AIDS IN THE USSR: CAN IT BE NIPPED IN THE BUD?

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• Document Page Count: 34
• Document Creation Date: December 27, 2016
• Document Release Date: February 6, 2013
• Sequence Number: 1
• Publication Date: December 1, 1988
• Content Type: REPORT

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AIDS in the USSR: Can It Be
Nipped in the Bud?
PR0.rEG`r NUMBER So~rA'oa~7~ 9
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PAGE NUMBERS
TOTAL NUMB OF COPIE/S
DISSEM DATE 8 Q`4/'/ /,2
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SOV 88-10080X
December 1988
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iufre%Lurafe of secret
AIDS in the USSR: Can It Be
Nipped in the Bud?
A Research Paper
This paper was prepared by
(
Office
of Soviet Analysis. Comments and queries are
welcome and may be directed to the Chief,
Domestic Policy Division, SOYA,
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ZOA]
Secret
SOV 88-10080X
December 1988
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Summary
Information available
as of 21 December 1988
was used in this report.
Aids in the USSR: Can It Be
Nipped in the Bud? ~ 25X1
1987 approval of a nationwide campaign against AIDS.
In February 1987, after two years of gathering evidence, medical experts
persuaded the Soviet leadership to stop viewing AIDS as a problem of the
"decadent West" and to acknowledge that the Soviet Union had its own
AIDS problem. This new approach culminated in the Politburo's August
The leadership's concern about AIDS has been demonstrated by the
energetic measures it has taken since then. Specifically, the regime has
distributed 10 million leaflets to the population, including one to every
household in Moscow, established mandatory testing for high-risk groups,
and imposed criminal penalties on those who knowingly transmit the
disease. The medical and scientific resources mobilized in the past year
include 40 participating research institutes, 400 testing laboratories, 50
voluntary testing centers, advanced training for doctors, and three hospital
units in Moscow, Leningrad, and Kiev. As the program is currently
operating, the regime will conduct 18 million AIDS tests per year,
screening all blood used for transfusions and testing known homosexuals,
drug addicts, and prostitutes, as well as military inductees, prison inmates,
foreign students, and Soviets returning from an extended stay overseas. A
bureaucratic structure has been set up to direct activities against AIDS 25X1
under the leadership of Health Minister Yevgeniy Chazov and an inter-
ministerial committee, which includes the police and security organs.F_~
Moscow's energy is directed at ensuring that the problem remains small. 25X1
The Soviets have reported only a few citizens with fully developed AIDS
and have identified only 93 infected individuals to November 1988.,
e es- 25X1
timate that the upper boundary of HIV infections-which ultimately
produces AIDS-is approximately 15,000 or 5.1 per 100,000. This worst
case estimate is less than a fourteenth of the rate of Great Britain, a
hundredth of the US rate of 484 per 100,000, and a miniscule fraction of
the most infected states of Africa. 25X1
The political and social barriers to the spread of AIDS are stronger in the
USSR than in many Western countries. Particularly important are the
obstacles to the free exercise of high-risk behavior in areas of a concentrat-
ed population of high-risk groups:
? Homosexuality, although increasingly visible in the USSR, is still
severely repressed. Homosexuals lack the places to congregate and the
privacy that facilitate frequent sexual encounters.
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? Although drug abuse is growing at a rate that alarms the Soviets, it
remains small by Western standards. Moreover, intravenous drug use
with needle sharing-the only type of drug abuse that actually spreads
the disease-accounts for only a small proportion of the total.
? The Soviets assign a lower priority than do Western countries to
protecting the rights of the individual when these rights are seen as
conflicting with the welfare of society. For example, there are currently
no strong legal constraints on the regime's ability to impose mandatory
testing or even to quarantine large numbers of people should the
leadership deem this necessary. Recently, a carrier who infected eight
others was sentenced to a four-year prison term.
? The Soviet population remains relatively isolated from foreign sources of
infection. Although the USSR is not a completely controlled society and
is becoming more open under Gorbachev, the regime monitors and, to
some degree, limits contacts with foreigners.
Nevertheless, the USSR is not entirely impervious to AIDS:
? Sexual contact with foreigners, primarily African students, has been the
major outside source of HIV infection
Mandatory testing of long-term foreign residents will sharply
? Although Soviet rates of venereal disease-which increases the risk of
contracting AIDS-are somewhat lower than US rates, heterosexual
promiscuity in the USSR has steadily increased in recent years.
? Prostitution is widespread in the Soviet Union and is conspicuously
oriented to fairly high-risk foreign visitors, such as sailors, students, and
tourists.
? Prison camps contain 2.4 million men who are highly vulnerable to AIDS
because of widespread homosexual behavior and high rates of venereal
and other infectious diseases.
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Poor health care and medical conditions also pose some hazards with
respect to AIDS:
? Reuse of medical needles and transfusion equipment creates a small but
continued danger of AIDS transmission. The Soviets claim that they will
switch to disposable needles in the early 1990s.
? Because condoms are in limited supply and of poor quality, the main
method of birth control is frequent abortions that, by injuring the genital
area, probably increase female susceptibility to AIDS.
? Poor diagnostic equipment and medical capability make it likely that 25X1
some AIDS cases have been missed. US experts have expressed some
concern about the accuracy of Soviet AIDS testing.
Many of these deficiencies are to be attacked by a new comprehensive 25X1
health reform program approved in 1987 that calls for a major increase in
expenditures to upgrade medical care.F___-] 25X1
Measures to guard against AIDS at home have interfered with some Soviet
programs designed to extend Moscow's influence abroad, especially in
Africa. Widespread ignorance about AIDS and fear of it in the Third
World and elsewhere, however, have created opportunities for the Soviets
to spread disinformation about US responsibility for the origin or spread of
the disease. Increasingly, the dominant impact of AIDS on Soviet behavior
abroad is to cause the Soviets to seek international cooperation in dealing
with AIDS as a threat to all countries. 25X1
AIDS in the USSR is likely to remain a small problem by world standards.
