ST. PETERSBURG -- Almost half of all prostitutes in St. Petersburg are infected with HIV, in large part because most local sex workers are drug users and the sex industry lacks the organization seen in Moscow, according to a new study.
"In Moscow, only 15 percent of prostitutes are HIV positive, and in St. Petersburg it's 48 percent," said Tatyana Smolskaya, head of the government's Northwest AIDS Center.
Of that 48 percent, 96 percent use drugs intravenously, she said. In comparison, just over 10 percent of the HIV-positive prostitutes in Moscow are intravenous drug users.
"St. Petersburg has become the leader in the number of women getting HIV from prostitution," Smolskaya said. "This is not by accident ... because prostitution is almost a synonym for drug use."
The study, conducted by the St. Petersburg Pasteur Institute and nongovernmental organizations Humanitarian Action and Stellit, put the number of HIV-positive people in Russia at about 260,000, with 10 percent living in St. Petersburg.
Humanitarian Action president Alexander Tsekhanovich linked the high concentration of HIV infections in St. Petersburg to "a very big increase in drug use some years ago" and said that every third drug user in the city is infected.
Tellingly, more female addicts are infected with HIV than male addicts in St. Petersburg, Smolskaya said.
One reason there are so many HIV-positive prostitutes is because they tend to work independently, Smolskaya said. "Each girl just goes out and works by herself," she said.
The prostitutes pay a percentage of their earnings to the police to work the streets. A Humanitarian Action official estimated that the police rake in as much $5 million per year from the trade.
The police, however, do not regulate the sex workers' lifestyles, and prostitutes are free to choose whether or not to use a condom. Some clients pay more for unprotected sex. "Prostitutes say this is the main reason why they don't use condoms," Smolskaya said.
But in Moscow, pimps and madams closely manage the lives of prostitutes and quickly abandon those who take up drugs or become infected with HIV, Tsekhanovich said. "If a girl takes drugs and somebody knows, she is expelled from the system," he said.
St. Petersburg sex workers, without the management of madams or pimps, are left free to abuse drugs. "Practically all of them are drug users," Smolskaya said.
Alexander Komarovsky, a doctor who travels with a Humanitarian Action bus that exchanges needles and hands out condoms on St. Petersburg streets, said he has seen many prostitutes working just to support their drug habits. "Practically all the money is for drugs," he said.
A sex worker who visited the bus on a recent evening confirmed this. The 27-year-old woman, who exchanged 150 syringes and 120 needles and collected free condoms, said she spends about $1,000 per month to support her four-year heroin addiction. "Life is hard," she said. "You want to break free from the drugs and this life, but you can't."
She said she was a former hairdresser and turned to heroin after friends told her that, unlike alcohol, it was not followed by a hangover.
She said she never reuses syringes and only has sex with men who agree to use condoms.
Smolskaya said the plight of St. Petersburg prostitutes is bleak. "On the one hand, they catch HIV through a syringe or a sexual partner," she said. "On the other hand, they pass the disease to their drug-using partners and their sexual partners.
"HIV is going to keep spreading," she said.
The World Health Organization and other international organizations have warned of an HIV epidemic in Russia. There are no reliable statistics for how many people have been infected with the deadly virus, but estimates run as high as 1 million. The number of officially registered HIV cases is about 250,000, according to the Federal AIDS Center in Moscow.
Figures from the Moscow health committee coincide with those in the new report. The committee's head, Andrei Seltsovsky, said last summer that 15 percent of prostitutes in Moscow have HIV. He also suggested forcibly testing prostitutes and drug users as two main groups at risk of contracting the virus, but the idea did not win support in the Moscow City Duma.
Murray Feshbach, one of the world's leading experts on health in Russia, said the 260,000 HIV cases cited in the report are far too low.
"The real number is 'God knows,'" Feshbach, a senior scholar at the Woodrow Wilson International Center for Scholars, said by telephone from Washington. "I would accept a figure much closer to 750,000 than I would to? 270,000, but I can use it to get started."
As of February, about 4,900 Russians had died of AIDS and other HIV-related illnesses. The optimistic projection of AIDS deaths each year by 2020 is 228,000, while pessimistically, that number could reach 648,000 per year, Feshbach said.
