Education And Debate

Russia: sex, drugs, and AIDS and MSF

BMJ 1998; 316 doi: (Published 10 January 1998) Cite this as: BMJ 1998;316:138
  1. Hans Veeken, public health consultant (
  1. a Médecins Sans Frontières, PO Box 10014, 1001 EA Amsterdam, Netherlands

    “Russians like to use drugs intravenously; it is culturally accepted,” says Vitalic without hesitation. I wonder if it is related to the preference of Russian doctors and patients for injectable drugs, but he goes on: “We do not like pills or smoking; we Russians go for the real thing.” Vitalic is one of the outreach workers, trained by Médecins Sans Frontières to give preventive education on AIDS to intravenous drug misusers in the streets of Moscow. He seems the right person for the job. His hair is purple and with his tattoos and piercings he looks like a stereotypical drug misuser in the West. But I'm told that most injecting drug misusers in Russia are not easy to recognise: they are youngsters who shoot drugs before going home and they do so rather incognito.

    We sit in Vitalic's tiny office in the middle of Moscow, not far from the Kremlin. There is Russian pop music, and outreach workers walk in and out: it resembles a youth centre. “There are an estimated 100 000 injecting drug misusers in Moscow. But cities such as Leningrad, Kalinigrad, and Rostov will have similar numbers. Users are mostly between 15 and 25 years of age, but some are as young as 12. Drug misusers are not losers as in the West,” Vitalic explains. “They lead a regular life, attend school, and socialise freely with non-users, which includes having sexual relationships.” This makes the dynamics of the epidemic in the Russian context more frightenening, as the virus can spread rapidly to the rest of the society.

    Ketamine is popular among schoolchildren, who use it intramuscularly. They buy the drug from babuschkas (the typical Russian grannies) in the street, one dollar per ml. “Some use up to twenty cc a day,” Vitalic says. I wonder where the …

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