If the vigorous measures the regime has taken to counter the disease are
continued, AIDS will not assume epidemiological proportions in the
USSR, although the Soviets probably will not be able to eliminate AIDS
altogether and the disease may spread slowly. Developments such as
expanded civil liberties, restrictions on the police, increased foreign
contact, and expanded freedom of residency, personal privacy, and urban-
ization could further the growth of homosexual and heterosexual promiscu-
ity, prostitution, and drug abuse. We do not believe, however, that
Gorbachev's reforms will change the behavior of either the regime or the
society so radically as to alter the prognosis for AIDS in the near future.
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Contents
Summary
The Soviet AIDS Problem
I
Discovering the AIDS Problem
I
Estimating the Extent of AIDS
I
Strong Barriers, Limited Vulnerability to AIDS
4
Exposure to Foreign Sources
5
Foreigners in the USSR
5
Soviets Abroad
7
High-Risk Behavior and Susceptible Groups
7 -
Prostitution
7
Homosexuality
The Military
10
Intravenous Drug Abusers
12
Health Problems and Practices
12
Prevalence of Infectious Diseases
12
Blood Transfusion
13
Multiuse Hypodermics
14
Abortion and Contraception
14
The Regime's Approach to Controlling AIDS
14
Educating the Public
Hardline Approach for High-Risk Groups
15
Cutting Off Foreign Sources of Infection
17
Testing and Diagnosis
Rebuilding the Health System and AIDS
20
Impact on Soviet Foreign Policy
Training Third World Leaders
21
Taking Political Advantage of the United States
21
Seeking Cooperation Against Global Problems
22
Impact on Domestic Policy
How Big a Problem Will AIDS Be?
23
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Scope Note This Research Paper evaluates the current extent of AIDS in the USSR,
the potential for its spread, and how the regime is dealing with the
problem. With glasnost and recent efforts to warn their own population,
the Soviets have published more information during the past year than
previously about AIDS, but important data have still not been released.
For example, while the Soviets had completed about 12 million AIDS tests
by late 1988, they have reported only partial findings and no systematic
projections from this data. In fact, it has recently become apparent that the
Soviets themselves may not have a good understanding of their own
problem. Consequently, conclusions of this paper are necessarily tentative.
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Aids in the USSR: Can It Be
Nipped in the Bud?
Discovering the AIDS Problem
Until the beginning of 1987, the Soviet people were
repeatedly assured that AIDS was somebody else's
problem. As worldwide concern over the AIDS threat
grew in 1985, Soviet propaganda organs launched a
worldwide campaign to blame AIDS on a US germ-
warfare experiment gone awry. Subsequently, when
Soviet scientists acknowledged the natural origins of
the disease, the cause of its spread was attributed to
lax morals in the "decadent" West or "primitive"
Africa. Soviet officials stressed that "conditions do
not exist here for the spread of the disease."F---]
A February 1987 detailed briefing of senior party
officials by AIDS experts-who presumably were
more concerned about the problem than their public
bravado suggested-apparently convinced the Polit-
buro that a major program to fight AIDS was needed.
The program was unveiled in August 1987. Simulta-
neously, the Soviet media began to treat AIDS seri-
ously and expanded discussion of prostitution and
homosexuality as well.
In January 1988, Health Minister Yevgeniy Chazov
cautioned, "There are now carriers of the disease in
our country and, of course, their number will in-
crease." At that time, the other principal Soviet
spokesman on AIDS, Valentin Pokrovskiy, president
of the Academy of Medical Sciences, described their
situation to be "more or less at the same stage as
France in 1982, which means that in five years we will
be facing a much more serious situation." In July he
told visiting US health officials that the situation
seems stable but "even now we must admit the virus is
in circulation and we are unable to control it." F_
Estimating the Extent of AIDS
These somber words from the regime's two highest
health officials imply a more serious concern than
This paper uses the term "AIDS" to refer to the
entire phenomenon of the acquired immune deficiency
syndrome, ranging from infection without apparent
illness by the human immunodeficiency virus (HIV)
to the illness of AIDS (often called acute or full-
blown AIDS). HIV eventually produces AIDS illness
by incapacitating the body's immune system and
eliminating its resistance to a wide variety of infec-
tions. According to current scientific consensus,
symptoms develop two to 10 years or more after
infection by HIV; AIDS will eventually afflict all
those infected and be fatal in all (or nearly all) cases.
The term "HIV infected" is used in this paper
regardless of whether the symptoms of the illness are
present. The term AIDS is used to refer to the disease
generically except where it is clear in the context that
a stage of illness is being discussed. F__1 25X1
would be warranted by the very small, albeit rapidly 25X1
growing, number of officially acknowledged HIV
cases. Although about 12 million Soviet citizens have
been tested, only 93 individuals were found to be HIV
infected by November 1988. From early 1987, the
Soviets maintained that they had only one citizen
actually sick with full-blown AIDS,' although two
AIDS fatalities were acknowledged in late 1988, and
Soviet officials confided to a US delegation that 16
HIV-infected persons were now beginning to show
AIDS symptoms
' Earlier, a prominent Soviet scientist at an international conference
mentioned another AIDS case, dating from 1984, but no other 25X1
Soviet official has referred to this death. LZDR I
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The discrepancy between these low numbers and the
expressions of alarm on the part of Soviet medical
officials suggests either that the Soviets have not
disclosed the full extent of their knowledge of the
AIDS problem, or that they are uncertain about the
accuracy of this data and their ability to make
reliable estimates based on it. Tests to date do not
provide a representative sample of the population by
risk group and geography. The Soviets have, for the
most part, avoided public projections of their tests
results for the total population.' The fact that over 90
percent of those tested were blood donors is a large
potential source of distortion because groups are
weighted on the low-risk side through donor self-
selection and recruitment procedures. In addition, US
experts who have closely reviewed Soviet test results
and methodology are somewhat skeptical that all of
the test results are valid (see inset).
The 93 infected individuals found in the roughly 12
million persons tested is estimated to be the equivalent
of a national infection rate of only 0.5 per 100,000
persons or about 1,300 persons infected with HIV.'
This small number can be considered the lower
boundary of HIV infection in the USSR. It squares
with an "unofficial estimate" of HIV infection of "a
thousand or more," which was recently quoted on
Moscow radio.
