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The young man sitting before the psychiatrist stared darkly at the wall and bit his lip to keep from crying. He had answered a dozen questions about his sexual habits and absorbed in silence a lecture about how AIDS would change his life.
I know how hard this is, but you have to believe me: nothing ends here. As if in answer, Aleksei stripped to the waist. He has three tattoos, but the one that draws the eye covers his left shoulder. It is a skull engulfed in huge batwings. Above the wings two English words have been burned into his skin: ''No Future.
Few words could apply more fully to Aleksei, who is 23, or to this odd and lonely city, which has suddenly become the center of what many experts say is the world's fastest-moving epidemic of AIDS infection. Kindled by a surge in the use of an easily contaminated liquid form of heroin, the epidemic has been fueled, as anywhere, by poverty and unemployment. But that is not why H. While the Soviet Union stood, official prudishness combined with totalitarianism to keep borders closed and sexual freedom to a minimum.
The AIDS virus, on the other hand, thrives on drug abuse and the open road. And since the fall of Communism, both have been particularly plentiful here, in the vague borderland between Europe and Russia. Kaliningrad is unique, but it is not alone.
A special economic zone that was supposed to become Russia's Hong Kong, it has floundered economically. But its status helped ignite the interlocking epidemics of drug addiction and AIDS that are now rolling across Russia.
An isolated outpost lost between Poland and Lithuania, Kaliningrad is one of Europe's essential crossro. It is a giant warehouse. Everything here is cheaper than it is elsewhere in Russia. Beer and vodka are a third of what they cost in Moscow. It is the best place to get smuggled cars and discount narcotics. There are 5, prostitutes on the streets in Kaliningrad, and more in clubs and casinos.
The syphilis rate -- a of sexual activity and a harbinger of AIDS -- is 3 times the average for Russia, and almost times the rate in Germany. After more than 15 years of an epidemic that has infected tens of millions of people across the world, there are few places on earth where the H. The virus has spread so fast in Kaliningrad that even the few people who are trying to do something are lost.
What you see in Kaliningrad today is only the beginning for Russia. Kaliningrad has now become the central pathway to Russia -- not just for cars or beer, but for disease as well. A year ago just 28 people here were known to have been infected with the AIDS virus.
As of Oct. From Kaliningrad, the truck routes -- and the epidemic -- head south through Belarus and Ukraine and north to St. It usually takes years for a person infected with H. But it only take minutes, and a quick contaminated dose of narcotics, to become infected at the park near the Baltika Stadium.
It has all happened that fast. He and officials here said that in a small sample of prostitutes who agreed to be tested, 85 percent were infected with H. A year ago the figure was less than 5 percent. Unicef, the United Nations Children's Fund, is considering starting a major program here, in part because so many of those affected are in their teens. Today, Kaliningrad is filled with an odd mixture of fear and complacency. Posters suddenly appeared throughout the city this week: ''Danger AIDS,'' they read, going on to warn residents that a disease ''worse than plague'' is upon them.
It then points out that every daughter on the way to a disco is under threat, as is every boy who might choose this as the day to stick a needle into his arm. The poster suggests that if things do not change soon, the only money in the city's slim health budget will have to be spent on AIDS.
But ignorance -- or perhaps more accurately, denial -- is the affliction that threatens Kaliningrad today more than any other. Some people here would call it an ignorance that should never have come to pass. Mormot is director of Kaliningrad's only AIDS center, a small nest of offices tucked behind the aging edifice of the city's ancient infectious disease hospital. The hospital itself has six H.
But because methadone use is illegal in Russia, the doctors there let them leave their beds and buy narcotics on the street once a day. Each time they leave the hospital, they take the virus back onto the street. Mormot said. You cannot convince a young drug addict or prostitute here that they are in danger, because most of them have never seen AIDS. That's the reality of it. Nothing else matters.
Dirty needles have always been the most efficient way to spread the AIDS virus. The way drugs are prepared in Kaliningrad has increased the efficiency to a grim science. Hymka, a liquid opiate that the addicts often mix with their blood to help it settle, is the drug of choice here. In the of people who tested positive for H. Less than 1 percent of them were drug abusers. Last year, 20 percent of those infected got that way by using dirty needles.
This year, as in much of Russia, the shift has been fundamental. Dreizin, the chief physician at the regional Narcology Hospital. The only people here who get AIDS any other way are prostitutes who have sex with infected drug addicts and children who are born to them. Dreizin says that there are about 10, addicts in the city and that many of them by now are probably infected with H.
Homosexual intercourse so far has played only a minor role in the spread of H. The reasons for drug use in Kaliningrad are not novel. Unemployment among the young is close to 50 percent, said Irina Vershinina, deputy chairman of the city council. There are few opportunities to advance and few avenues of escape. Throughout the day young men with stringy hair and dark jackets exchange what cash they have for their fix in front of the Polytechnic Institute or one of the local theaters.
Late at night the prostitutes add their commerce to the mix. There are no needle exchange programs. Although the local Governor, not a political radical by any means, has called for a closer look at legal prostitution and an end to Russia's long prohibition of methadone treatment of drug addicts, neither is likely. The idea of spending public health money on a methadone program for drug users is politically impossible in Russia at a time when there is not even money for the most basic programs of childhood vaccinations.
But when I do, I don't buy the Gypsy drugs. Most people here attribute the habit of mixing blood with the opiates to Gypsies -- although there seems to be no truth to the idea. So I'll be O. I don't do it that much, anyway. Oddly enough, the official who appears to recognize most clearly what Kaliningrad is up against, and is the most eager to do something about it, is Valery A.
Zaborovsky, a colonel in the Russian Interior Ministry who overseas the region's prison system. The head of the regional health department, Larisa Melchenko, refused in an interview to discuss any aspect of the AIDS epidemic or divulge the regional health budget. But Colonel Zaborovsky answered every question put to him and granted a reporter and photographer total access to a special prison ward for people infected with the AIDS virus.
Unlike most of his colleagues across Russia, he believes in making prostitution legal, opening methadone clinics and maybe even closing the AIDS ward at Special Prison That is the locked quarters where H. Their gray barracks looks like any other but comes at the end of a long row of prison housing not far from the city. The first four dorms have wooden picket fences in front of them and prisoners strolling aimlessly in the yards. The last dorm is hidden behind a locked concrete gate.
He said the isolation ward was a protection for the inmates -- those who are infected and those who are not. Rape is at least as common in the Russian prison system as it is in the United States. The ward itself is depressing, but no more so than its neighbors. Hot water is rare, medical treatment more so. Most of the men are in their early 20's. They want aid, hospital rooms and fancy new drugs that next to no one in Russia can afford.
Is that fair? Shouldn't I get a better break than that? About an hour earlier, Colonel Zaborovsky made the same point.Kaliningrad hookers Kaliningrad
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Kaliningrad: from Russian relic to Baltic boom town