The two activists spert the following day making hundreds of the special packets which they later tossed at the hordes of Saxons and other Easterners crossing through Checkpoint Charlie.
“Everything that is new is welcome now in East Germany,†Eaves explained. “The old stigmas have been thrown away, and everything is possible. We hope East Germany will achieve a world level in everything, except AIDS deaths.â€
No one could imagine that just four months later prostitutes in West Berlin would be on the verge of staging a protest strike over the thousands of competitors that flooded in from the East every Friday night to earn valuable deutsche marks over the weekend. Hungry for hard currency, young women, most of whom didn’t really consider themselves prostitutes, would pour into Berlin to turn a few quick tricks, often for as little as five deutsche marks. The regular hookers would be outraged because the newcomers would charge far less than the former going rate, and they wouldn’t require that their customers wear condoms.97
Within three years the Eastern prostitutes would be a regular feature of red-light districts all over the wealthier West.
HIV would also ride Europe’s new heroin trail. Opening up the formerly secluded states rang bells of opportunity for organized criminal elements on both sides of the former Wall. Poland, in particular, would become both a center for a locally produced opiate called kompot and a transfer point for pure heroin imported from other parts of the world and destined for distribution in Central Europe.
The first serious emergences of HIV in Eastern Europe were not via either prostitution or heroin injection, however. Rather, they came by means that reflected the tragic state of medicine in much of the communist bloc.
Though there had been isolated AIDS cases in Russia for at least four years, HIV really emerged during the early spring of 1988 in Elista, capital of the Kalmyk Republic, located on the Caspian Sea. A baby languished on the pediatric ward of the town’s hospital, suffering every imaginable ailment. Doctors were stumped, unable to reach a diagnosis, until one suggested sending blood samples from the infant to Valentin Pokrovsky, a virologist doing AIDS research in Moscow. Pokrovsky confirmed that the child was infected with HIV.
The child’s father, it turned out, had visited the Congo in 1981, where he apparently was exposed to HIV. He passed the virus sexually to his wife, who, in turn, transmitted HIV to the child.
It was tantamount to treason to publicly acknowledge shortages of vital goods during the regime of Joseph Stalin, and forty years after the dictator’s death many Soviet citizens remained reluctant to step outside normal bureaucratic channels in order to draw attention to production deficiencies. In 1988, however, prior to news from Elista, U.S.S.R. Minister of Health Alexander Kondrusev publicly decried the country’s sorry state of medical supplies. In particular, he warned that the nation needed to use 3 billion syringes per year, but was only manufacturing 30 million annually, and importing none. Simple mathematics indicated, then, that the average syringe was being used 100 times. Kondrusev warned that this syringe shortage could spell disaster.
He would soon prove remarkably prescient.
The AIDS baby at the Elista hospital was treated by staff who used the same syringes to withdraw blood samples from and administer drugs to all the babies on the neonatal ward. For more than three months the nurses unknowingly injected HIV into all of the babies and, in a few cases, their mothers.
As the numbers of AIDS babies mounted, the overwhelmed Elista doctors ordered some of the infants shipped to a hospital in Volgograd. And again, the medical staff reused syringes over and over, soon having infected nearly every child on the Volgograd baby ward.
The incidents were kept quiet until early 1989 when a Russian trade union newspaper, Trud, broke the story. According to Trud, Health Minister Kondrusev had grossly underestimated the enormity of the gap in the Soviet Union between the number of injection procedures of one kind or another that were performed by health providers and the annual production rate of sterile syringes.98 While leaders in Moscow received single-use sterile injections, the masses living in outlying areas relied on hospitals that suffered permanent supply shortages. So in Elista and Volgograd, for example, health care workers had little choice but to reuse syringes 400 or 500 times, occasionally honing the needles on a whetstone so that they would still pierce skin.
It was horribly reminiscent of the events in Yambuku Hospital in 1976, where Belgian nuns used a handful of syringes hundreds of times per week, unwittingly spreading the deadly Ebola virus. That, however, occurred in a remote, impoverished region of Central Africa; the Soviet Union was, allegedly, part of the advanced industrialized world.