At the other end of the range of probability, we can
calculate an upper boundary of HIV infection based
on the 670,000 non-blood-donors who were tested
' The lack of such projections could reflect the regime's traditions of
secrecy, the reluctance of lower officials to take the responsibility of
prediction, or Soviet lack of competence in epidemiological model-
ing. Health Ministry officials have recently proposed that epidemio-
logical projections be made a subject for a cooperative project
under the US-USSR Health Agreement to be renegotiated in
November 1988. This approach might have the dual attraction for
Soviet scientists of tapping international expertise and spreading
responsibility for the results.
' This infection rate has been-es-ti-mated-by taking the ratio of
persons infected to the total persons tested and extending that ratio
to the national level. The raw "infection rate" from the sample is
multiplied by the population aged 16 to 60 in 1987 (158.6 million),
which is the age group at risk for AIDS, to get the total persons
infected nationwide. This number is divided by the midyear
population (283.1 million) to establish the HIV infection rate for the
through mid-1988. This group included homosexuals,
prostitutes, and drug addicts, as well as prisoners,
military inductees, returning overseas personnel, and
volunteers. The 61 positive tests in this group equate
to a national infection rate of 5.1 per 100,000 or about
15,000 total persons infected, which can be considered
the upper end of the range of HIV infection in the
USSR. This estimate corresponds to the figure that a
group of knowledgeable scientists provided to a visit-
ing US academic in late 1987.'
The lack of firm numbers on the current Soviet AIDS
situation and the current inability to confidently
project the growth of HIV infection make it difficult
to estimate the future size of the AIDS problem. One
of the few known Soviet projections was made infor-
mally by Valentin Pokrovskiy, who told a US delega-
tion in mid-1988 that there would be over 10,000
HIV-infected persons and 100 persons sick with the
disease in three to four years. This estimate is not
inconsistent with the parameters of current infection
we estimated above.
Whatever the exact proportions of AIDS in the
USSR, it seems safe to conclude that the USSR at
this point fits in the pattern of those countries least
affected by the disease. Even our worst case estimate
would still be less than a fourteenth of the rate of
Great Britain, a hundredth of the US rate of 484 per
100,000, and a miniscule fraction of the most infected
states of Africa (see table 1).
In terms.of magnitude, the Soviet level of infection is
similar to most of Asia, the Middle East, and Eastern
Europe, where rates of HIV infection vary from
negligible to 20 per 100,000. By contrast, in Western
nations the prevalent pattern of infection rates is from
70 to 500 per 100,000 people; 90 percent of the AIDS
victims are men (75 percent homosexuals), 15 percent
' While there does not appear to be sufficient justification for a
higher estimate of infection, there are estimates above this upper
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Problems in Gauging the Extent of AIDS and HIV
Infection
It is possible that much AIDS illness has simply been
missed or ignored by Soviet physicians and health
authorities. A vivid example of this problem was the
discovery of AIDS in October 1988 in a Leningrad
woman who died after having been under medical
treatment for six months for pneumonia, weight loss,
and mucous membrane infections, all of which are
well-known AIDS symptoms in the West. In the wake
of this event, even a major Soviet newspaper ques-
tioned whether this was really the first death, specu-
lating that other AIDS cases may have been misdiag-
nosed as "acute pneumonia. "
At least until mid-1987, rank-and-file Soviet doctors
received no systematic information about AIDS
through medical literature or training and had no
laboratory resources for AIDS testing. Therefore, it
is highly possible that people could have died of
AIDS under other diagnoses in the past and even to
some extent in the present. High levels of pneumonia,
tuberculosis, and hepatitis may provide a confusing
backdrop that heightens the likelihood of such mis-
takes.
(published reports in scientific journals of
substantial amounts of Kaposi's sarcoma, a rare
cancer so closely associated with AIDS in the West
that in most cases in a person under 60 it would be
considered a definitive indicator of AIDS. In 1984, a
Soviet medical journal reported 127 cases of Kaposi's
sarcoma in Soviet citizens under 60 at the Moscow
Central Institute of Dermatology. A 1987 medical
journal article reported 59 persons of unknown age
with Kaposi's sarcoma were tested for AIDS, but
surprisingly no HIV-positive individuals were found. 25X1
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Direct information on the Soviet testing program
gives some reason to doubt the precision of Soviet
AIDS testing. A delegation of US health officials
recently given the opportunity to review the results of
Soviet tests found grounds for concern in several
areas. Soviet scientists were unsure about a number
of their negative test results. Some of these were
attributable to their lack of exposure to the varied
appearance of positive tests; another could have been25X1
the presence of the HIV-2 strain, which requires a
special test for accurate identification but which 25X1
could have produced an ambiguous partial indication
of its presence on the Soviet HIV-1 test. Another
indicator of possible faulty procedures was a smaller
number of false positives in initial testing than has
been found to be normal in the US experience. Finally
there was the suggestion that locally conducted test
results were being reported in a misleading fashion to
suppress the embarrassing finding of possible cases.