"In Moscow, only 15 percent of prostitutes are HIV positive, and in St. Petersburg it's 48 percent," said Tatyana Smolskaya, head of the government's Northwest AIDS Center.
Of that 48 percent, 96 percent use drugs intravenously, she said. In comparison, just over 10 percent of the HIV-positive prostitutes in Moscow are intravenous drug users.
"St. Petersburg has become the leader in the number of women getting HIV from prostitution," Smolskaya said. "This is not by accident ... because prostitution is almost a synonym for drug use."
The study, conducted by the St. Petersburg Pasteur Institute and nongovernmental organizations Humanitarian Action and Stellit, put the number of HIV-positive people in Russia at about 260,000, with 10 percent living in St. Petersburg.
Humanitarian Action president Alexander Tsekhanovich linked the high concentration of HIV infections in St. Petersburg to "a very big increase in drug use some years ago" and said that every third drug user in the city is infected.
Tellingly, more female addicts are infected with HIV than male addicts in St. Petersburg, Smolskaya said.
One reason there are so many HIV-positive prostitutes is because they tend to work independently, Smolskaya said. "Each girl just goes out and works by herself," she said.
The prostitutes pay a percentage of their earnings to the police to work the streets. A Humanitarian Action official estimated that the police rake in as much $5 million per year from the trade.
The police, however, do not regulate the sex workers' lifestyles, and prostitutes are free to choose whether or not to use a condom. Some clients pay more for unprotected sex. "Prostitutes say this is the main reason why they don't use condoms," Smolskaya said.
But in Moscow, pimps and madams closely manage the lives of prostitutes and quickly abandon those who take up drugs or become infected with HIV, Tsekhanovich said. "If a girl takes drugs and somebody knows, she is expelled from the system," he said.
St. Petersburg sex workers, without the management of madams or pimps, are left free to abuse drugs. "Practically all of them are drug users," Smolskaya said.
Alexander Komarovsky, a doctor who travels with a Humanitarian Action bus that exchanges needles and hands out condoms on St. Petersburg streets, said he has seen many prostitutes working just to support their drug habits. "Practically all the money is for drugs," he said.
A sex worker who visited the bus on a recent evening confirmed this. The 27-year-old woman, who exchanged 150 syringes and 120 needles and collected free condoms, said she spends about $1,000 per month to support her four-year heroin addiction. "Life is hard," she said. "You want to break free from the drugs and this life, but you can't."
She said she was a former hairdresser and turned to heroin after friends told her that, unlike alcohol, it was not followed by a hangover.
She said she never reuses syringes and only has sex with men who agree to use condoms.
Smolskaya said the plight of St. Petersburg prostitutes is bleak. "On the one hand, they catch HIV through a syringe or a sexual partner," she said. "On the other hand, they pass the disease to their drug-using partners and their sexual partners.
"HIV is going to keep spreading," she said.
The World Health Organization and other international organizations have warned of an HIV epidemic in Russia. There are no reliable statistics for how many people have been infected with the deadly virus, but estimates run as high as 1 million. The number of officially registered HIV cases is about 250,000, according to the Federal AIDS Center in Moscow.
Figures from the Moscow health committee coincide with those in the new report. The committee's head, Andrei Seltsovsky, said last summer that 15 percent of prostitutes in Moscow have HIV. He also suggested forcibly testing prostitutes and drug users as two main groups at risk of contracting the virus, but the idea did not win support in the Moscow City Duma.
Murray Feshbach, one of the world's leading experts on health in Russia, said the 260,000 HIV cases cited in the report are far too low.
"The real number is 'God knows,'" Feshbach, a senior scholar at the Woodrow Wilson International Center for Scholars, said by telephone from Washington. "I would accept a figure much closer to 750,000 than I would to? 270,000, but I can use it to get started."
As of February, about 4,900 Russians had died of AIDS and other HIV-related illnesses. The optimistic projection of AIDS deaths each year by 2020 is 228,000, while pessimistically, that number could reach 648,000 per year, Feshbach said.
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