For three years Soviet health leaders counted the numbers as similar hospital outbreaks of HIV surfaced in Rostov, Astrakhan, and Stavropol.
By June 1990, Vadim Pokrovsky was telling the world that 260 children had become infected with HIV as a result of unsterile needles.99
Moscow’s Second City Hospital for Infectious Diseases was designated the nation’s AIDS treatment center and half the patients on its wards were children under five years of age. As fear of AIDS mounted in the Soviet medical community, widespread shortages were reported not only of syringes but of latex gloves, sterile catheters, surgical gowns, transfusion equipment, dental drills and probes, and other essential supplies. In the new atmosphere of perestroika, young physicians for the first time spoke frankly about the inadequacies of the Soviet medical system.
The result was widespread public panic and a sharp decline in willingness to undergo invasive medical procedures. Dentists, vaccinators, physicians—all health providers noted a drop in attendance, particularly in large cities where the media gave serious attention to the young physicians’ disclosures.
Dr. Mikhail Narkevich, newly appointed head of AIDS education in the Ministry of Health, was forced to concede that the nation’s economic difficulties were so grave that adequate medical supplies could not possibly be available until 1992–93. By 1994 Russian physicians would be crying out even more loudly for supplies that still hadn’t materialized.
In the absence of supplies sufficient to limit the spread of HIV within medical facilities, panic further increased. There were anecdotal reports of people beating AIDS patients and of health care workers refusing to go near people who carried the virus. The Ministry of Health was forced in 1991 to offer higher salaries to doctors and nurses who worked with HIV/ AIDS patients as compensation for the perceived risks involved.
But Soviet leaders were preoccupied with far more pressing issues than supplies of syringes. The country was literally falling apart. Food shortages, riots, separatist uprisings, political instability, and a face-off between the hero of glasnost, Mikhail Gorbachev, and upstart leader Boris Yeltsin monopolized national attention. By 1991 the Soviet Union no longer existed. By 1993 two major coup attempts had threatened the stability of the Russian Republic, and insurrections had occurred inside most of the former Soviet socialist states.
AIDS was overshadowed by history. And the microbe spread, unfettered by any serious efforts on the part of human beings to limit its modes of transmission. Prostitution and drug abuse stepped into the economic vacuum of social restructuring. Criminal elements gained control of many foreign trade sectors, and syringes remained in short supply.
By late 1993 the microbial situation was clearly out of control. Before the Berlin Wall fell, Russia’s syphilis rate was 4.3 cases per 100,000 people annually. Amid the national chaos, health officials said they were witnessing a syphilis epidemic. In St. Petersburg, for example, the incidence of syphilis increased eightfold between 1989 and 1993, with most of the newly infected individuals young, destitute female prostitutes. In the same city the incidence of gonorrhea among teenagers had soared 150 percent by 1993, as compared with 1976 levels. And in the same subpopulation syphilis incidence was up 400 percent.
Dr. Nikolai Chaika,
of the St. Petersburg Pasteur Institute, announced that all Russian disease data, including numbers of HIV/AIDS cases, were unreliable due to the “complete collapse of Russian medicine.†The social fabric of Russian society was unraveling, he said, and people were turning to behaviors that virtually guaranteed the spread of disease.
Thirdworldization had set in. Russia, as well as nearly all of the other former Soviet states, was rolling backward on the development scale. Epidemics of all sorts of diseases were reported anecdotally, though most were impossible to verify given the collapse of epidemiological systems. In the summer of 1992 cholera outbreaks were reported in Makhachkala, Nizhny Novgorod, Krasnodar, Naberezhnye Nizhny, and Moscow. The Tass news agency reported an outbreak of anthrax among peasants in the Altai region and typhoid fever in Volgodonsk. Even a case of bubonic plague was reported from Kazakhstan.100
In March 1993 special counsel to President Boris Yeltsin, Dr. A. V. Yablokov, addressed the grave state of the Russian people’s health in a speech before the nation’s Security Council.101 He revealed that in 1991 Russia’s “total losses due to premature mortality amounted [to] 2.23 million person-years of labour activity … . It is obvious that prevention of population health losses due to premature mortality from socio-economically conditioned causes is the most important strategic direction in improving safety and security of life of peoples of Russia [his emphasis].â€
The primary cause of Russia’s massive excess death burden was suicide, which rose by 20 percent between 1991 and 1992. Alcoholic self-destruction, drunk-driving accidents, and homicides ranked as the remaining top causes of the excess death rates.
