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P58-69 Specter AIDS Fact.L.Ps A REPORTER AT LARGE THE DEVASTATION Since 1965, life expectancy for Russian men has decreased by nearly six years. And now there is AIDS. BY MICHAEL SPECTER he first days of spring are electrify- beds, and they are not filled. The direc- War did a generation ago. “We are on Ting in St. Petersburg. The winters tor, Olga Leonova, is a valiant woman the front line of a war,” she said. “This are hard and dark and long, and when with an impossible job: trying to assure city was under siege by Hitler for years. the light finally returns each year thou- patients that they have a future while We lived through Stalin. We have to sands of people pour onto Nevsky Pros- convincing everyone else that AIDS threat- prevail, and I think, somehow, we will. pekt and into the squares in front of the ens to turn Russia back into the Third We don’t have a choice.’’ Winter Palace and St. Isaac’s Cathedral. World country it was before the Sec- From Tambov, the old Soviet bread- Petersburg has always been more open ond World War. “You can see it getting basket, to the Pacific port city of Vladi- and more openly European than other worse every day,’’ she told me as we vostok, and even in Moscow, which has Russian cities, and the day I arrived this walked around the floor one morning. become a world showcase for conspic- spring was the first on which men in “It’s not just drug addicts now.’’ For years, uous displays of wealth, Russians are shirtsleeves could fling Frisbees across H.I.V. infection in Russia was driven al- dying in numbers and at ages that seem the endless avenues. I settled into one of most exclusively by shared needles. “We impossible to believe. Heart disease, al- the many coffee shops along the Neva are seeing pregnant mothers and peo- cohol consumption, and tuberculosis are River—they are a recent innovation— ple we would never have even tested in epidemic. So is addiction to nicotine.You and noticed something else that was the past.’’ won’t see many pregnant women on the new: a large stack of pamphlets advertis- Dr. Leonova is a middle-aged woman streets; Russia has one of the lowest ing an H.I.V. support group. AIDS is not with chestnut hair and hazel eyes. She peacetime birth rates in modern history. a subject that people talk about much wore stylish striped pants under her lab Long life is one of the central character- in Russia. Even though the epidemic is coat, and her fingernails were painted istics of an advanced society; in Russia, spreading here more rapidly than any- gunmetal gray. She is proud of her ward, men often die too young to collect a pen- where else in the world, there are virtually and enjoyed introducing patients. One sion. In the United States, even during no public-service ads on television about of them, a frail boy with sandy-colored the Great Depression mortality rates it, and the government spends next to hair, had tried to kill himself, because he continued to drop, and the same has been nothing on prevention, treatment, edu- thought he had no hope of living. With true for all other developed countries. cation, or care.This year, the entire bud- drugs provided by the hospice, he would Except Russia. In the past decade, life get for H.I.V.-related matters is a little soon go home. Cases like his are com- expectancy has fallen so drastically that more than five rubles per person, less mon. “Most of our patients have noth- a boy born in Russia today can expect than the cost of a pack of cigarettes. ing when they get here,” Dr. Leonova to live just to the age of fifty-eight, youn- St. Petersburg has been a rare ex- said. “They are dirty and hungry. The ger than if he were born in Bangladesh. ception to what seems like an official first thing we do is take their clothes and No other educated, industrialized nation policy of ignorance and neglect.The city burn them.’’ We had returned to her of- ever has suffered such a prolonged, cata- is responsible for the first program in fice, and while we talked she stood at strophic growth in death rates. Russia that sends buses to deliver in- the window, staring at the birch trees. “I formation—and clean needles—to peo- worry that AIDS will send us over the n 1991, on the day the Soviet Union ple who cannot be reached in other ways. edge—that we will become a country Iwas dissolved, Russia’s population It also pays for health workers to travel too sick to cope. Most people don’t get it. stood at a hundred and forty-nine mil- to schools, hospitals, and even construc- Many of those who do understand have lion. Without the huge wave of immi- tion sites to inform people about their left. My five closest friends now live in gration from the former Soviet republics choices. Condoms are available, and often the United States and Israel. My gen- which followed, the country would have free. Almost two years ago, St. Peters- eration has no children. Husbands are lost nearly a million people each year burg opened the country’s first AIDS hos- dead. And now the young . ” Her voice since then. If Russia is lucky, by 2050 pice.There is still only one. Funded with trailed off. Dr. Leonova is an optimist, the population will have fallen by only local money, it sits not far from the city’s but she knows that the illness she en- a third, to a hundred million. That is the Botkin Infectious Disease Hospital, one counters each day is a sign of an even most optimistic government scenario. of the largest such facilities in Russia. larger problem—one that threatens Rus- More realistic predictions suggest that The hospice is small; it has just sixty sia at least as seriously today as the Cold the number will be closer to seventy-five JOHN RITTER Even the government’s estimates—which ignore the AIDS epidemic—say that Russia will lose a third of its population by 2050. TNY—10/11/04—PAGE 58—133SC.—#2 PAGE THE NEW YORKER, OCTOBER 11, 2004 59 TNY—10/11/04—PAGE 59—133SC.—LIVE OPI ART #R13539 eral AIDS Center, in Moscow, and for two decades he has been the public face of Russia’s efforts to curtail the epi- demic. “They only pay attention when people are dropping dead in the streets. That is going to happen. We can no longer pretend it won’t. It’s just a matter now of how many will die.’’ So far, that message has not sunk in. No senior Kremlin official was willing to discuss AIDS policies with me, because, as one explained, “we don’t have an AIDS policy to discuss. There is no plan, no goals, nothing. It’s not even on our radar.” For most of its history,Russia has de- fined itself physically: as the biggest country on earth and as the place where Europe and Asia come together. Today, however, a nation’s significance is deter- mined more by people than by land. Twenty-five years ago, the population of Russia was a hundred and forty million, •• and that of its neighbor Pakistan was eighty million.Within twenty years, that or eighty million—a little more than tered in Russia, ninety-nine per cent ratio will have reversed itself. If United half the current population. And none have been reported in the past five years, Nations projections hold true, even of these figures allow for the impact of and sixty-five per cent in the past three Yemen will soon have more people than AIDS, which remains, in many ways, un- years. Just at the time when the country Russia.The prevailing view, initially,was recognized and unreckoned with. The will begin to reel under the burden of its that Russia’s sharp decline would be World Bank has estimated that by 2020 shrinking labor force and an increasingly brief—a reflection of the chaos and un- at least five million people will be in- disabled population, it will have to find a certainty confronted in the nineteen- fected with H.I.V.; a more pessimistic, way to cope with millions of AIDS pa- nineties by a new and deeply troubled but equally plausible, figure is fourteen tients, too. society. But the trend actually began de- million. Even without AIDS as a factor, The Russian government has re- cades ago. In an era of antibiotics, molec- working-age people are starting to dis- corded two hundred and ninety-two ular medicine, and universal literacy, the appear. (In the United States, fifteen per thousand people with H.I.V.,but doctors life of the average Russian man is almost cent of men die before they retire; in and AIDS workers estimate that there are six years shorter today than it was in Russia, nearly fifty per cent die.) By at least seven hundred and fifty thou- 1965. Just fifteen years ago, the Soviet 2015, the number of children under the sand. Most epidemiologists, including Union’s status as a superpower was un- age of fifteen will have fallen by a quarter. those from the United Nations AIDS questioned; today, the country is so weak There will be at least five million fewer Program and the World Health Organi- that it is hard to see how it could ever re- people in the workforce.
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