There is a hidden HIV epidemic in St Petersburg, the pre-Communist Russian capital where President Vladimir Putin is preparing to welcome world leaders to lavish celebrations to mark his home town's 300th anniversary in a fortnight.
Official figures show that 20,000 people are infected with HIV in a city half the size of London. Doctors agree unofficial estimates of 50,000 are nearer the mark, more than in the whole of Britain. HIV charity workers say the real total may be nearer 100,000. The epidemic is a new one and few people show any signs of Aids-related illness. The government is spending £450m on the renovations for the birthday celebrations, but last year's Aids budget, for the whole of Russia, was £4m.
On a bleak stretch of road, far from the historic sights of the city centre, one prostitute watching women being picked up at the roadside said: "There are a great many girls with HIV infection. It is spreading at the speed of light." She added that many Russian men refused to use condoms.
A converted single-decker bus is among the few places where addicts can obtain clean needles and free condoms. It is run by a charity headed by Sasha Tsekhanovich, who spends night after night on the bus. He said if there were 300 similar vehicles in St Petersburg, it would still not be enough. "I have the impression the Russian government is interested in the rapid death of all undesirable people, drug-users, gays, prostitutes," he said. "They don't realise that in some years it will no longer be the problem of these specific groups, but of all the population."
Attitudes to people with HIV are at best prejudiced. Alexei, 21, was diagnosed four days before I met him in his shared room in a tower block. He, like the others, slept on the floor. And, like many young Russians, he used to be a heroin user, infected by a shared needle. "They put me in hospital and I stupidly told them where I lived and worked," he said. "They told my work and I lost my job. They told my landlord and I was chucked out of my flat."
Patients say even the most basic tests have a waiting list of several months. At one hospital, Dr Svetlana Zhukova shrugged when asked about a list of effective HIV medications: "I am aware of them, but what's the point? People just can't afford it. We are on a budget. We can't make the drugs freely available."
Nigel Wrench's film about the spread of HIV in St Petersburg, 'From Russia With Love', is on BBC3 this evening at 9pm.Reuse content