Молчание = Смерть (Silence = Death)

For Rodrick.

Two weeks ago readers of the Moscow Times were met with a rather chilling article on the front page. The headline: “Growing Number of Army Draftees Have HIV”. According to Major General Valery Kulikov the number of draftees rejected by the Russian army with HIV “skyrocketed by 27 percent over the past five years.” Last fall, 9000 were rejected for having HIV. Before 2000, only 300 were rejected. The military admits that this new figure is difficult to quantify because there aren’t reliable numbers of HIV/AIDS of the population as a whole to compare to, the extreme reluctance of the Russian armed forces to discuss the matter, the lack of equipment for reliable testing, plus recruits are not systematically tested. In many ways the military is a microcosm of the overall problem of HIV/AIDS in Russia.

The prognosis for Russian is not good. For 2004, UNAIDS estimates 420,000 to 1.4 million cases of HIV/AIDS, compared to the official Russian figure of 240,000. By 2020, they predict 5.3 million to 14.5 million cases, and 252,000 to 648,000 HIV/AIDS related deaths per year. For female sex workers, the estimates are staggering: 33.3% of female sex workers between 15-19 years old, 63.5% 20-24 years old, and 40% between 30-34 years old are infected with HIV. The numbers are shocking. Russia has the undesirable distinction of having the highest rate of HIV infection in the industrialized world.

Some might ask what the point of yet another article about the problem of HIV/AIDS in Russia. The issue is not new. There perhaps nothing new that one can say. Not to mention that nothing can top Michael Specter’s profound and chilling explication of the global AIDS pandemic in his series of articles in the New Yorker. (Unfortunately, Specter’s article “The Devastation” is not available online without paying. However, you can read an interview with him discussing the issue here. You can also get the article through Lexis-Nexus if you have access.) The issue might not be “new” and there might not be much more one can say about it. But the problem is real. All too real. It is also being consistently ignored by the Russian government and society. All one can do is scream. Scream so loud into the darkness of ignorance and denial in hopes that a ray of sense pierces through.

Pointing out the dire situation that exists in Russia on the HIV/AIDS front has nothing to do with Orientalist pretensions. This is no East/West thing. This has nothing to do with our “superiority” and their “backwardness.” It is about life and death. It is about a preventable problem. It is about putting the breaks on a still emerging epidemic. In fact the Russian case is illustrative of the global problem. The Russian discourse on HIV/AIDS is reminiscent of how the American government dealt with the issue in the 1980s. Hell, much of it is so strikingly similar to the American discourse now.

After I read Specter’s article I asked a young Russian friend of mine about what she knew about AIDS. At first, my questions were met with blank stares. The reality of AIDS in Russia just flew over her head. She did respond and her response was telling: “Well, this disease only afflicts drug users and homosexuals.” That’s right the dregs of society, the depraved, the “abnormal.” One can’t really blame her. Much of the official discussion is about these “high risk groups.” Since they continue to engage in these risky behaviors they will be more likely to get HIV. Behind such statements is an implicit: “They deserve it.” Specter noted similar in his piece. As an unnamed “prominent” Russian liberal told him in reference to drug addicts, “AIDS might be a good thing, in a way, because it is killing people who only destroy the country anyway.” However, behind such crude and social Darwinist statements is also its binary opposite: those who don’t engage in those practices are “safe.”

My argument is not with the fact that HIV/AIDS infection is higher among these groups. My problem is about how the creation of the category of “risk group” suggests a “safe group.” You can see it in statements like the following from Mosnews.com:


“In those countries [Southeast Asia, India and China], HIV is creeping out of marginalized urban groups such as prostitutes and intravenous drug users and into the population mainstream. The latest research gives a strong statistical boost to those warnings.”

“Urban groups” versus “population mainstream.” Our concern should not be with the former. We know what that code screams. It is the latter that is troubling. What is the “population mainstream”!? And if the AIDS is penetrating into the “population mainstream” means heterosexuals, non-drug users, and people who don’t go to prostitutes, then isn’t there something equally risky about their behavior? Shouldn’t they also be lumped in with the so-called risk groups? The point is that ultimately HIV/AIDS does not discriminate. It does not care about risk groups, urban groups or population mainstreams. The pandemic has gotten worse in the last 20 years not better, especially in Africa, India, China, and now Eastern Europe/Russia. Isn’t it time to stop speaking about “risk groups” and time to start talking about safe sex?

It is here that the ideology of sex of in Russia and the United States converges. They both assume a hetero-normative position based on the ideal of monogamy. We know all too well, or we should know, that the Bush Administration has tied AIDS funding to abstinence education. The idea behind this is that no sex until marriage will cut down on unwanted pregnancy and STDs. Such a policy is starving organizations that urge condom as they find themselves more and more excluded from the money trough. Just read Helen Epstien’s excellent article “God and the Fight for AIDS” in the New York Review of Books.

