John Ranard

These photographs examine the evolution of the HIV epidemic in Russia and Ukraine, where the vast majority of new infections are due to injecting drug use.

In the early 1990s, rumors circulated in Moscow and Kiev that Slavs had a peculiar immunity to HIV. In August 1995, after observing and photographing a group of typical Moscow university students, who injected a variety of drugs with little precaution or understanding of how disease is transmitted, I realized that the myth of immunity would not last long.

Russia’s younger generation experimented with vint, a powerful liquid methamphetamine made from cough syrup, or they boiled chonryi, opium poppy straw cooked with industrial solvents. Today, inexpensive but potent heroin is easily available everywhere, smuggled from Afghanistan and North Korea.

Russia and Ukraine quickly fell into a deadly downward spiral, with injecting drug use and HIV becoming inextricably linked. As the economy got progressively worse, many teenagers started using drugs as an antidote to the excruciating boredom of provincial urban life, few prospects to relocate, and no promising professional opportunities. Many young girls, some of them drug users, turned to sex work.  This exchange of sex for drugs or money for food is fraught with risk of HIV infection and physical violence and has helped fuel the epidemic.

The governments of the two countries responded to the crisis with harsh law-and-order programs aimed at achieving a “drug free society.” But their policies have done little to curb drug use or the rate of HIV infection. Police harassed teenagers with track marks on their arms, and so drug users began to shoot drugs in their neck and underarms. And with drug users incarcerated for months in prisons with horrendously poor hygiene and little access to rudimentary health care, prisons became breeding grounds for the spread of both HIV and tuberculosis. Until recently, the possession of minute quantities of nonpharmaceutical drugs, including cannabis, was punishable with long prison sentences.  In a move that may signal its readiness for drug policy reform, the Russian government in  May 2004 changed this law so that people caught with very small amounts of drugs can no longer be sent to jail.

There is little money allocated for public health services or education. Antiviral treatment is virtually nonexistent in Russia and extremely limited in Ukraine. Methadone and other substitution therapies are illegal in Russia and are yet to be made available in Ukraine.

The deteriorating public health system is ill prepared to handle the hundreds of thousands of HIV cases. The medical facilities I saw were dark (to lower electricity bills), understaffed, and in shabby condition. The few patients admitted to hospitals bring their own sheets, towels, toilet paper, and medicine, and opiate-addicted AIDS patients often smuggle in drugs. Most people living with HIV are reluctant to seek assistance from public health facilities for fear they will be turned over to the authorities or stigmatized by hospital staff.

The current policies in Russia and Ukraine are driving underground the people who most need help. Unless the governments acknowledge the severity and reasons behind the HIV epidemic, this tragedy will only deepen.

—John Ranard, March 2005