On front line of AIDS in Russia

The young Russian woman with hoop earrings and blond hair tucked under her baseball cap, couldn't appear healthier.

Her jeans jacket, blue sweater, and calm demeanor frame the promise of a saleswoman on her way up.

But Irina has been keeping a secret from her parents and all but five intimate friends: Four years ago, on her 18th birthday, she was diagnosed as HIV positive - making her part of the tip of an HIV/AIDS epidemic in Russia that is shifting from high-risk groups like drug users to mainstream society.

Irina, who says she never used drugs, is pregnant, too, with a boyfriend who is also HIV-positive. Her dream, she says, is to have a healthy child and move forward with her life. But the shock of her diagnosis lingers.

"I was so careful about my health ... but nobody has any guarantee," she says, wiping away tears. She believes she became infected by a previous boyfriend when a condom broke. "I never thought I would have HIV. I was 100 percent sure it was something that could never happen to me."

The human cost of Russia's epidemic, which so far counts an estimated 1 million cases of HIV, is growing fast in cities like Tver, 100 miles northwest of Moscow. A wildly overgrown and grungy industrial city of about half a million that sits along the St. Petersburg-Moscow drug-trafficking route, Tver witnessed one of the earliest outbreaks of heroin and opium addiction in Russia - and some of its cases of HIV/AIDS among users who shared needles.

As a result, Tver provides a glimpse into the future of Russia's AIDS crisis - in particular, how HIV has leapt beyond tight circles of drug users. The city also demonstrates how some communities are beginning to respond by reaching out to a broader audience.

"We are trying to explain to the population what this infection means," says Alexander Kolesnik, chief doctor of the Tver Regional AIDS Center. "Some find it difficult to understand: The popular stereotype is that HIV means drug users ... but now it has changed. Even when people know sexual contact is the main way of [HIV] transmission, it is very difficult to change their behavior."

"Many think HIV is not about them," says Tatiana Vinogradova, a doctor at the AIDS Center, which is housed in a battered Soviet-era kindergarten building. "They usually judge people by their appearance: they see a normal person, with normal clothes and no alarm bells, and they think they are a normal [sexual] partner."

In late 1996, the Tver region registered just seven cases of HIV. But the drug trade - combined with bleak futures for youths and heroin that cost less than cigarettes - caused addiction and HIV to surge.

By the end of 2001, Tver had 2,870 diagnosed cases of HIV. Today the official figure stands at more than 4,000, with estimates of the real number soaring to 16,000 cases and beyond.

Drug use has dropped by nearly two-thirds, thanks to higher-priced, poor quality heroin that has made amphetamines and alcohol more fashionable. But HIV continues to spread.

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