HIV infection rates raise fears of Aids catastrophe in Russia

Next to the casino in the lobby of the 1,500-room Hotel Cosmos in Moscow, Elena is drinking tea and waiting for her first customer. "If you want I come to your room - €100 (£68) for one hour. For sex and massage," she says.

She is wearing platform sandals, cropped jeans and has the long limbs and aquiline features of a cat-walk model. Four more women - high-class, elegant whores, like her - sit gossiping in the busy café on the other side of the lobby.

In this booming city, where the size of the largest denomination note is about to double to 5,000 roubles (£100), Elena and her friends are trying to scoop up some of Russia's new-found wealth. Instead they could become the crucible of a wholly different kind of explosion - in HIV.

Russia is on the cusp of a catastrophe. The UNAIDS report published yesterday says the global rate of new HIV infections peaked in the 1990s. In Russia, the rate of infection continues to accelerate faster than most other countries in the world.

As global leaders focus on Africa at the UN summit on Aids which opens in New York today, an epidemic is building on western Europe's doorstep. Over the past decade the Aids virus has swept through injecting drug users across the world's largest country and infected a known 350,000 people.

At least three times that number - one to 1.5 million - is HIV positive, according to the Federal Aids Centre in Moscow.

There are about 22,000 people with HIV in St Petersburg alone, almost half as many as in the whole of the UK, and the city receives hundreds of thousands of Western business and tourist visitors a year. Increasing numbers of Russians are also migrating to the capitals of western Europe in search of work, new lives and new loves - and are bringing the virus with them.

The statistics are chilling. In 2001, 95 per cent of new HIV infections in Russia were transmitted by injecting drug users who shared needles, mainly men. By 2005, almost half of new cases - 43 per cent - were contracted through heterosexual sex - and the victims were mostly young women aged 20 to 29.

The spread of the disease has now reached tipping point. If the estimates are right, and 1.5 million Russians are HIV positive, that is more than 1 per cent of the population, 10 times the rate in the UK. That proportion is the threshold at which the virus starts to move out of the high-risk marginal groups into the general population.

Aids experts cite the example of South Africa, where, in 1991, 1 per cent of the population was infected. A decade later that figure had grown to 25 per cent and South Africa now has more HIV cases than any other country in the world.

The accelerating epidemic has already begun to spill beyond Russia's borders. Drug users migrate and women are trafficked for the sex industry. Frankfurt, in Germany, is looking for Russian-speaking social workers to work with drug users. "If you go to a brothel in Frankfurt you will find Russian girls," said Urban Weber, the head of the Global Fund for eastern Europe.

There are, at last, signs of a response to the crisis. In April, President Vladimir Putin convened the State Council of regional governors to examine the epidemic, calling the situation "alarming". Earlier this month, between 15 and 17 May, the first regional conference on Aids was held in Moscow attended by 1,500 participants, an event that would have been inconceivable a few years ago.

Richard Feachem, the executive director of the Global Fund, which organised the conference, said: "The epidemic is younger here [than in Africa] but growing very rapidly.

"It is now at the point of spreading outwards via heterosexual transmission. How rapidly it spreads depends on the factors we know about - how many concurrent sexual partners people have, the frequency of other sexually transmitted infections."

The Global Fund, the independent foundation set up to fight Aids, tuberculosis and malaria, has so far invested $70m (£37m) in Aids projects in Russia and approved grants worth $222m over five years. The Russian government has followed its lead and is belatedly pouring millions more into Aids projects. But there remains widespread ignorance, prejudice and resistance - and time is running out.

In Saratov, a crumbling town on the Volga 300 miles south of Moscow, there is a flourishing HIV/Aids centre led by its charismatic head physician, Luba Potemina, who is committed to reducing the stigma associated with the disease. She admits, however, that the country has difficulty with the idea of harm reduction - such as handing out condoms to gay men.

"In this region it is too early for such issues to be widely discussed. The population is not yet ready for it," she said.

Meanwhile, Moscow's city council called in April for a ban on foreign anti-Aids campaigners working in Russia and the Patriarch of the Russian Orthodox Church has accused Western organisations of promoting "beliefs and stereotypes alien to Russian culture" in the interests of Western contraceptive manufacturers.

But the sexual behaviour of young Russians is similar to that in the West, says Alexey Bobrik, the head of the Globus project, which is operating in 10 regions, supported with $88m, over five years, by the Global Fund.

"The bad news is that rates of sexually transmitted diseases such as syphilis are more than 10 times as high - and a lot of young Russians practise unprotected sex," he says.

Ignorance and denial lie behind these trends, despite the rising tide of infections. "A majority still do not believe in HIV," Mr Bobrik said.

Near Red Square in Moscow, Ilya Vasilev, 31, a computer specialist who was handing out Marxist literature to passers by, condemned talk of Aids as a conspiracy designed to undermine his country. "Aids is a genocidal weapon devised by the US to destroy family love and trust. If people are afraid of Aids they will not make love. Nations will disappear," he said. As long as Mr Vasilev and his comrades hold such views, Russia's future - and Europe's - is at serious risk.

The experiment that offers hope

In the warm wind blowing off the Siberian steppe, Katya, 18, and Tanya, 21, are standing beside a dusty four-lane highway called Nakhimov Street in Tomsk, a university town about 1,800 miles east of Moscow. They wear bright leather jackets, miniskirts revealing plump thighs, and high-heeled wedge shoes.

They are the target of one of the first harm-reduction campaigns being piloted in Russia. Twice a week, a van tours the highway, where cars are parked at intervals in which other young, lipsticked and mascaraed girls can be seen in the yellow neon light, handing out condoms and sex advice.

Katya and Tanya charge 300 roubles an hour (£6) for sex, of which half goes to their "mummy", Svetlana. She plays a double role as pimp - taking calls, driving them to appointments - and outreach worker, ensuring they use condoms and taking them for regular medical checks and HIV tests. She has been to Moscow on a harm-reduction course as part of the White Lilac project - so called because it is the first flower to bloom in spring - paid for by the Global Fund.

The girls say they refuse requests for anal sex and for sex without a condom. "We put it on with our lips so they don't notice. Or we tell them we have already had sex with someone else," says Katya.

Tanya, the more confident of the two, says she is saving money to buy a house, before adding: "I need to live that long." If Tomsk can prove that harm reduction works, the aim is to roll out the approach to the oil towns of the north, where tens of thousands are infected with HIV. "It is still controversial for Russia. We cannot implement it everywhere," said Elena Zaitseva, project manager for Globus (Global Efforts Against Aids in Russia).