Editor in Chief of Positive Nation, an HIV and sexual health magazine
Action is needed within 10 years
HIV is running out of control among the ruins of the former Soviet empire. Health workers are desperately worried by the rapid spread of the disease, which has been accelerated through widespread drug use, prostitution, ignorance and official apathy.
All over Russia, from St Petersburg and neighbouring Estonia in the west, thousands of miles over to Irkutsk in Siberia and throughout the Ukraine, young people are fixing up drugs and catching HIV.
The HIV rate in most of these countries has doubled every year for the last four years.
Experts warn that unless the problem is tackled swiftly it will result in large numbers of deaths. It could also pose a security threat, as already one third of prospective military conscripts have the disease.
A report in this week's issue of the Lancet predicts that the social problems in the former Eastern-block countries has resulted in a large number of injecting drug-users and a rise in sexually transmitted diseases. They say there will soon be a major HIV/Aids epidemic in eastern Europe.
Report author Francoise Hamers said: "In view of the current levels of HIV prevalence, eastern Europe will soon be confronted with a major Aids epidemic.
"By contrast, rates of HIV in central Europe remain low at present, but behaviours that promote HIV transmission are present in all countries. Improved measures to prevent further HIV spread are urgently needed."
We have a tiny breathing space before people start dying enmasse
Recent statistics show that at least 450,000 Ukrainians are HIV positive - one per cent of the population, or 17 times the UK rate. Nearly 90% of them caught it through drug use.
As a result, most also have hepatitis B and C.
One recent survey found that 56% of young drug users in the mid-Russian town of Togliatti are already HIV positive, most having acquired their infection in the last two years. Three quarters of them didn't know they had it.
It is also spreading to the other states of the former Soviet Empire.
Uzbekistan in Central Asia saw more cases of HIV in the first half of 2002 than had been recorded for the entire previous decade.
So far the official reaction to HIV has been dismal. The Russian government spent the equivalent of £3million on Aids care and prevention last year. That's about a hundredth the UK budget for 20 times as many people with HIV.
Most of that goes on very basic treatment. Not anti-retrovirals, no chance. One recent survey could only find 733 people on HIV drugs among the one and a quarter million people with HIV in the whole of Belarus, Russia, Moldova and Ukraine.
That is a lower proportion than in Africa.
Ilona van der Braak, who has worked on HIV in Moscow for the last seven years at the Aids Foundation East West, a non-governmental organisation founded in 2001 by Medecins san Frontieres, explained that the time to take action to prevent an epidemic is running out.
"Russians are very practical people. 'Tell us how to stop Aids and we'll do it' they say."
"We have about 10 years. Because it's such a young epidemic we have a tiny breathing space before people start dying enmasse.
"We'd better pray that the former Iron Curtain countries get some help with their HIV problem before then, or the consequences to world stability could be incalculable.
A recent UNICEF report forecasts that five to eight million Russians and 1.5 million Ukrainians could have HIV by 2010, and noted that already one third of prospective military conscripts in Russia are deemed unfit for service because of HIV and chronic hepatitis from drug use. The document concludes that HIV/Aids could become a real security threat.