The Politics of Mind over Matter

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On the last day of 1999, Russians turned on their TV sets and received the shock of their lives. Instead of his traditional New Year's message, Boris Yeltsin painfully slurred out the news that he was leaving office that day, handing the country over to a "powerful man, worthy of being President," his 47-year-old Prime Minister Vladimir Putin. Within hours Yeltsin had disappeared from the Kremlin and people's lives.

The change was exhilarating. Gone was the inarticulate, feeble old man whose tippling and endless vacations were the stuff of black jokes. In his place was a crisp young graduate of one of Russia's best universities, a judo black belt and a former officer in the elite foreign branch of the KGB. His biography became a best seller, and even the quality of his Russian received rave reviews. The new President stimulated a sea change in the public mood. Putin's first aim, his p.r. guru Gleb Pavlovsky remarked at the time, was to help Russians overcome the mass inferiority complex that had set in since the 1991 breakup of the Soviet Union. By most accounts, he has succeeded brilliantly. Concludes Yuri Levada, one of the country's top sociologists, looking back on Putin's first 12 months: "He has given Russians hope."

Putin was supposed to have given them a lot more than hope. At the beginning of his second year in power, he has consolidated his grip on power and enjoys unprecedented popularity, but Russia faces a host of economic and health problems. Promised economic and military reforms have yet to happen, while government conduct seems to be sliding back toward what some observers call "the new autocracy."

This time last year expectations were different. Then, Kremlin officials described his appointment as the final victory of the old fox Yeltsin. Putin would continue Yeltsin's line, at the same time protecting the former presidential "Family" of relatives and hangers-on a term consciously borrowed from the Mafia from political or legal retribution. Putin's aides quietly put out a sharply different story. As soon as he was elected President in his own right, they said, he would embark on sweeping economic and political changes. Neither happened. Putin has indeed protected Yeltsin, but the Family is not pulling the strings: the price of their safety is silence and loyalty. One Family intimate, Boris Berezovsky, the billionaire power broker who played a major role in promoting Putin's career, challenged the new President. He is now chafing in exile, sometimes in the U.S, sometimes in France, trying to reinvent himself as a dissident, while his business empire is being sold off.

On the other hand, Putin's first year has turned out to be a remarkable example of mind over matter in public opinion. There have been few major achievements, several disasters and some ominous developments in the field of human rights and press freedom. Chechnya, Putin's signature policy initiative, has not been pacified as he promised and is instead sinking deeper into a brutal quagmire. Putin mentions it rarely these days. The loss of the submarine Kursk, played out in agonizing slow motion last August, showed the Russian military at its incompetent, mendacious worst. His team is weak and largely untested, while reforms in key areas like banking and land ownership have failed to materialize. Recently Putin's economic adviser, Andrei Illarionov, accused the government of squandering a year of booming world oil prices. Imports were down and foreign reserves were up, he noted, yet the government had made little headway in restructuring the economy, and a new financial crisis could occur as early as this summer. Modernization of the military, another of Putin's constant promises, is still on hold. An erratic foreign policy has worried the West, but even the flurry of official Putin visits has not led foreign capitals to take Russia any more seriously as a world power. And as the population continues to drop by about 750,000 a year, the work force is being ravaged by alcoholism, drug abuse and a growing HIV/AIDS epidemic.

Yet most Russians do not care. Putin's public approval ratings have remained phenomenally high even the Kursk triggered only a brief dip. At the end of last year one nationwide poll asked Russians whether they looked to 2001 with more hope than in the outgoing year. The vast majority said yes, though few could explain why. MORE>>
By ANDREW MEIER St. Petersburg

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 Medecins 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." MORE>>


Tolyatti also reveals the economic and social forces behind the rise of HIV in Russia. The trouble is drugs to be precise, heroin. Nearly every registered case of HIV in the city stems from a shared needle, primed with $2 worth of smack. "If we didn't have heroin," proclaims Mikhailova, "we would not have HIV."

The tragedy is born of prosperity. "We're a young city, and we're a well-off city," says Mikhail Khoutorskoy, head of the local health department. Once a boon, that combination is now lethal. Jobs at the car plant pay well by Russian standards. And nearly one out of five residents is under 16 years old. "These are the kids who wanted to live free," says Alexander Ablamonov, a weary doctor who nightly crisscrosses Tolyatti's most populous region "Car Factory District" answering SOS calls in one of the city's 44 ambulances. "They've got freedom now, and this is what they do with it." One recent night, Ablamonov and his crew responded to seven calls. Four were drug overdoses.