However, the US delegation did not believe the
central scientific authorities were systematically min-
imizing the AIDS threat and even had an organiza-
tional self-interest in maximizing it. Overall, it seems
unlikely that errors in testing have been so serious as
to result in a radical undercountin o the numbers of
HIV-infected individuals. 25X1
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Table 1
AIDS in Selected Countries: Total Estimated
HIV Infection Versus Reported AIDS Illness
Rate Per 100,000
Officially
Reported Cases
Rate Per 100,000
Uganda
15.9
2,400,000
15,086
4,006
25.2
Congo
2.1
125,000
5,700
1,250
60.0
Zimbabwe
9.4
469,000
5,000
119
1.3
Zaire
33.3
383,000
1,150
335
1.0
Canada
26.1
130,000
498
1,809
6.9
United States
243.1
1,177,500
484
69,085
28.4
France
57.5
250,000
435
4,211
7.6
Brazil
150.7
600,000
398
3,687
2.5
Italy
57.4
200,000
349
1,865
3.3
United Kingdom
56.8
40,000
70
1,598
2.8
Sweden
8.4
4,700
56
197
2.4
Note: HIV infection can be expected to be much larger than the
number of cases of AIDS illness because infection precedes illness
by two to 10 years or more. However, some of the extremely wide
variation in the ratio between HIV infection and AIDS is probably
attributable to combinations of deficient official data and intention-
al misrepresentation to avoid embarrassment
are drug addicts, and a small portion are the victims
of contaminated transfusions. In Africa and parts of
the Caribbean, a third pattern is apparent; levels of
infection range from 1,000 to 15,000 per 100,000. The
victims are evenly split between men and women, and
most transmission is through heterosexual intercourse
Strong Barriers, Limited Vulnerability to AIDS
The Soviets base their hope to successfully combat
AIDS on their relative isolation from sources of
foreign infection, the small size of high-risk groups,
Sources: HIV infection estimates are from the world AIDS data
base of the Life Sciences Branch, Office of Science and Weapons
Research as of 30 September 1988. US infection is from the US
Centers for Disease Control, Morbidity and Mortality Weekly
Report, 18 December 1987 (average of 945,000 to 1,410,000
estimate). USSR estimate is based on Soviet reports of the results
of mass AIDS testing from 1987 through late-1988. Reported
AIDS cases are from the World Health Organization, Weekly
Epidemiological Record, 31 October 1988.
ing with the welfare of society.
and the regime's ability to impose social controls on
the population. These controls include tightly regulat-
ed borders, stringent laws against high-risk behavior,
and repression of homosexuality. The Soviets main-
tain a large police force and assign a lower priority
than do Western countries to protecting the rights of
the individual when these rights are seen as conflict-
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The USSR has a less mobile population than does the
industrialized West. Extremely long distances and
poor transportation in rural areas isolate much of the
population from frequent social contact with persons
outside their immediate locality. High-risk groups-
in particular, homosexuals, prostitutes, and drug ad-
dicts-are prevented from congregating and having
the intense interaction that epidemiologists believe is
necessary to rapidly transmit AIDS 5 (see inset). Resi-
dency permits, housing shortages, and occupancy
regulations help to restrict the concentration of these
groups in major cities and coastal resort areas. Under
Soviet housing rationing practices, it is very difficult
for single or unmarried cohabiting adults to obtain a
separate apartment. Even group residences have resi-
dent supervisory personnel, which further inhibits
promiscuous behavior.
Finally, the regime has the power-at least in
theory-to quarantine those infected with AIDS. The
past willingness of the regime to use imprisonment to
deal with social problems is testimony to its capacity
to swiftly institute a mass quarantine if it felt it was
necessary. The technical, organizational, and legal
ability to conduct large-scale HIV testing also allows
the regime to assess more quickly the levels of infec-
tion among potentially vulnerable groups, for exam-
ple, returning seamen, prisoners, prostitutes, or homo-
sexuals.
3 The importance of this scattering effect on the potential for rapid
AIDS transmission is confirmed by the history of the AIDS
epidemic in the rest of the world. In the United States through
1987, 45 percent of AIDS cases were concentrated in New York
City, San Francisco, and Los Angeles, which constitute only 11
percent of the population. New York is reported to have a
homosexual community of 750,000 and San Francisco, 70,000.
According to Dr. James Curran of the Centers for Disease Control,
AIDS swept through these communities during the "gay libera-
tion" period of heightened sexual activity, infecting 25 percent of
the homosexuals before AIDS was even discovered. Currently, the
continuing expansion of HIV infection in the United States is being
propelled by the growth of infection among the 200,000 intravenous
drug abusers in the New York City area who have a somewhat
overlapping membership with the homosexuals. The first major
expansion of heterosexual HIV infection is occurring in this area as
well. In Africa, the highest rates of HIV infection in the world are
found in cities such as Kinshasa and Nairobi, which are among the
poorest and fastest growing in the world. In large regions of the
Despite these strong barriers to AIDS, the USSR is
not entirely immune to high-risk behavior-homosex-
uality, prostitution, and drug use-that breeds AIDS.
Moreover, the USSR probably has been exposed to
the infection for a decade or more through Soviets
returning from abroad and foreigners in the USSR.
Exposure to Foreign Sources
Although the USSR is not a completely controlled
society and is becoming more open under Gorbachev,
the regime limits and, to some degree, monitors
contacts with foreigners. The regime has already
ordered AIDS testing for all foreigners, excluding
diplomats, residing in the USSR, for more than three
months and can use its tight controls over entry still
further. Although there has been some relaxation of 25X1
restrictions this year, the State Department has esti-
mated that 75 percent of the population does not live
in areas that foreigners are permitted to enter or can
reach with available transportation facilities.
Foreigners in the USSR. Some 140,000 foreign stu- 25X1
dents study at Soviet educational institutions. While
proportionately a much smaller group than in the
United States, many of these students come from
Sub-Saharan Africa, where the USSR has worked
hard to cultivate ties since the collapse of colonialism.
By late 1988, after completely testing substantially all 25X1
foreign students, Soviet officials found 329 infected
students, nearly all of them African. The HIV-
infection rates among these African students were
about twice the rate of the United States population
and equivalent to the rate in Zaire and Tanzania in
the African AIDS belt.bF__~ 25X1
6 At present there are approximately 23,000 African students in the
USSR and more than 50,000 have studied there since 1960.
Despite the hostility of many Soviets toward Africans, many
African students have become involved in sexual relationships with
Soviet citizens. For example, Rwanda has sent only 600 students to
the USSR since 1956, yet there are 50 Russian wives in that
country; presumably they married Rwandans studying in the
USSR and subsequently emigrated. Recently, a Ukrainian woman
who returned to the USSR, after living four years with her husband
in the Congo, was discovered to have infected eight other Soviets.
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AIDS is rather difficult to contract for heterosexuals
who are in good health and are not intravenous drug
users. It is transmitted most frequently through
sharing of needles in intravenous drug use, homosex-
ual intercourse, and, to a lesser extent, by heterosex-
ual intercourse and transfusion of contaminated
blood. The first two methods of transmission are the
ones that drive the spread of AIDS most powerfully
in developed countries:
infection for the partner in only 10 to 68 percent of
the cases, depending on the stage of the progression of
AIDS, the health of the uninfected partner, and other
factors. Heterosexual activities have proved highly
infective only where they are associated with highly
promiscuous behavior or the presence of genital sores,
inflammation, and other health "cofactor" condi-
tions, particularly sexually transmitted diseases.