Meanwhile, he said, the nation’s medical and public health system had deteriorated to the point where in 1991, 70 percent of all pregnancies involved serious complications, “only half of deliveries were considered normal,†anemia rates among pregnant women had increased by 61 percent in just three years, and maternal mortality rates were five times those in Western Europe. And preventable deaths—those ascribed directly to drug shortages or medical and public health failures—had risen sharply since 1990.
“Among these are all forms of tuberculosis, some infectious diseases (measles, whooping cough, tetanus, typhoid fever) … respiratory diseases, pregnancy complications, diseases of the perinatal period,†Yablokov said.
Life expectancy in Russia was lower in 1990 than in 1964 (70.1 years versus 70.4) and real life-span measurements for some areas of the country were as low as 44 years.
Separate EC studies of Russian health revealed that tuberculosis rates were climbing sharply. In Siberia in 1990 there was a TB incidence of 43 cases per 100,000 people (as measured by positive sputum). By 1993 that ratio had more than doubled, to 94:100,000. Over the same period Moscow’s TB rate jumped from 27:100,000 to 50:100,000. The principal cause of the escalation was said to be the lack of foreign exchange with which to purchase European- and American-made antituberculosis drugs; without treatment an ever-expanding pool of contagious individuals was spreading the disease to others.102
Perhaps the most striking example of Russian Thirdworldization was the 1993 outbreaks of diphtheria in St. Petersburg and Moscow.
A hallmark of the old Soviet Union had been its tremendous success in universal vaccination and resultant declines in the incidence of former scourges such as measles, whooping cough, polio, and diphtheria. By 1976 the numbers of diphtheria cases diagnosed in the U.S.S.R. approached zero.
But in 1990 diphtheria reemerged in Russia, with 1,211 cases reported from St. Petersburg, Kaliningrad, Orlovskaya, and Moscow. The epidemic took off, with reported cases and geographic spread increasing steadily well into 1994. In 1991 nearly 1,900 diphtheria cases and 80 deaths were reported in Russia. Though the bacterial disease could be treated with antibiotics, deaths occurred due to the sorry state of the nation’s health care systems.
During the summer of 1993, when nearly 1,000 cases were reported in a single month in Moscow and St. Petersburg, the British government issued travel advisories recommending that its citizens be revaccinated prior to traveling in the former U.S.S.R. And the numbers kept rising: between January and August 1993, nearly 6,000 Russians came down with diphtheria, 106 died.103
There had been massive waves of migration from outlying rural and rustbelt areas of Russia into Moscow, St. Petersburg, and, to a lesser degree, Kaliningrad and Orlovskaya. Most of the migrants were economic refugees, hoping to find work in the country’s largest cities. But they soon discovered quite the opposite, according to Russian authorities, and many thousands ended up living inside public transport stations—train depots, airports—in squalid conditions. Over 40 percent of the diphtheria cases occurred among these homeless.
Diphtheria had been virtually eradicated from the United States because of strict rules about preschool vaccination of children with the so-called DTP shots. But DTP shots had also been meticulously administered in Russia since the early 1960s. Nearly every new diphtheria case in the country had involved individuals who were previously vaccinated.
Officials concluded that the vaccine didn’t, as previously thought, work for a lifetime. It might offer less than five years’ protection against the disease. The reason, they said, was not a failure of the vaccine, but its success.
