This article is part of Telescope: The New AIDS Epidemic, a deep-dive investigation into the modern face of a disease that transformed the world.
MOSCOW — In 1986, the year before Russia would register its first official case of HIV, a Soviet health official named Vladimir Trofimov spoke on state television about the troubling new infection that was making international headlines. “This is a Western disease,” he said. “But there is no base here for the spread of this disease, since in Russia there is no drug addiction and no prostitution.”
Today, there’s little denying that AIDS is also a Russian disease. More than 340,000 Russians have died of AIDS, two-thirds of them in the past decade. In 2018 alone, the last year for which precise figures are available, AIDS took the lives of 37,000 people across Russia, with the rate of new infections rising by between 10 percent and 15 percent a year, according to the World Health Organization.
And while Trofimov was also wrong about drug addiction and prostitution in Russia, traditional at-risk groups no longer account for the majority of new infections.
Although needle-sharing among drug addicts was one of the main reasons the disease spread so quickly, most HIV transmissions in Russia — 57 percent — are now a result of heterosexual sex. Drug use is responsible for 40 percent, while gay sex accounts for around 3 percent, according to Russia’s Federal Research Center for AIDS Prevention and Control in Moscow.
Russia has resisted calls to introduce sexual education in schools and has cracked down on NGOs attempting to stem the tide of new infections.
“There is no such thing now as a group of risk — there is only risky behavior,” said Maria Godlevskaya, a project coordinator at the St. Petersburg-based EVA organization, which helps women living with HIV. “This can concern anyone from athletes to ballerinas to priests.”
Godlevskaya, who has been HIV positive for over 20 years, says low levels of testing in the past was one of the reasons why the epidemic grew so quickly in Russia.
“This lack of testing means married couples are now infecting each other, because one of them didn’t know that the other had been HIV positive for years,” she said. Many women, she added, only find out they are HIV positive during pregnancy, when they are screened for the disease. Even rural pensioners are increasingly at risk, doctors say.
The number of people living with HIV in Russia now exceeds 1 million, according to official statistics. Most experts say the true figure is likely to be at least 1.5 million — around 1 percent of the total population of 146 million — because many people are unaware of their HIV positive status. In five Russian cities in Siberia and the Ural region — Chelyabinsk, Irkutsk, Samara, Tolyatti and Yekaterinburg — more than 1.5 percent of the population is HIV positive.
Although Vladimir Putin has never described HIV as a “Western disease,” he has shown a remarkable reluctance to discuss the country’s HIV epidemic. Beyond a few brief comments, the Russian president has not spoken at any length about HIV since 2006, when he called for urgent action to tackle the virus. Yet in the intervening years, Russia has resisted calls to introduce sexual education in schools and has cracked down on NGOs attempting to stem the tide of new infections.
Traditionalism
Critics say Russia’s reluctance to adopt tried and tested means of reducing new HIV infections is a result of the ultra-conservative government policies that have been promoted by the powerful Russian Orthodox Church since Putin returned to the presidency for a third term in 2012.
In 2013, Pavel Astakhov, at the time Russia’s top official for children’s rights, said that the novels of Russian authors such as Leo Tolstoy contain everything a child needs to know about love and sex. Astakhov quit his post in 2016, but attitudes have been slow in changing. In 2017, plans to hold online lessons about HIV/AIDS for Russian students were scrapped after the education ministry insisted on avoiding “delicate topics” and the use of the word “condom.”
“Instead of sex education, the government says young people should adhere to the slogan ‘the main weapon against HIV is love and fidelity,’” Iskander Yasaveyev, a sociologist at the Higher School of Economics in St. Petersburg, wrote in an article published recently by Novaya Gazeta, an opposition newspaper.
“Putin, through his silence and traditionalism, bears a significant part of the responsibility for the HIV epidemic in Russia,” he added.
Russia’s drug policies are also an obstacle toward reducing new infections, say HIV activists. Methadone, which international researchers say can lower the risk of passing on the virus by reducing intravenous drug use, is banned in Russia and anyone supplying it faces up to 20 years in prison.