High rates of heterosexual transmission of AIDS
have been found primarily in Africa, where the rates
of STD reach 100 times the rates of the USSR and
? Transfusion of HIV-contaminated blood is the most
dangerous mode of transmission for each exposure,
but, according to scientists studying hemophiliacs
who contracted AIDS, infection only results in
about half of the transfusions. In practice, screening
of donors effectively limits HIV contamination, and
comprehensive testing of the blood supply virtually
eliminates it.
? In drug abuse the sharing of uncleaned needles
among intravenous users approaches the infectivity
of an HIV-contaminated transfusion since a sub-
stantial amount of blood is usually transmitted in
the process. Because of the multiple exposures and
other risk factors involved in the lifestyle of ad-
dicts, intravenous drug users are the most danger-
ous transmitters of AIDS.
? Scientific studies indicate that anal intercourse is
the most highly, infective of sexual practices (per-
haps 1 in 10 chances of infection per incidence).
? Some experts believe heterosexual intercourse and
other forms of sexual activity under conditions of
good health are 100 to 1,000 times less infective.
The lower risk of AIDS transmission through hetero-
sexual intercourse is demonstrated in studies of
infected hemophiliacs and their spouses. An extend-
ed, unprotected heterosexual relationship resulted in
the United States.
The frequency of repetition of high-risk behavior and
variety of contacts are exceptionally important in
AIDS transmission. These "high-risk behaviors" are
most frequently practiced in various combinations
among homosexuals, prostitutes, drug addicts, and
other very sexually active people. Scientists believe
these "high-risk groups" drive the AIDS epidemic
because they are most likely to transmit the infection
to a number of others. The AIDS epidemic has
advanced rapidly where such people congregate and
interact in large numbers.
Statistics indicate that the inadvertent transmission
of infected blood through transfusions, medical acci-
dents, or mother-to-infant contacts are of decidedly
secondary importance in the generation of an AIDS
epidemic. While these events are tragic, they add
little to an epidemic because the victims are generally
unlikely to transmit the disease further. The low rate
of infection from accidents with HIV-contaminated
material indicates that HIV transmission through
reused medical needles or accidental needle sticks
will account for a very small number of infections.
(Scientists have found the HIV virus unable to sur-
vive prolonged exposure to air or even relatively low
temperature sterilization. Furthermore, most believe
a fairly large amount of viral material is usually
necessary to accomplish infection.) -_-]
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The Soviet Union also hosts an additional 7-9 million
foreign visitors each year. These include over 13,000
merchant seamen, a few thousand foreign business-
men, and a much larger group of tourists. Tourists
accounted for almost 7 million visits to the USSR in
1983, the latest year for which statistics are available,
but their short and generally closely supervised stays
make them unlikely conduits for AIDS. An exception
are tourists from Scandinavia, who are less circum-
scribed in their activities in the USSR and make more
repeat trips.
All foreigners are popular with Soviet prostitutes
because of their access to hard currency. The Soviet
press has described how hundreds of prostitutes gath-
er in major port cities. An Ethiopian student studying
in Odessa reported that prostitutes clustered nightly
outside his student dormitory. A recent article in the
Leningrad Komsomol newspaper described local pros-
titutes as having staked out jealously guarded ethnic
turfs, specializing in Africans, Scandinavians, and
Asians.
Soviets Abroad. Soviets abroad provide another poten-
tial avenue for the disease. Not counting its highly
regulated and insulated military forces stationed in
Eastern Europe, the Soviet Union has 240,000 person-
nel posted abroad, consisting of 15,000 diplomats and
related personnel, 79,000 technical advisers, and
147,000 military advisers and troops. Two-thirds of
Soviets overseas serve in the apparently AIDS-free
environments of Mongolia and Afghanistan.' Those
stationed in areas of some exposure to AIDS include
15,000 people in Sub-Saharan Africa and approxi-
mately 13,100 in Cuba.
Before Soviets are sent abroad they are very carefully
screened for reliability. While out of the USSR, they
must report any significant foreign contacts to Soviet
security officers. These procedures are reported to be
successful in causing most Soviets to avoid frequent
sexual encounters with foreigners. The case of the
translator who became infected in Africa and re-
turned to directly and indirectly infect 14 others
' There are no reports of the presence of AIDS in either Mongolia
or among the civilian population in Afghanistan. However, there
have been a few unconfirmed reports of some troops returning from
indicates these checks are not always sufficient, but
such cases are probably rare (see inset). In any event,
the Soviets are now requiring AIDS tests for officials
returning from abroad, undoubtedly to prevent a
repetition of such an occurrence. F____1 25X1
The Soviet merchant marine, which consists of 7,200
ships manned by 21,000 seamen who make as many
as 37,500 port calls a year outside the USSR, could be 25X1
another source of infection. Of these stops, however, 25X1
only 554 are in Africa and 2,248 in Latin America
and the Caribbean, and port calls on these voyages are
reportedly usually tightly controlled.
recently a number of sailors of the Bulgarian fishing 25X1
fleet have tested positive for AIDS. 25X1
High-Risk Behavior and Susceptible Groups
While the Soviets suffer from the same risk factors
that have driven the AIDS epidemic in the West,
these factors have a very different weight in the Soviet 25X1
risk equation. In particular, the overwhelmingly domi-
nant risk factors in the West-homosexual promiscui-
ty and intravenous drug use-are barely visible in the
USSR. A much more potent force in the Soviet
context is prostitution, which is surprisingly wide-
spread.
Prostitution. Despite sometimes intense police harass-
ment and occasional arrest and imprisonment, prosti-
tutes are common in much of the urban USSR,
resorts, and even many remote areas. Because of their
mobility in all parts of the country, their reportedly
high rates of sexually transmitted diseases, and other 25X1
"cofactor" health conditions, they are more capable
than any other group of spreading an AIDS epidemic
in the USSR. According to the Soviet press, prosti-
tutes frequently travel in the USSR, including a
seasonal invasion from northern cities to serve the
tourists at the Black Sea resorts. A former prostitute
with some medical knowledge claimed that 40 percent
of the prostitutes in Krasnodar suffered from syphilis
or gonorrhea. Soviet officials in July discussed at
length the case of a prostitute in Odessa who had
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Figure 1. The 'first" case teaches a lesson.
