Russia - Alex Majoli

Russia - © 2003 National Geographic Society

Alex Majoli found that in St. Petersburg-one of the Russian cities where antiretroviral treatment is now widely available-treatment is effective, but often only addresses a part of the problem. Drug use and alcohol have taken a terrible toll on the young. The four people Majoli photographed were infected by shared needles. "HIV in Russia is a disease caused by social unrest and economic depression," says Dr. Olga Leonova of the St. Petersburg AIDS Center. "Much has to be done to solve those people's social problems." And something has to be done about curbing injected-drug use. Young people keep dying."

Igor Tereshenko, 24; Dmitry Smirnov, 34; and Alexey Smirnov, 26, (not related) saw their lives fall apart after alcohol and drug abuse killed their friends, caused them to drop out of school to work, and infected them with HIV. All three began antiretroviral treatment very late. Igor became paralyzed from the waist down due to a spinal tumor. Although he made progress on antiretroviral treatment, his doctors discontinued treatment when they realized that he would soon die from his inoperable tumor. Igor died six weeks after Majoli's first visit to Russia.

Dmitry Smirnov, 34 Dmitry died from a hemorrhage some weeks after starting treatment. “Young people like my son, who got used to living in the Soviet Union, who were born in the Soviet Union, saw the system collapsing and kind of lost hope for the future— and they lost their system of values,” Dmitry’s mother said. “So they were prone to illicit drugs. And that’s how it started, and the problem is growing. That’s the main problem that has led to high HIV prevalence.”

Alexey Smirnov, 26 Alexey died from alcohol intoxication six weeks after starting treatment. “Nobody was interested in his life, his health, and his well-being,” said his doctor. “I think Alexey died because he was too depressed. He had no life in his eyes. I think life had lost meaning for him.”

When Oksana Nikandrova, 29, was diagnosed she was “on the brink of committing suicide.” Though she had support from a German friend on treatment, she said “Still I was desperate … I felt devastated.” Oksana got diagnosed early enough to start treatment before she was too ill. She can now focus on raising her son, Sergei. Oksana remains wary in the face of ongoing stigma in Russia. “You never know how people will react. I don’t want anyone at my work to know I’m HIV infected. I don’t want this unnecessary compassion, either.”