The Russian case is different in this respect. There isn’t the brick wall of religion in the way. Denial has a different optic. Consider this statement from the article “Sex in Russia: Teeming with Unpleasant Surprises”: “On the other hand, an average Russian’s thoughts on safe sex include the following maxim: Having sex while wearing a condom is like smelling flowers while wearing a gas mask.” Yeah sure, and having sex without a condom could also be like inhaling nerve gas without a gas mask. The article continues that the risk/safe binary is so ingrained that:


“Many people doubt they can contract a disease simply because of their high social status – surely they and people they sleep with can’t possibly be infected. But STDs know no social boundaries, [urologist, Dr. Leonid] Spivak says: “Quite frequently, young women come in thinking they have cystitis [a urinary tract infection] that won’t go away, and we find gonorrhea. Of course, when you tell a young woman who’s well-off and professional and certain she’s clean that unfortunately, she has such a disease, she’s going to be rather shocked.”

I’ve read and heard other, more outlandish beliefs about AIDS. Myths and folklore that produce a shock in me perhaps comparable to that of the HIV infected “well-off and professional” Russian woman. AIDS is a number of things here. Rarely these things are anything close to the truth. AIDS is a CIA conspiracy. AIDS can be contracted by a cough, kissing, even touching. Many don’t understand the basic complexity of the disease—that there is a time lag between infection and symptoms. That it is a blood born disease that has a short lifespan outside of a plasma environment. Education about AIDS is sorely lacking. But the Russians do not possess a monopoly on such thinking. A recent U.S. Congressional report on sex education showed that many American teens think similarly.

It also doesn’t help when the disease itself is so infused with stigma. Because many associate HIV/AIDS with risk behavior, those who are actually brave enough to disclose their infection to family, partners or even doctors can sow suspicion, hatred, and disgust. According to a Human Rights Watch report, HIV-positive women are frequently berated by doctors and nurses, sometimes refusing them treatment. Natasha R, a HIV-positive woman in her thirties from St. Petersburg, told Human Rights Watch the following:


“She and her friends have found one way to avoid the contemptuous glances and rude treatment at the clinic – they have stopped going there altogether. “We go to our own clinic,” she said, referring to the St. Petersburg AIDS center. In theory, the local clinics are supposed to treat all HIV-positive patients within the district for comprehensive medical care—gynecological, dental, surgery, etc. But since many of these local doctors refuse to treat HIV-positive patients—and many HIV-positive patients refuse to continue to go there—the AIDS center has to pick up the slack. The lines are often very long, says Natasha R., but it is worth it to be able to avoid her local clinic”

Lenin’s slogan “??? ????” (who beats who) is eternally caught in a historical echo chamber. Its meaning and context changes but its core rhetorical power haunts the Russian societal landscape. If Russia was flesh those two words would protrude from its surface as keloid scars. ??? ???? silently hovers over the problem of HIV/AIDS. The question remains as to whether Russia will be “???” or will be “????”. At the current pace Russia will be the object and not the subject of this phrase.

Sadly, full acknowledgment of this issue remains elusive. The Putin Government has taken steps, albeit very small, toward recognizing that there is a problem. Aleksey Kudrin, Russia’s Minister of Finance recently approved an addition $20 million to the global fund against AIDS, tuberculosis, and malaria for 2005-2008. Kudrin also reported on the particular threat AIDS poses to Russia. Mikhail Zurabov, head of the Health and Social Development Ministry, has also complained that the current government funding for AIDS treatment is only adequate for treating 1000 people. Even the outgoing U.S. Ambassador Vershbow noted the necessity to engage the Russian media to “talk up particular issues where we see problems that need to be addressed, whether it is sensitive issues like the independence of the media or social problems that they’re not paying enough attention to, like HIV/AIDS.”

Unfortunately, states have done miserably in combating the short but deadly life of AIDS in the late 20th Century. In star-fucker culture of America, it was the death of Rock Hudson and the infection of Magic Johnson that partially awoke a sleepwalking public. Some suggest that this is what Russia needs; one of their cultural icons to contract or die of AIDS to make the disease a mainstream reality.

But also In America it wasn’t until homosexuals took up radical positions toward sex that anything was accomplished. True they didn’t alter much as to how the government concretely dealt with the issue. What the activism of ACT-Up did with their slogan “Silence = Death” was to throw AIDS into the face of the homosexual community. It became a zero tolerance issue. Perhaps this is also one possibility for Russia. If the state isn’t going to recognize the issue then it must come from society itself. There are, however, signs of this necessary radicalism developing. In the tradition of ACT-Up, the group FrontAIDS looks to turn silence into death. They protest and chain themselves to government health buildings. They scream and shout about the reality of AIDS. We can only hope that their efforts are not in vain; that their small numbers can help penetrate the morass of denial. For this we can only wait and see. And hope. And hope that the shocking quantitave particularies of HIV/AIDS do not become a horrific qualititive universal.