NEW YORK — In recent years, HIV/AIDS infection in Russia has been spreading at the fastest rate in the world. Several experts estimate that more than 1.5 million Russians are HIV-infected at present. According to World Bank estimates, that number could total 5.4 million to 14.5 million by 2020 unless the epidemic is contained. Such a large number of people with HIV/AIDS will have a significant impact on Russia’s social stability, national security and economic development.

As in other countries, AIDS in Russia first appeared among gay men, then spread to and through the intravenous drug-user population and commercial sex workers. It is now moving into the general heterosexual population.

The spread has been accompanied by an explosive increase in the incidence of other sexually transmitted diseases as well as drug-resistant tuberculosis. According to the Red Cross, Russia has 340,000 cases of TB, and every year there are 130,000 new cases, many of them multidrug resistant.

There is a high prevalence of both TB and HIV/AIDS among prisoners. Estimates are that the number of HIV- and TB-infected people is approximately 30 times higher in Russia’s overcrowded prisons than in the general population.

Moreover, syphilis-infection rates in Russia are hundreds of times higher than in Western European countries. Because of the skin lesions and mucosa caused by them, sexual contact with people who have syphilis and related infections greatly increase the chances of becoming HIV-infected.

The Russian government’s reaction so far has been inadequate for dealing with the level of the HIV/AIDS threat, or for learning what other countries have done successfully to control the infection.

According to several experts, Russia’s AIDS policies serve to fuel the epidemic, rather than control or reverse it. For example, although the majority of Russians now living with HIV/AIDS were infected through drug use, drug addicts with AIDS are excluded from anti-retroviral treatment.

Lee B. Reichman, executive director of the National Tuberculosis Center at New Jersey’s Medical School, calls the refusal of Russian authorities to accept foreign assistance to deal with the epidemic “the Kursk syndrome” — after the nuclear submarine that sank in the Barents Sea in 2000. (On that occasion, Russian authorities refused foreign assistance early on when it could have been effective.)

Experience in other countries has shown that significant improvements in controlling the epidemic can be achieved through strong government leadership and partnerships among business, labor and religious leaders, as well as through the efforts of those with HIV/AIDS.

AIDS is both a social and a public-health problem. Given the extent of the epidemic, an interdisciplinary commission on HIV/AIDS is needed to creatively attack the problem. It should comprise not only public-health experts, but also social and political leaders across the spectrum of Russia’s civil society plus HIV/AIDS victims. Such a commission must be given wide powers to coordinate policies among ministries and to partner with other national and international nongovernmental organizations.

The government must negotiate with pharmaceutical providers to reduce the price of anti-retroviral drugs.

Prejudice against the HIV-infected persists in Russian society, exacerbated by a lack of understanding of the mechanisms of infection. A massive education campaign should be conducted that focuses on high-risk groups, particularly the young, those in the military and those in prison. The campaign should include sex education in the schools, including lessons on safe sex and harm-reduction strategies, as well as instruction aimed at reducing the stigma and discrimination associated with HIV/AIDS.

In Russia, at least 80 percent of the HIV-infected are under 30 years old. Premature morbidity and mortality among young people with high productive potential could trim 4 percent off the gross domestic product by 2010, according to World Bank estimates. The effect of that on Russia’s shattered economy would be devastating.

The Russian government should increase current funding levels for prevention and treatment. Prevention efforts are practically nonexistent at present. In 2003, the government provided about $4 million to fight HIV/AIDS, a paltry sum compared with the $1.3 billion in federal funds that President Vladimir Putin allocated for the celebration of St. Petersburg’s 300th anniversary.

HIV/AIDS poses serious threats to life expectancy, demographic growth and economic development. Unless more effective treatment and prevention measures are implemented soon, the effect on Russia’s population and on its economic development and political security will be nothing short of catastrophic.

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