The consequences of Russia’s methadone ban were illustrated starkly after the Kremlin’s seizure of Crimea from Ukraine, where the drug is prescribed to people battling heroin addictions.
According to the United Nations, around 800 former heroin addicts were cut off from methadone-based replacement therapy after Russia annexed the Black Sea peninsula in 2014. Around 100 died of suicide, overdoses or complications related to HIV and tuberculosis over the next year, the U.N. says. Russia denied the deaths were related to the methadone ban.
‘Foreign agents’
Nongovernmental organizations that work with drug users have also come under attack in Russia. The Andrey Rylkov Foundation, which has around 25 members, is the sole source of free, clean needles and condoms for addicts in Moscow, a city of more than 12 million people.
In 2016, the Russian government placed the foundation on a list of so-called foreign agents because it receives overseas funding. In April, the organization was forced to limit access to its website after Vasiliy Piskarev, the head of the Russian parliament’s security committee, accused it of promoting drug use following a report by an opposition website about its efforts to help addicts during Moscow’s coronavirus lockdown.
“The government believes that any work carried out in accordance with the WHO’s international recommendations is work aimed at introducing a corrupting Western influence on Russian youth,” said Anya Sarang, the foundation’s director.
Vadim Pokrovsky, head of Russia's federal AIDS center | Vasily Maximov/AFP via Getty Images
Vadim Pokrovsky, the outspoken head of the Federal Research Center for AIDS Prevention and Control in Moscow, has also frequently blamed social conservatism and the influence of religious groups for the rise in new HIV infections.
“Conservative sentiments prevail,” Pokrovsky said recently. “The rules of conduct must be consistent with Christian traditions, which some believe will of themselves reduce the spread of HIV infections.”
Pokrovsky cited Germany as an example of how to combat the virus effectively. Germany has around 3,500 new HIV infections a year, some 30 times fewer than in Russia. It also has all the things that Russia does not — compulsory sex education in schools, legal prostitution, as well as state-run clean needles programs and opioid substitution therapy.
Although Russia allocates around 29 billion rubles (€360 million) annually for HIV treatment, Pokrovsky says that much of the money is spent on ineffective drugs with harmful side-effects. Russia also has problems getting antiretroviral medicines to those who need them: Only around half of the country’s 1 million or so registered people living with HIV are currently receiving the treatment they need, according to Pokrovsky.
Breakthrough
Despite the terrifying statistics, there are tentative signs that things could be slowly changing for the better. This glimmer of hope is mainly down to a 33-year-old video blogger named Yury Dud.
The former editor of a Russian sports website, Dud now produces immensely popular documentary films on controversial issues such as the Soviet gulags and the 2004 Beslan school siege. On February 11, he released an almost two-hourlong film entitled “HIV In Russia — The Epidemic That No One Talks About.” Within five days, it had been watched by more than 12 million people on YouTube. It currently has over 17 million views.
“The film was kind of a breakthrough,” said Godlevskaya, the EVA activist. “People stopped being afraid to get tested, and quite a few people even started to talk about their status. Social services in big cities like Moscow even started to become more friendly.”
In the days after the film’s release, Russian-language searches for HIV tests on Google shot up 56-fold, while queues for tests were reported in a number of cities across Russia. On February 17, the documentary was shown to lawmakers at a special screening in Russia’s parliament. Dmitry Peskov, the Kremlin spokesman, and health ministry officials also praised it.
Just 10 days after its release, on February 21, parliament hosted a HIV roundtable that was attended by Pokrovsky, health ministry officials, as well as a number of people living with the disease. Although the COVID-19 outbreak has since redirected the government’s attention away from HIV, many activists left the parliamentary roundtable with a rare sense of optimism.
“I really hope that the roundtable isn’t the end of this,” said Godlevskaya. “My colleagues who attended said that it seemed that it wasn’t held just for show. We’ll see.”
Pokrovsky was more cautious. "We are basically like-minded people,” he told fellow roundtable participants. “But there are a lot of people around us who hold much more conservative views. Get ready for a fight."
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