HIV soars in Russian city

Drug addicts in a cramped Yekaterinburg rehabilitation centre

The BBC's James Rodgers travels to Yekaterinburg ahead of next week's International Aids Conference in Durban to examine the increasing number of HIV cases there.

Yekaterinburg is a city with a special place in Russian history. It is the place where the last Tsar of Russia, Nikolai II, and his family were shot by Bolshevik revolutionaries.

It is also the home town of the first post-communist Russian president, Boris Yeltsin.

However, it is becoming known as one of the areas of Russia where HIV is threatening to reach epidemic proportions.

If you walk around the streets of certain areas of the city in the evening, it is not hard to see why.

Sex and drugs trade boom

At intervals along the length of Shchorse Street, prostitutes wait for clients.

A heroin addict stumbling around the city centre

There are more than 5000 registered heroin addicts in the city, which has a population of about 1.5 million.

Medical officials and voluntary workers accept that this is probably a fraction of the real number.

Now we have to take decisive, adequate, measures to stop the increase.

Victor Chirkov, Chief Health Officer

The same goes for the HIV infection figures which now officially stand at 354.

What is clear, as the city's Chief Health Officer Victor Chirkov points out, is that registered cases are increasing at the rate of 42% a month.

"We are at the beginning of an epidemic," says Mr Chirkov.

"And now we have to take decisive, adequate, measures to stop the increase. Even if we can't stop the increase, then we must at least significantly reduce it to keep as many people as possible healthy."

Breaking the habit

Addicts agree to be chained to their beds

For one group in Yekaterinburg, called A Drug Free City, those measures include chaining addicts up until they break their habit.

In a wooden house outside the city, 20 or 30 young men are handcuffed to metal beds 24 hours a day.

They say they are glad to be there, but that they are not free to leave.

"There's no other way," says 21-year old Dmitry.

"But anyone who's used narcotics will understand."

As part of the programme run by A Drug Free City, each user is taken for an HIV test at the local Aids clinic.

Dmitry: An addict who has been positively diagnosed with HIV

The handcuffs are not removed until they are in the surgery.

For some, breaking the habit coincides with finding out that they are HIV positive.

Dmity, who is 19, has received this news.

"It's as if you don't think about getting HIV," he says.

"You don't think about anything. That's the thing. You don't worry about what's going on around you."

Changing attitudes

Slowly, the city authorities are trying to change these attitudes, or at least give people the opportunity to protect themselves.

Yekaterinburg's first needle exchange opened this year

Earlier this year, the first needle exchange opened in Yekaterinburg.

It is one of the places which Britain's Secretary of State for International Development, Clare Short, visited recently.

She was concerned about the way society viewed drug users.

"There's an old kind of punitive attitude," said Ms Short.

"There are vigilante groups who beat people up. But of course if you do that, then you don't know what people are doing, and if they're sharing needles, they're spreading the infection, which will eventually spread outside the drug-using community - you're in trouble."

Yekaterinburg, and cities like it across Russia, will have to find a way of stopping this if the spread of HIV is to be contained.