are negligible. In theory -- or, rather, by law -- Russia provides treatment free of charge for all people with HIV who need it. In practice, though, treatment is provided only in certain large cities and only to people who are legally registered to live there, and then not to all of them. Illegal-drug users and, often, former drug users, are among those usually excluded.

My friend fits the profile of someone who would get treatment in Moscow -- almost. He has never used drugs. He has regular employment, which demonstrates his ability to stick to a strict drug regimen. The sticking point is, he is not registered to live in Moscow, and though he works, rents an apartment and pays taxes in Moscow, he cannot be legally registered because such is the Moscow system of residence registration. My friend and I have long had other, extremely convoluted plans B and C for getting him treatment when he needs it. We discussed them now by instant messenger, he bemoaned the difficulties involved, and we said goodbye.

A couple of days later, I went to a reception held by the Trans-Atlantic Partners Against AIDS, a huge and wealthy international charity that was hosting the actress Julia Ormond. On Wednesday, the star participated in a ceremony giving out MTV's Staying Alive award, handed out annually for the best AIDS-education videos. This year there was also a special jury award, given to an AIDS activist from St. Petersburg named Alexandra Volgina.

Alexandra is a terrific young woman who has been advocating for access to treatment. She herself was not receiving treatment, and neither were most of her friends and fellow AIDS activists -- generally because they had used or were using drugs. Then someone pulled some strings to get her the anti-retroviral drugs -- but, like other AIDS activists elsewhere in the world before her, she refused what literally amounted to special treatment.

The reception was held at a nice restaurant. There were dignitaries, including State Duma deputies and international activists, who spoke about the need to prevent a full-fledged epidemic in Russia and issued warnings about HIV spreading beyond such populations as gay men and drug users. They congratulated themselves on their successes in drawing President Vladimir Putin's attention to the problem and getting the amount of money allocated to AIDS in the federal budget increased. It was unclear whether they meant money for AIDS prevention or AIDS treatment -- they did not specify. In fact, no one said a word about access to treatment.

Most of the roughly 1 million to 1.5 million Russians who are already living with HIV have been written off by everyone, including AIDS doctors and even wealthy international charities. So it is fitting one of them should get an award for staying alive: It is quite an incredible feat.

Masha Gessen is a contributing editor at Bolshoi Gorod.