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The Death of a Nation

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In his 20 years on this earth, Dima has seen a lifetime of abuse. At 16 he shot his first heroin, and in the years since he has lived on and off the streets of St. Petersburg. What life is left for him is likely to be brutal and short. "I can't say this is how I hoped to die," he says. "But at least I'll have plenty of company where I'm going."

Dima's humor may be black, but sadly, his prediction may be right. Something terrible is happening in Dostoyevsky's old city. Doctors believe that as many as 40,000 young people in St. Petersburg, mostly addicts, were infected with HIV last year. Five time zones to the east, in the Siberian outpost of Irkutsk, the toll is rising with equal ferocity. The same in Tolyatti, a grim city of automobile workers on the Volga in Russia's heartland. Moscow leads the nation with as many as 100 new HIV cases registered each day. In fact, virtually no place in Russia has been spared. Says Irina Savchenko, the head HIV specialist at the Ministry of Health: "By now wherever you look, from Kaliningrad to Kamchatka, from Grozny to Murmansk, HIV is not only there, it is moving faster and faster."

After a false lull for most of the first post-Soviet decade, HIV is now sweeping across Russia faster than almost anywhere else in the world. In the last year alone, the number of registered cases of HIV has more than quadrupled, from 15,652 to 80,300. Experts believe the actual number is 10 times higher. "It will not be long before we have 1 million Russians infected with HIV," says Dr. Vadim Pokrovsky, who has directed the country's federal center for the fight against AIDS since 1985.

Vladimir Putin describes Russia as "a great power with unlimited potential." But given the rise of HIV, tuberculosis and other diseases, Putin's Russia is in danger of becoming known as a land of unending affliction. Even the most ardent patriots concede that their country is dying. Fewer and fewer Russians are able to escape the clutches of the old scourge of alcoholism, and the new one, drug abuse. In the past decade, the death rate has risen by a third, while the birthrate has fallen precipitously. Last year alone, the population dropped by about 750,000. Hepatitis B and C rage, while old world diseases largely extinct in the West - measles, typhoid and diphtheria, to name a few - are staging a comeback. But HIV poses the greatest danger. "The HIV epidemic is a tragedy in itself," says Pokrovsky. "Far worse will be the eventual depopulation of the country. Not only will those with AIDS die, but they will not have children."

On one recent frigid night in St. Petersburg, near a metro stop on the city's desolate southern edge, two dozen teenagers gather outside a retrofitted bus. They are there to get clean needles, free condoms and, for many, their first HIV test. In the first 10 months of last year, St. Petersburg registered 3,652 new cases of HIV, compared with 400 in 1999. "From 13-year-olds to over-30-year-olds, they come to us," says Sergei, a former addict on the MÚdecins du Monde team that has been providing anonymous HIV tests and psychological counseling - something the state does not offer - since 1998. In recent months, the crew has seen the HIV rate skyrocket. "Nearly one out of four kids we test is positive," says Dr. Vladimir Musatov, the team's medical coordinator and deputy head of St. Petersburg's AIDS clinic. "The epidemic is growing faster than anyone dared imagine."

Tolyatti, home to the giant AvtoVAZ car plant, offers a terrifying example of the epidemic's speed. The city has 3,250 registered cases of HIV. A year ago, it had 11. "We are waking up late," admits Dr. Larisa Mikhailova, head of the city's drug treatment clinic. "We should have started working with the addicts years ago. Now for thousands it's too late."

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