It seemed that thirty years of worldwide vaccination had drastically reduced the numbers of diphtheria microbes in the world, and most people lived their lives never being naturally exposed to the bacteria. Natural exposure in the 1960s, however, acted like booster shots, constantly rejuvenating lagging immunity: that explained why health officials had then mistakenly concluded that the vaccine provided lifetime protection. But by the 1980s most people’s immune systems never saw diphtheria, and the natural booster effect didn’t take place.
In response to global concern that the Russian epidemic might spread to other parts of the former Soviet Union, the Baltic States, or Scandinavia, the Russian Ministry of Health announced in 1993 a five-year plan to revaccinate up to 90 percent of all the nation’s citizens. Some UN officials privately questioned whether the Russians were responding with the proper amount of urgency and haste: a handful of diphtheria cases were reported during the summer of 1993 in Finland and the Baltic States. 104 Still other skeptics questioned the wisdom of a mass adult vaccination campaign in Russia, given the country’s acute shortage of syringes. Considering the lesson of Elista, they asked, might such an effort only hasten emergence of blood-borne microbes, such as hepatitis B and HIV?
The Elista tragedy was closely mirrored by events in Romania, where the government of communist dictator Nicolae Ceausescu covered up the existence of thousands of institutionalized orphans who were the legacy of decades of strict bans on all forms of contraception. Further, the Ceausescu regime hid evidence that many of these children were infected with HIV,105 the tragic outcome of common use of contaminated syringes106 and the primitive belief that injecting adult blood into children gave them strength.107
When the Iron Curtain was lifted, it revealed the Third World status of the old communist regimes, and conditions which only worsened amid the infrastructural chaos. And with that revelation came recognition of countless opportunities for the further emergence of not only HIV but all manner of microbes.
But there was no need to search behind the Iron Curtain, the Bamboo Curtain, or below the Sahara to witness microbial exploitation of Thirdworldization. The process was occurring during the 1980s and the early 1990s inside the wealthy nations of North America and Western Europe.
Despite the AIDS epidemic, most of the public health community, which was not involved in infectious diseases work, remained optimistic during the 1980s. So much so that health became a matter of personal responsibility. Health economists tallied up the costs of diseases that were preventable through diet, exercise, cessation of tobacco or illicit drug use, elimination of alcoholism,
and the like, reaching the conclusion that personal health decisions were no longer the exclusive purview of individual choice. Smokers, they concluded, cost the rest of society billions of dollars. So did alcoholics. And fat people.
“The cost of sloth, gluttony, alcoholic intemperance, reckless driving, sexual frenzy, and smoking is now a national and not an individual responsibility,†wrote Dr. John Knowles, president of the Rockefeller Foundation. “This is justified as individual freedom—but one man’s freedom in health is another man’s shackle in taxes and insurance premiums. I believe that a right to health should be replaced by the idea of an individual moral obligation to preserve one’s own health—a public duty if you will.â€108
Public health advocates warned, however, that it was exceedingly unfair, and unrealistic, to hold poor Americans responsible for their health—to condemn them, as it seemed Knowles did, for their inability to afford ideal foods, membership in exercise clubs, and temperance in all sexual and intoxicant affairs. Further, they warned that the medical triumphs that had sparked such rosy calls for personal responsibility were fleeting. In the face of rising poverty, they said, the old scourges would return.109
It wasn’t necessary to go to Africa to see AIDS orphans or whole families buried side by side. New York City alone would have more than 30,000 AIDS orphans by the end of 1994, Newark over 10,000. The U.S. Department of Health and Human Services predicted that there would be 60,000 AIDS orphans in the country by the year 2000.110 Just as AIDS was exhausting the extended-family networks in much of Africa, so it was taxing the social support systems in America’s poorest communities.
With every passing year in America’s AIDS epidemic the impact upon the nation’s poorest urban areas grew more severe. It compounded the effects of other plights—homelessness, drug abuse, alcoholism, high infant mortality, syphilis, gonorrhea, violence—all of which conspired to increase levels of desperation where dreams of urban renewal had once existed.
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