Half of All Prostitutes In City Have HIV

A joint research project conducted by the St. Petersburg Pasteur Institute, and nongovernmental organizations Humanitarian Action and Stellit show that about 260,000 people in Russia are registered as HIV-positive. Of those, 26,000 are from St. Petersburg, said Tatyana Smolskaya, head of the Northwest region AIDS Center, which is part of the Health Ministry and Social Development Ministry.

Humanitarian Action president Alexander Tsekhanovich attributed the high concentration of HIV infections in St. Petersburg as being due to "a very big increase in drug use some years ago" and said that every third drug user in the city is infected. Nearly all St. Petersburg prostitutes are drug users.

"In Moscow, only 15 percent of street prostitutes are HIV-positive and in St. Petersburg, it's 48 percent," Smolskaya said.

Of that 48 percent, 96 percent use drugs intravenously. In Moscow, only 12 percent of HIV-positive prostitutes are intravenous drug users. In St. Petersburg there are more female HIV-positive drug users than men, she added.

"St. Petersburg has become the leader in the number of women getting HIV from street prostitution," Smolskaya said. "This is not by accident ... because street prostitution is almost a synonym for drug use."

In Moscow, pimps and madams manage the girls' time and life, dictating what is and what is not allowed. There, prostitution has become a highly organized profession, while in St. Petersburg, each girl is independent, Smolskaya said.

"Here in St. Petersburg, each girl just goes out and works by herself," she said.

When the prostitutes are managed, their lifestyles are controlled. If a prostitute gets involved with drugs or contracts HIV in Moscow, she will be discarded.

"In Moscow, if the girl takes drugs and somebody knows, she is expelled from the system," Tsekhanovich said,

In St. Petersburg, prostitutes pay a percentage to the police or militsia to work the streets.

A Humanitarian Action employee estimated that the militsia could rake in as much a $5 million annually from prostitution here.

But the militsia do not regulate the sex workers' lifestyles. Prostitutes here are free to choose whether or not to use a condom.

Some clients pay the prostitutes more money for unprotected sex.

"The prostitutes say this is the main reason why they don't use condoms," Smolskaya said.

St. Petersburg prostitutes, without the management of madams or pimps, are also free to abuse drugs.

"Practically all of them are drug users." Smolskaya said, a statement confirmed by a sex worker on Friday.

The 27-year-old woman came to a Humanitarian Action-sponsored bus, which travels the city passing out condoms and exchanging clean syringes for used ones.

The woman exchanged 150 syringes and 120 needles and collected free condoms.

She said she never reuses syringes and only has sex with men who agreed to use a condom.

"Life is hard," she said, her orange-fuchsia lipstick smeared haphazardly on and around her lips. "You want to break free from the drugs and this life, but you can't."

An addict for 4 years, the woman had worked as a hairdresser previously. She tried snorting heroin after her friends told that unlike alcohol, heroin does not result in a hangover.

At first, 50 rubles ($1.74) worth of the drug satisfied her and her two friends. But the woman became hooked and within a year, she had become a prostitute to support her drug habit. Now she spends $1,000 a month on heroin and injects it intravenously.

"Practically all the money [earned by prostitutes here] is for drugs," said Alexander Komarovsky, a doctor who travels with the Humanitarian Action bus.

Smolskaya said St. Petersburg prostitutes' plight is bad whichever way you look at it.

"On the one hand, they catch HIV because they get the virus through a syringe or a sexual partner," she said. "On the other hand, they can pass the disease to their drug-using partners and their sexual partners."

"HIV is going to keep spreading," Smolskaya said, adding that it is a "hidden" epidemic.

Tsekhanovich said although there have been fewer HIV cases reported in the last few years than previous years, the problem has not been solved because the epidemic is passing through several phases.

In the first stage it built up critical mass, in the second it became concentrated among specific at-risk groups - such as drug users - and the third and final stage is generalized. When that stage matures, getting HIV will be a risk in any sexual contact, not just sex with drug users or prostitutes.

Tsekhanovich said Russia is currently entering the final phase of the epidemic.

In addition, the government can only assess the number of those with HIV or AIDS that are officially registered.

The number of people who don't report their condition is unknown, making the disease even more difficult to control and estimate.

Many experts say the official numbers are not accurate and should be increased by anywhere from three to five times to reflect the real problem.

"Nobody knows the official number because there is no official notion of prostitution," Smolskaya said.

"I don't believe any of these numbers," said Murray Feshbach, one of the world's leading experts on Russia's health crisis. "The real number (of officially registered HIV cases) is 'God knows.' I would accept the figure much closer to 750,000 than I would to 270,000, but I use it to get started."

As of February, only about 4,900 Russians have died of HIV-related illnesses or AIDS. The optimistic projection of AIDS deaths each year by 2020 is 228,000. Pessimistically, that number could reach 648,000 per year, Feshbach said in a telephone interview from Washington.

"It's going to change the structure of the causes of death in the country; it's going to maybe finally get the message through," Feshbach said. "Not enough people have died yet because it doesn't grab the attention ... it's not the right people [who would capture the nation's attention] who die."

According to the Russian Federal Aids Center, only 18 cases of AIDS are registered in St. Petersburg.

"That's just not right," Feshbach said. "The whole explosion [of HIV cases] essentially took place in '97, '98, '99 ... It takes three to five years to convert HIV to AIDS. So if it's '98, we're talking about just the beginning of this explosion to AIDS. So that number of 18 isn't even worth talking about."

About 80 percent of those infected with HIV are aged under 30, which will direly affect Russia's demographic crisies, Feshbach said.