A medical journal shows the suffering of the
translator with Kaposi's sarcoma before and
Out ofA.frica: The Notorious "First" Case
The Soviets have given much publicity to what was,
until recently, their only acknowledged full-blown
case of AIDS, a bisexual man who contracted AIDS
while attached to the military mission in Tanzania as
a translator (he is usually referred to as a journalist
in open press accounts). Since he returned to the
USSR in 1982, he has been directly or indirectly
responsible for the infection of at least 14 people and
provides a vivid illustration of how AIDS might enter
and spread in the USSR:
? The translator maintained an active homosexual
sex life from his return to the USSR in 1982 to his
becoming ill with AIDS in 1987 (he is reported to
suffer from Kaposi's sarcoma tumors). Of his 22
male partners, he infected five.
become HIV infected; she reportedly admitted to
having had several hundred Soviet sexual partners. A
Leningrad prostitute, as noted, was the first acknowl-
edged death from AIDS. Press accounts indicated she
had numerous sexual partners and continued these
after she was infected. One newspaper even carried
her photograph in an effort to alert those who had
sexual relations with the woman to come in for
testing!
Homosexuality. Some Soviet homosexuals have al-
ready been found to have AIDS and to have transmit-
ted it to others. But they are unlikely to play as
important a role in its transmission as in the West,
where they constitute over 70 percent of those sick
with AIDS
' Prostitution in the USSR functions largely without brothels,
blatant street solicitation, or even a stable cadre of professional
practitioners. While reliable numbers may never be available, in
1987 former Moscow party boss Boris Yel'tsin admitted to an
audience of foreign diplomats that there were over a thousand
prostitutes in the capital. This is probably a considerable under-
statement, because a district police commander showed a Soviet
reporter his file compiled over a number of years of 3,500
prostitutes operating in his area alone. On Soviet radio in January
1988, the local deputy police chief of the Krasnodar region revealed
that "at the present moment officially there are 267 prostitutes in
the region." This may also be an understatement because of this
? Three of his infected bisexual partners failed to
infect any of their 11 female contacts; another
bisexual infected one of his five female contacts.
? The fifth bisexual partner, however, infected two of
his six female contacts, and also donated blood,
infecting five of the six recipients.
? One of the females infected by the man above gave
birth to a child who shows some signs of having
been infected through the mother.
This case has probably had an impact on the con-
sciousness of the general public and high-level offi-
cials as well. It has been used repeatedly by Soviet
health officials to make their point about the dangers
of AIDS and probably was connected to the leader-
ship's decision to test all Soviets returning from
extended stays abroad. The case also illustrates the
reality of active homosexuality in the USSR and its
link to the female population through substantial
bisexuality. On the other hand, the fact that only
three of the 22 known female contacts of the infected
males became infected also suggests the limits of
heterosexual transmission of AIDS in the USSR.
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Figure 2. Warning, AIDS car-
rier. This photo of the Lenin-
grad prostitute who died of
AIDS was shown in a Lenin-
grad newspaper as a service to
readers who might have been
There are no statistics on the number of homosexuals
in the USSR. Until recently, Soviet media, officials,
and medical doctors have often flatly denied the
existence of homosexuality in the Soviet Union-
leaving the regime in a poor position even to ascertain
how prevalent it was, much less to educate homosex-
uals to safe practices, find them for testing, or ensure
their sexually transmitted diseases are treated. Some
experts suspect there may be proportionately as many
homosexuals in the USSR as in the West. If this were
the case, there would be roughly 4 million homosexual
males in the USSR.
However large the pool of homosexuals in the USSR,
their frequency of sexual activity and number of
partners are probably much lower than in the West
before the onset of AIDS, because greater repression
in the USSR inhibited contact. In the USSR, homo-
sexual behavior is considered a crime rather than a
psychiatric disorder or an acceptable lifestyle choice.
The crime of pederasty, including any homosexual act
by consenting partners, can be punished by five to
eight years imprisonment. If figures from 1966 are
still indicative, about a thousand persons per year are
convicted under this statute. Once a homosexual is
identified by the police' and is "registered," he faces
the loss of his job and expulsion from the party if he is
a member. The Soviets' punitive approach to homo-
sexuality has not prevented homosexual networks
from existing in major cities, but it certainly has
restricted their activities to largely clandestine en-
counters.
' Homosexuals will go to great lengths to avoid official discovery
and, therefore, are easy prey to blackmailers.
On the other hand, frequent bisexuality and marriage
increases the role of Soviet homosexuals in transmit- 25X1
ting AIDS to heterosexuals. A high percentage of
Soviet homosexuals marry for protection.
A potentially crucial factor in assessing the links
between homosexuality and AIDS in the USSR is the
kind of sexual practices engaged in by Soviet homo-
sexuals. A former Moscow journalist has provided one
of the few detailed discussions on this subject. He
asserts that Soviet homosexuals, because of the furtive
nature of most of their contacts, generally practice
oral sex rather than anal intercourse. A lower rate of
the latter would dramatically decrease the likelihood
of AIDS transmission. In effect, it would mean that
perhaps some substantial portion of Soviet homosex-
uals practice "safer sex" and to that degree reduce the
danger of spreading AIDS among them.
In recent public statements, which were subsequently
confirmed to a visiting US delegation, Health Minis-
ter Chazov stated that none of the 8,000 homosexuals
and bisexuals rounded up for mandatory testing in
late 1987 (obviously not including those infected by
the translator) was found to be HIV infected. This
claim seems extraordinary, given the probable expo- 25X1
sure to foreign and domestic sources of HIV infection
likely among Soviet homosexuals. The authorities
have reportedly detected and registered only a small
fraction of the total number-probably the least
protected and most inhibited in their behavior-which
may account for the results in Chazov's sample.