The Ministry of Health whose AIDS department comprises a staff of three cannot cope. It cannot even keep an accurate tally of the HIV cases registered. The federal statistics lag far behind the numbers reported in the provinces. In Irkutsk, the Siberian city that thanks to a sudden flood of Central Asian heroin witnessed an HIV explosion in 1999, seven out of 10 addicts tested are infected with HIV. "The numbers grow by thousands each week," Savchenko concedes , while the federal funds budgeted for all AIDS programs in 2000 was a scant $1.75 million. "We need more than an education campaign," says Pokrovsky, the federal AIDS center director. "Putin must see this as a national security threat. He must declare war on HIV."

As grim as the epidemic is now, the prognosis is worse. Unlike the early stages of the AIDS crisis in the West, HIV in Russia is spread among the country's burgeoning population of intravenous drug users an estimated 2 to 3 million nationally. "Today the infected are mostly addicts, but addicts are sexually active and addicts also become prostitutes," says Dr. Yevgeny Voronin, who heads a clinic in St. Petersburg that is Russia's largest facility for mothers and children with HIV. As the virus spreads through sexual contact, experts foresee a heterosexual HIV boom in three to five years. Condoms, once scarce in the U.S.S.R, are now in every pharmacy. But they are rarely used.

The virus moves swiftly but invisibly. Only 741 Russians are known to have died of AIDS to date. "It's hidden because we haven't yet had one known case of AIDS in our city," says Mikhailova in Tolyatti. "But in a few years, the plague will appear before our eyes." Pokrovsky explains: "Treatment today costs $10,000 a year, and in eight years we are likely to have a million people with AIDS. And so the state would have to spend at least $10 billion on treatment. The question 'To treat or not to treat' will arise, and given our federal budget, I think I know the answer we'll hear."

Still, those on the front lines have hope. More and more Russian cities are launching prevention programs, like those in St. Petersburg, Irkutsk and Tolyatti, where former addicts have teamed up with doctors to stem the HIV tide. Not all understand the urgency of the cause. In Irkutsk, local officials have thwarted attempts to distribute clean needles, but in Tolyatti two needle exchange points opened last fall. "It may be a small step," says Mikhailova, "but it's a big one psychologically." She notes that the city even funded the program, giving a grand total of $28,571.

"No one can save us except ourselves," says Aleksei Surikov, a 25-year-old former addict who works in a fledgling Irkutsk detox center that has helped more than 50 young addicts go clean. "If we do nothing, we'll lose every addict here. They believe in nothing. Not the state, not the church, not school, not their parents. But if we can reach them, something changes. We can help them change their lives."

These street warriors know well they face a Sisyphean struggle. Russia's health care system is antiquated, worn-out and desperately underfunded. The World Bank is expected to lend Russia $50 million for HIV and AIDS prevention and $100 million for TB treatment. "Russia still has a window," says Jean-Jacques de Saint Antoine, head of the World Bank's Russian health program. "The virus has barely entered the mainstream population." But from the country's head AIDS doctor to the prevention activists on the St. Petersburg bus, people involved in the HIV fight know that the funds, spread out over five years, will not suffice. They complain above all of the silence in the Kremlin. "It comes down to economics and a political will," says Voronin, the young doctor in St. Petersburg. "Putin must make HIV his top priority. Never mind Chechnya. This is our future and we are losing it."

Late last year the author and Nobel laureate Aleksander Solzhenitsyn described the crisis bluntly, questioning the urgency of Putin's campaign for a new state hymn and flag. "You cannot save a dying country with symbols," the writer chided. "When men are dying without any hope in the prime of their lives, it makes no difference what hymn is sung over their heads." Adds Mikhailova in Tolyatti: "Attention must be paid, and something must be done." The politicians may not like it, but as more and more young Russians succumb to HIV, it will become harder to hide the obvious: Russia stands to lose a generation. BACK>>
By ANDREW MEIER St. Petersburg

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 Medecins 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." MORE>>