The United Nation's Children's Fund, UNICEF, recently released a report saying that the spread of aids AIDS is growing faster in the former Soviet Union than anywhere else in the world. The report warns that the victims are becoming younger and more of those infected with the virus that causes AIDS are female. To learn more about this growing problem, VOA's Betty Van Etten went to the Saratov region of Russia, and spoke with former prostitutes and intravenous drug users.
In the city of Engels Russia, Lena was a former intravenous drug user. She also ran a prostitution ring she called her "company."
"I shot up with the needle about nine years. Had a company of my own with this type of girls. Then I closed the company and stopped shooting up."
Lena was not alone in running a prostitution ring.
"My name is Natalya. I also had a company with commercial sex girls."
The past behaviors of Natalya, Lena and other prostitutes and drug users in this group put them in two of the highest risk groups for contracting the human immunodeficiency virus that causes AIDS. Volodya is a recovered drug addict trying to cope with AIDS.
"My name is Volodya. I am perhaps the best choice for this topic, because I am HIV positive. There, you have it. I started using drugs in 1991, heavy drugs, intravenously. I got infected through a syringe in 1998. My wife also caught HIV and a year later she died of pneumonia."
The number of AIDS related deaths in Russia will only increase according to Dr. Vadim Pokrovsky, head of the Russian Federal AIDS Center.
"We can calculate that about a million people may have already been infected, and since the average lifespan of these people is about 12 years, we can expect as many as a million people to die of AIDS within 12 years," he said.
The Saratov region may be more progressive than other parts of Russia in fighting AIDS. An AIDS and infectious disease clinic, was built there with local government funding. Doctor Lyubov Petrovna Potyomina says in 1998, only 400 people came for testing, screening and counseling. Now she says 10,000 come each year.
"I can say every month, the number of HIV positives keeps growing due to this voluntary and anonymous examination," Dr. Potyomina said.
But to reach those not likely to come to a clinic, Lena and other former prostitutes and drug users take the message about HIV prevention to the streets. Lena talks with prostitutes about the need for condoms and where they can go for free medical tests for HIV and other sexually-transmitted diseases. She has found two young women willing to talk, both young and pretty. They say they work as sex workers because they need the money.
"Well, girls are you aware of the project on decreasing harm in our city, to prevent the spread of sexually transmitted disease and AIDS in particular?," Lena asks. "Girls, I have not yet given you these booklets. Here one, two, I'll also give you cards. Look this one is for a free, anonymous check up by gynecologist."
As Lena hands out condoms, the sex workers say they are concerned about AIDS and ask their clients to use condoms. But when questioned further by Lena, the prostitutes say their regular customers pay extra to not use a condom.
Lena: "But when the client pays extra and asks you to work without a condom do you work without a condom?
Prostitute: "No, it happens very rarely."
Lena: "But it does happen doesn't it?"
Prostitute: "It does, but only with our regular customers."
For the former sex workers and drug users it is a battle against misinformation and public perception. One young man speaks with passion about how little he believes the public cares about drug addicts.
"Those who have nothing to do with drugs, couldn't care less about all these problems," he said. "The problem of drug addicts is of interest to no one but drug addicts."
However, Dr. Pokrovsky, head of the Russian Federal AIDS Center, warns it is wrong to assume the AIDS epidemic in Russia is primarily tied to intravenous drug use.
"In a way, this in incorrect information, it may be correct in essence, but as for prevention, it kind of pacifies people and they think the threat of infection comes from drugs only and they are not afraid to get infected through a heterosexual," he said. "As for us, the biggest fear is that the virus will be passed to the heterosexual population, and this will trigger the spread of the virus epidemic through sex among the heterosexual population, which may become exactly like the situation in Africa. This is exactly what we don't want."
The group that organized Lena and the others to work with high risk groups is Population Services International in Saratov. Director Olga Andrianova says its efforts also include aids prevention in the general population.
"And if three years ago the word 'condom' made many of them shake and turn pale or blue, I mean those in the management who issue permits to do something, and it was impossible for me to talk with them about it, now the situation is changing," Ms. Andrianova said.
And it is crucial, she says, to get that message to the public, especially teenagers.
"There is no correct and normal information, because it is not provided in schools and in general, they are very reluctant to speak about it, about safe sexual behavior," she said.
The lack of information and prevention will take a toll on Russia according to Doctor Pokrovsky.
"If the epidemic keeps growing, it will create a serious threat to the population number in Russia and to the country's economy," he said.
Does Olga Andrianova feel she is winning this battle?
"Good question, I hope, at least when we try to do something, it's already a good step. If you do nothing, nothing will happen," she answered.
And Lena who has worked on both sides of the street knows it.
"There is of course a problem here, which is international in a sense," Lena said. "We can't cope with it on our own. We need somehow to band together, to meet more often and in general, all of us have kids, including me, I have a son and I tell him everything. He is far from it yet, but at least he is afraid of AIDS."
But unless others have the same fear, the spread of aids, the outlook for Russia is dim.