THE DEVASTATION
Since 1965, life expectancy for Russian men has decreased by nearly six years. And now there is AIDS.

The first days of spring are electrifying in St. Petersburg. The winters are hard and dark and long, and when the light finally returns each year thousands of people pour onto Nevsky Prospekt and into the squares in front of the Winter Palace and St. Isaac’s Cathedral. Petersburg has always been more open and more openly European than other Russian cities, and the day I arrived this spring was the first on which men in shirtsleeves could fling Frisbees across the endless avenues. I settled into one of the many coffee shops along the Neva River—they are a recent innovation—and noticed something else that was new: a large stack of pamphlets advertising an H.I.V. support group. aids is not a subject that people talk about much in Russia. Even though the epidemic is spreading here more rapidly than anywhere else in the world, there are virtually no public-service ads on television about it, and the government spends next to nothing on prevention, treatment, education, or care. This year, the entire budget for H.I.V.-related matters is a little more than five rubles per person, less than the cost of a pack of cigarettes. St. Petersburg has been a rare exception to what seems like an official policy of ignorance and neglect. The city is responsible for the first program in Russia that sends buses to deliver information—and clean needles—to people who cannot be reached in other ways. It also pays for health workers to travel to schools, hospitals, and even construction sites to inform people about their choices. Condoms are available, and often free. Almost two years ago, St. Petersburg opened the country’s first aids hospice. There is still only one. Funded with local money, it sits not far from the city’s Botkin Infectious Disease Hospital, one of the largest such facilities in Russia. The hospice is small; it has just sixty beds, and they are not filled. The director, Olga Leonova, is a valiant woman with an impossible job: trying to assure patients that they have a future while convincing everyone else that aids threatens to turn Russia back into the Third World country it was before the Second World War. “You can see it getting worse every day,’’ she told me as we walked around the floor one morning. “It’s not just drug addicts now.’’ For years, H.I.V. infection in Russia was driven almost exclusively by shared needles. “We are seeing pregnant mothers and people we would never have even tested in the past.’’

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A Disappearing Country
This week in the magazine and here online (see Fact), Michael Specter discusses the burgeoning problem of aids in Russia, and the wider demographic crisis that threatens the nation’s future. Here Specter talks to The New Yorker’s Amy Davidson about the connections between disease, democracy, and Russia’s place in the world.

AMY DAVIDSON: You’ve previously written for The New Yorker about the aids crisis in Africa and in India; this week, you look at aids in Russia. What makes the situation different there? MICHAEL SPECTER: It takes an average of ten years before somebody who is infected with H.I.V. shows the signs of aids; the epidemic hit much of Africa before anybody on earth knew that it existed. In addition, the poverty in Africa is acute. In India, much of the population is desperately poor, diseases like malaria are epidemic, and millions are illiterate. Russia had the special advantage of avoiding the earliest waves of the aids epidemic. It is a highly literate country. Yet the Russian government has done almost nothing to capitalize on that advantage. It seems a special shame for an epidemic to be spreading in a country that is not poor, and at a time when so much is known about how to prevent infections.

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Russia is dying. As it deteriorates it becomes more unstable. Something to watch.