The Russian city Chelyabinsk is a major transit point for drugs coming from Central Asia and Afghanistan. Because of that, there has been a dramatic increase in drug use and, with it, an explosion in HIV. Local officials estimate 1 in every 100 residents is now infected — twice the national average.
JACKI LYDEN, host: We'll turn to Russia now and the city of Chelyabinsk, which has become a major transit point for drugs coming from Central Asia and Afghanistan. Narco trafficking has led to a dramatic rise in drug use and with this, an explosion of HIV. Local officials estimate one in every 100 residents is now infected, twice the national average in Russia. The government was slow to address the issue of HIV. And as NPR's Anne Garrels reports, the area is paying a steep price.</s>ANNE GARRELS: Every night, a gray van from the city-backed AIDS center pulls into a different neighborhood. The team inside includes a doctor, a psychologist, and a former addict who now works for the Protestant Rehab Center. They offer blood tests and counseling. A young heroine addict accompanied by her child slides open the door to get her results. She's HIV negative, but positive for hepatitis C. Dr. Natalia Golubia(ph) gives advice on what to do next.</s>Dr. NATALIA GOLUBIA (Physician, Chelyabinsk, Russia): (Through translator) 30 percent of those who come in for tests are positive for HIV. Almost all have hepatitis C.</s>ANNE GARRELS: The team also offers a needle exchange program, though Pavol Bimacoff(ph), the team's 21-year old psychologist, says they don't talk about this publicly.</s>Dr. PAVOL BIMACOFF (Psychologist, Chelyabinsk, Russia): (Through translator) Many people here are against it, and we don't want protests. Many think drug addicts and those infected with HIV should be isolated. Despite a recent information campaign, many still don't know enough, and many just don't want to know.</s>ANNE GARRELS: Compass(ph), the city's AIDS center, is run by a hip young doctor, Sergai Avdeyef(ph). He offers support groups, sends the mobile van out every night, and provides a few beds to former addicts just out of prison who are at risk on the streets.</s>Dr. SERGAI AVDEYEF (Head, Compass AIDS Center, Chelyabinsk, Russia): (Through translator) We only have five beds, but at least we can offer them a break and begin their case management.</s>ANNE GARRELS: He compares attitudes here to the backwoods of Arkansas, which he once visited. Battling prejudice and ignorance has been hard.</s>Dr. SERGAI AVDEYEF (Head, Compass AIDS Center, Chelyabinsk, Russia): It's not just the school administration, which can be a problem. It's the kids. Kids are cruel. We are most afraid of parents of children who can hurt and affect a child, so it's important this information remains confidential so a child can go to school.</s>ANNE GARRELS: The government's programs have focused on drug addicts, but Avdeyef says the hidden gay community is also at risk.</s>Dr. SERGAI AVDEYEF (Head, Compass AIDS Center, Chelyabinsk, Russia): Homosexuality is still considered a sin here. I don't know any openly gay men. Helping to find those who are infected is hard. You think it's not a problem, but it is.</s>ANNE GARRELS: Dr. Avdeyef attributes the good care now in place to his mentor, the head doctor at the Regional Infection Center, Alexander Vizcuzoff(ph). He diagnosed the first case of AIDS here in 1990.</s>Dr. ALEXANDER VIZCUZOFF (Head Physician, Regional Infection Center, Chelyabinsk, Russia): (Through translator) The first patient was a homosexual. The authorities did not think it was much of a problem.</s>ANNE GARRELS: Vizcuzoff says the government waited six long years to respond. Faced with an economic crisis, officials had other priorities, and he didn't get necessary funds for medicine or prevention. In the meantime, drug use exploded. Addicts infected their partners and unborn children. He says one in every five prisoners now has AIDS, with many more probably HIV-positive.</s>ANNE GARRELS: Some here say the government only truly got mobilized when the children of some senior officials got involved with drugs. Vizcuzoff now has all the medicines he needs to treat his patients for free, and he's constantly on the road educating the region's doctors and community leaders.</s>Dr. ALEXANDER VIZCUZOFF (Head Physician, Regional Infection Center, Chelyabinsk, Russia): I just met with the local Muslim leader and the Orthodox priest in a village where there are several new cases. The mulla was convinced AIDS is a curse from God. He now understands the problem.</s>ANNE GARRELS: He's drawn together specialists who help AIDS patients with legal and emotional problems, and he's clearly much beloved by his patients.</s>ANNE GARRELS: 28-year-old Renad Pazvoy(ph), a former drug addict with AIDS, comes in for blood tests. This thin, young man in jeans and a black baseball cap greets the doctor with a warm hug.</s>Dr. ALEXANDER VIZCUZOFF (Head Physician, Regional Infection Center, Chelyabinsk, Russia): He knows his blood counts. I love it when I can talk to a patient about  details! When he understands his levels, it means he is involved in his treatment.</s>ANNE GARRELS: Renad, who lives in an outlying town, says he can't reveal he has AIDS or he would immediately lose his job.</s>Mr. RENAD PAZVOY: (Through translator) This is not the West. This is the Urals. By law, they can't fire me, but if I told anyone in town, there would be real problems, and it's not going to change any time soon.</s>ANNE GARRELS: The AIDS program is understaffed. Vizcuzoff is worried about the impact of yet another financial crisis.</s>Dr. ALEXANDER VIZCUZOFF (Head Physician, Regional Infection Center, Chelyabinsk, Russia): These medicines are too expensive for people to buy on their own. Without them, my patients will die.</s>ANNE GARRELS: At Compass, Dr. Avdeyef invites me to come back to Chelyabinsk in another 10 or even 20 years, when the region might be more tolerant, qhen those with HIV are not afraid, when there's a gay bar, and when everyone who needs treatment can openly receive it. Anne Garrels, NPR News, Chelyabinsk.