(Chazov also ignores those persons infected by the
homosexual who contracted AIDS in Africa.) Never-
theless, Soviet homosexuals may be far less infected
than might have been supposed even by Soviet offi-
cials before testing began.F__1 25X1
Prisoners. The correctional system, which confines
over 2.4 million prisoners under severe conditions of
overcrowding, exposure to the elements, malnutrition,
and appalling health conditions, presents the largest
concentrated environment for the rapid spread of
AIDS in the USSR.
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? a majority of prisoners engage in
homosexual activity at one time or another.
The most prevalent form of promiscuous homosexual
activity is not between consenting partners but instead
a form of sexual assault or forced prostitution orga-
nized by prison toughs. Approximately 20 to 30
percent of prisoners are said to be involved in this
exploitive system. Under this system, a group of
unfortunate prisoners are permanently stigmatized as
pederasty and forced to engage in homosexual prosti-
The regime is apparently aware of the danger posed
by these conditions. Academy of Medicine President
Pokrovskiy told a US delegation in July 1986 that
testing of prisoners has begun and that, to date, only
one HIV-infected prisoner has been found. However,
it is likely that the testing process has only just started
because there are over 2 million prisoners to be tested
at hundreds of extremely remote facilities. In March
1987, the Soviet press quoted a Georgian health
official that HIV-infected individuals had been found
among the prison camps in that republic. It is unlikely
that problems with the correctional system can be
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In such an environment, sexually transmitted diseases
are rapidly spread. This is one of the few places in the
USSR where a homosexual could rapidly encounter
many sexual partners. Not only are prisoners in poor
health generally, but syphilis and gonorrhea are also
prevalent. If AIDS has entered the prison population,
it is likely to spread rapidly because of the high
infectivity and susceptibility of the prisoners. Unsani-
tary medical practices and needle contamination may
also transmit the disease to other prisoners.
Moreover, prisoners have more opportunities to infect
others than may be supposed. Some prostitution oc-
curs between prisoners and female camp workers and
between male and female prisoners. Heterosexual
transmission may occur through conjugal visits, which
are permitted as many as four times a year in Soviet
prisons. Nearly all prisoners survive their sentences,
which are often fairly short, even for serious criminal
offenses, and return to communities all over the
country, including rural areas. In fact, many of the
toughest criminals, the most dangerous potential car-
riers, are forbidden to return to the cosmopolitan
cities, where AIDS got its initial foothold, but instead
spread the disease to remote areas to which they are
10 Our knowledge of sexual activity among prisoners is to a large
extent provided by the memoirs of former prisoners. The most
notable account is to be found in the book, Sex in the USSR, by the
sex therapist, Mikail Stern, who did a three-year term in an
intensified regime camp in the Ukraine in the late 1970s. His
detailed account of widespread homosexual activity and sexually
transmitted diseases is corroborated
fully laid to rest for some time.
The Military
The Soviet military, by gathering approximately 4
million men from all strata and regions of the country
and placing them in a generally unhealthy, stressful
environment, is another potential medium for the
transmission of AIDS. At present, however, AIDS
does not appear to have affected the military to any
significant degree. In July 1987, the army's chief
military doctor, Gen. F. I. Komarov, denied that the
military had any cases of AIDS to date.
It is unlikely that the Soviet military will be able to
prevent some soldiers from bringing AIDS into the
service with them. Soviet officials indicated to a US
delegation that military authorities are taking precau-
tions by testing draftees at induction, and they have
found some infected individuals among them. It would
probably be difficult to test all of the nearly million
conscripts in each biennial callup. The young age of
the Soviet conscript army, however, will limit the
incidence of AIDS among recruits. Western experi-
ence indicates that the overwhelming majority of HIV
infection occurs after the early twenties, when most
Soviet soldiers have completed their service.
Some US military psychologists doubt that any con-
fined environment of young men is entirely free of
homosexual behavior, and Soviet media have recently
confirmed some cases of homosexual behavior during
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that AIDS does exist in the Soviet
military, that it is spreading there, and that military
officials are particularly concerned about the
situation:
? Early reports in 1985 and 1986 by Soviet scientists
visiting US research facilities, claimed the Soviet
military was taking an early lead in encouraging
AIDS research and expected to have a problem
with the disease in the future. An article by senior
military doctors in the June 1987 Military Medical
Journal cites a series of reasons why AIDS is likely
to be found in the military and prepares doctors to
recognize it and to properly refer patients.
? A prominent AIDS scientist at a Moscow public
lecture told the audience that a military officer had
become infected with AIDS overseas. (This may,
however, be another reference to the best known
case of the homosexual who brought back AIDS
from his service in Africa as a translator for the
military.)
military service. The captured papers of a dead officer
in Afghanistan contains an order to commanders to
take strong measures against homosexuality and to
involve themselves personally in its control. The star-
iki system in which senior conscripts brutally domi-
nate junior conscripts has some potential for sexual
exploitation.
However, the Soviet military culture is very hostile to
homosexuality. Continuing command vigilance ap-
pears to be maintained against the establishment of a
homosexual subculture. A former Moscow journalist
claimed that efforts are made to screen out suspected
homosexuals before enlistment, and if homosexuals
are discovered during service they are segregated in
special units. He termed actual homosexual liaisons
among troops as "practically unprecedented." He
reported that a central register was said to be main-
tained on all military persons suspected of homosex-
uality and that all officers discovered to be homosex-
ual were immediately transferred to the reserves.
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LZDAI
Poor health conditions within the Soviet military 25X1
the time and that treatment is often ineffectual.
find that major illnesses are misdiagnosed over half
create elements of potential vulnerability to AIDS."
These military health problems are, in part, symptom-
atic of the weak capability of Soviet military medi-
cine. Should AIDS ever become prevalent, military
doctors with their weak training, supervision, and
equipment would be less likely to correctly diagnose
or treat it. Studies in the Soviet military medical press
? A Soviet military unit in East Germany is reported
to have an incident of AIDS among its personnel as
of May 1988.
