In Russia, 1999 was a watershed year for the AIDS epidemic: For the first time, the number of people with HIV exceeded the number of myths about AIDS. Public officials had long predicted that as many as 10 million Russians would be infected by the end of the century, but even as late as 1996 there was no sign of an epidemic. That year, an even more paranoid claim was added to the doomsaying repertoire: The health ministry announced that the Russian AIDS crisis would take a unique route because drug dealers were smuggling in barrels of ready-to-inject substances prepared from their own infected blood. In one of the world's biggest drug bazaars, where prices are low and laws loose, HIV would soon be listed among the bargains.
Reality is more prosaic. No one smuggles barrels of drugs across the border; Russia's drug of choice -- opiate surrogates with generous additions of other chemicals -- is either prepared from locally grown poppies or imported from the Ukraine. The runaway infection rate stems not from an exotic, new way of transporting the virus but from the old, familiar causes: shared needles, shared vessels from which the drug is repeatedly drawn, shared cups of water in which syringes are rinsed. Russian drug users, and young people in general, are well-informed about the risks and routes of HIV. The tragedy is: This knowledge has done little to lead them to protect themselves or one another.
According to the latest UN AIDS data, 1999's steepest rise in new HIV infections took place not in Africa or Asia but in the former Soviet Union. Two countries in particular -- Russia and the Ukraine -- had the largest number of new infections caused by IV drug use. Nearly half of the 23,000 total AIDS cases registered in Russia appeared in the first nine months of 1999, many in cities and towns previously believed to be untouched by either HIV or IV drug use. (Experts agree that the UN stats are underestimates.) Russia has, of course, a rich tradition of substance abuse. In the decade since the Soviet Union fell, a vast swath of society -- including college students, housewives and kids as young as 12 -- has shifted its substance of choice from vodka to IV drugs, all due to increased availability.
In December, Russia's leading public-health AIDS expert, Vadim Pokrovsky, predicted that over the next five years, between 10 and 14 million people will become infected. This time the official doomsaying, minus the science fiction, may just prove to be on the mark.