HIV infection rates are dropping throughout the world, but not in Russia, where poor sex education, ignorance, and harsh government policies have resulted in a toxic environment where disease sufferers are stigmatized, shunned, and don't receive help.
A bizarre, sexy storefront display celebrating New Year's in Moscow, Russia. The country is filled with sex-soaked advertisements, but education and awareness about HIV is lacking. Photo via Flickr user Peter PZ
One uncharacteristically sunny morning in St. Petersburg, Russia, Nikolai Antonovich (not his real name) got a phone call from his local clinic demanding that he come over immediately. After sitting for several hours in the waiting room, his name was called by the nurse, who led him into a small room and coolly informed him he was HIV positive. She then mechanically read out a pamphlet informing him that it was against Russian federal law for him to engage in sexual intercourse with another Russian citizen without telling them about his incurable disease. Then he was sent on his merry way, with no drug prescriptions, no counseling, not even a sympathetic pat on the back. The process was as formal, rote, and heartless as any bureaucratic procedure—it was like telling him his life visa had just been denied.
Stories like Nikolai’s are depressingly common. Between 2001 and 2009, HIV infection rates have dropped everywhere on the planet (including sub-Saharan Africa, the world’s most famous AIDS hotspot) by 25 percent, but they’ve increased dramatically in Russia, Eastern Europe, and Central Asia. According to the most recent UNAIDS fact sheet, the number of people living with HIV in the region increased from 970,000 to 1.4 million from 2001 to 2011, while annual AIDS-related deaths went from 76,000 to 92,000 between 2005 and 2011. Not only that, but only a quarter of HIV patients receive treatment, due to the intense social stigma surrounding the disease. This region, says UNAIDS, wins the dubious honor of being “the only region where HIV prevalence clearly remains on the rise.”
Every year, the government makes a grand statement about its commitment to fight AIDS, with no real results. Programs implemented largely through NGOs and funded by the Global Fund to Fight AIDS were terminated years ago, primarily because Russia sees itself as a global power who should be donating to other countries, not the recipient of help. The Russian government wants to present Russia as a strong, global leader, so it’s apparently willing to risk a few thousand extra deaths.
Then there’s the country’s generally toxic attitude toward those who have the virus. As was the case in the US during the early years of the AIDS epidemic in the 80s, the afflicted are shunned and treated like pariahs. Common stories among HIV-positive people include friends disappearing, lovers leaving, abrupt firings, and relatives too scared to shake hands. One man I talked to recalled how he was driving a hitchhiker home one day and when he mentioned he was HIV positive, the hitchhiker immediately jumped out of the moving car.
AIDS is viewed largely as a disease that affects drug abusers, and addicts are treated as criminals and failures who should be scorned rather than sick people who need help. “Most people feel stigmatized and are afraid to go to the hospital,” Anya Sarang, the president of the Andrey Rylkov Foundation for Health and Social Justice, told the Washington Post earlier this year. “Doctors say that by the time people get into the medical system, they already have advanced stages of HIV and tuberculosis.” While some harm reduction tactics are “tolerated” in Russia, she said, the use of popular substitution treatment programs such as methadone are illegal. The government maintains that providing needle exchanges and substitution treatments just encourages healthy people to inject heroin. This is in keeping with the government’s “tough love” logic: if you treat drug abusers like shit, it will discourage people from using drugs in the first place. It’s no wonder that in this environment, those who have HIV are reluctant to seek help or even tell anyone about their illness.
Perhaps the more important, and even less discussed, issue is that the vast majority of Russian schools don’t have anything remotely resembling proper sex education. This has always been an issue—my mother’s friends all had to get illegal abortions back in the 70s because they didn’t know how babies were made. But it’s been especially problematic since the late 90s, when rates of pregnancies and STDs skyrocketed among teens, and today the number of sexually-transmitted HIV cases is rising especially quickly. (On top of everything else, it recently became illegal for teachers to talk at all about homosexuality.)
For a nation that runs milk commercials featuring young maidens running topless through a pasture, Russians are oddly conservative when it comes to talking about sex. The government’s very limited funding for HIV prevention focuses on Mean Girls–style PSAs reminding you that you should have sex with only one partner or else you will get AIDS and die. No one seems to think condoms are important, especially if you are protected by the power of love.
When I was living in Russia, getting a guy to put on a condom was like trying to stuff a wool sweater over a Chihuahua. Many of them would get offended when I insisted they wear one, testily replying, “I’m not a drug abuser or anything.”
“HIV is a sexually transmitted disease!” I’d yell in response, killing the mood for good.
To be honest, I’m not entirely convinced Russians are that put off even if you do have AIDS. One woman I spoke to said none of her boyfriends declined to sleep with her just because she was HIV positive. I couldn’t decide whether or not I was happy for her.
“Ignorance is the real problem,” a woman I’ll call Tanya told me. She discovered that she was HIV positive after she went to the doctor for a pregnancy consultation, which is a common way for Russian women to find out they have the virus. A week after her appointment, she got a call from a stoic nurse who told her, “You have to come in. I don’t know anything, the doctor will tell you everything.” After waiting in line for several hours, she came in and asked the nurse what was wrong. “Don’t you know anything about yourself?” the nurse retorted. “You have AIDS. Now go see your doctor.” Trembling and lighting a cigarette as she walked through the hall, all Tanya could think about was what would happen to her baby. “As soon as I walked into the doctor’s office, I could feel all of that discrimination that I’d heard about just from his judgmental gaze,” she told me. “He told me to get an abortion. My husband left me because he was certain that I’d either cheated or become a drug abuser.” The truth was that Tanya had contracted the virus while getting a tattoo at a shady apartment. She didn’t even know you could get the disease that way.
The obvious solution is to educate the public more about HIV and how it’s transmitted, but that’s a foreign concept to Russian society—when I asked my cousin what the Russian translation for “raise awareness” was, she told me there was no such common phrase. There are no plans to install a comprehensive sex education system either. The government’s policy toward sex and drugs seems to be to ignore them and clamp down hard on anyone who engages in deviant behavior, which means that those afflicted by HIV get shunted to the margins of society—and also that there’s a greater chance that people will engage in dangerous behavior without knowing the risks.
For some Russians, just about the only thing to do is laugh bleakly at the situation. When I asked my Russian friends if they were taught anything about sexually transmitted diseases at school, some of them replied, “No, we learned about them the best way: through experience.”
Diana Bruk is a freelance writer who was born in St. Petersburg, Russia, and raised in New York City. You can follow her on Twitter: @BrukDiana
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