? Staff at the Epidemiology Institute charged with
tracking AIDS nationwide told a US delegation
that the military had found six HIV-infected men
since it had begun screening recruits at induction.
does not appear to be significant sexually transmitted disease in the
Soviet military. However, there are even higher rates of many other
serious infectious diseases than exist in the Soviet population as a
whole. A typical Soviet soldier has a 68-percent chance of catching
such an illness during the first months of service. Many simply get
colds or dysentery, but high percentages catch very severe diseases
such as measles, mumps, pneumonia, or meningitis. There is
evidence that many diseases-such as mumps, which the Soviets
call the "soldiers disease"-are more highly concentrated in mili-
tary ranks. Perhaps most severe is hepatitis, which produces a long,
debilitating illness and remains as a chronic infection in many. One
Soviet study found 2.5 percent of the sailors in the North Sea Fleet
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Intravenous Drug Abusers. AIDS has reportedly al-
ready struck some Soviet intravenous drug users, but,
because of their small number, they are unlikely to
play the pivotal role in the transmission of AIDS to
the heterosexual population as drug abusers do in the
West. Soviet officials from the Ministry of Health
privately estimated for a US delegation that there
were 150,000 to 200,000 drug users and 50,000
addicts in the USSR. Partly because of the shortage
of injectable drugs and needles, and partly because of
the persistence of traditional habits, however, most of
these users smoke hashish, take pills, or sniff intoxi-
cants rather than inject drugs. By comparison, in the
United States there are officially estimated to be 1.1
million intravenous drug abusers among 4.5 million
total drug users. Soviet drug users are widely scat-
tered: a quarter are in Moscow, and other areas of
high use are reported in the Ukraine, Georgia, and
Central Asia
Changes in Soviet society could alter the drug situa-
tion radically in coming years, producing that critical
mass of intravenous drug abusers that could acceler-
drug use continued to be very small, it was growing at
the rate of 50 percent per year. Reduced social control
combined with continued social tension could acceler-
ate that growth to the point of qualitative change.
Paradoxically, the Soviet effort to reduce the transfer
of infection through the production of more disposable
needles may have the unwanted side effect of increas-
ing the number of needles available for drug abuse.
Many Soviets believe that policies to reduce alcohol
availability are increasing drug use.
Health Problems and Practices
The Soviets have more serious health problems and
more serious deficiencies in health care than other
industrialized countries. Less healthy and well-cared-
for people are to some extent and under certain
circumstances more likely to catch and transmit
AIDS. However, the health problems that afflict the
Soviets are the kind that increase general vulnerabili-
ty but do not in?themselves drive an epidemic.
Prevalence of Infectious Diseases. The Soviets have
serious difficulties in controlling infectious diseases.
While the diseases prevalent in the USSR could not in
themselves cause an AIDS epidemic, they are widely
believed to weaken the immune system, making it
more vulnerable to HIV attack. Despite noteworthy
progress since 1960 in reducing such diseases as
measles, typhoid, and mumps, Soviet rates of infection
for these diseases are 20 to 50 times higher than those
found in the United States in 1985 (see table 2).
Moreover, such diseases as hepatitis and meningitis
actually increased during the 1960-85 period, and
some others, after initial sharp declines, rebounded to
a degree in the late 1970s in association with deterio-
ration of various aspects of health care and social
conditions.
In the area that has the greatest impact on AIDS-
the sexually transmitted diseases (STDs), which di-
rectly multiply the risk of HIV transmission-the
Soviet Union is in a more favorable situation than
many countries. its reported
rates of gonorrhea and syphilis are over 70 percent
lower than the US rates. In Africa-where high rates
of heterosexual AIDS transmission are found-rates
of STD are 100 times higher than the Soviet rate.
Despite this good news, a long-term trend of increased
vulnerability may have been established in the USSR.
Historically, Soviet STD rates rose sharply in the
1970s and early 1980s-gonorrhea doubling and
syphilis increasing five times-in parallel with the
West, but from an appreciably lower base. Since
1982, rates of these diseases fell sharply, but the
gonorrhea rate remains 30 percent above its prior
level and the syphilis rate remains 80 percent above
its prior level.
Overall, the high prevalence of diseases in the Soviet
Union that are preventable or curable in the West
indicates that Soviet medical facilities would be hard
pressed to cope with a severe AIDS epidemic. Because
of their problems with infectious diseases, the Soviets
have a competent service to control epidemics, but
their basic health delivery service suffers from
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Table 2
Comparative Rates of Severe Infectious Diseases,
USSR Versus US, 1960-86
Mumps
USSR
395.40
293.60
386.90
159.10
176.60
US
NA
51.70
3.90
1.30
3.40
USSR/US ratio
5.68
99.21
122.38
51.94
Scarlet fever
USSR
313.20
193.60
86.70
95.30
128.00
USSR/US ratio
3.96
8.33
22.25
89.18
22.69
Typhoid/
USSR
22.10
9.30
6.00
6.00
5.00
paratyphoid
US
0.50
0.20
0.20
0.20
0.20
USSR/US ratio
44.20
46.50
30.00
30.00
25.00
Meningitis
USSR
0.40
2.00
3.00
3.10
2.90
US
1.30
1.20
1.30
1.20
1.10
USSR/US ratio
0.31
1.67
2.34
2.58
2.64
Gonorrhea
USSR
73.80
106.00
147.90
125.90
94.60
US
134.90
295.30
445.00
374.80
376.40
USSR/US ratio
0.55
0.36
0.33
0.34
0.25
Syphilis
USSR
4.20
14.20
19.70
11.80
7.60
US
67.80
44.80
30.50
29.80
28.50
USSR/US ratio
0.06
0.32
0.65
0.4
0.28
Sources: US data are from US Centers for Disease Control,
Mortality and Morbidity Weekly Report, September 1987. Soviet
data are from Narodnoye Khozyaystvo 1987 (measles and typhoid);
Sovetskoye Zdravookhranenye, February 1988 (gonorrhea and
syphilis); and P. N. Burgasov, Sostoianye i perspektivy dalnayshevo
snizheniya infektsionoy zabolevayemosti, Moscow 1987 (hepatitis,
mumps, and meningitis).
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decades of neglect. In a key area for AIDS, the Blood Transfusion. In the United States only 2.4
diagnosis of severe illness, many Soviet studies have percent of all AIDS cases have been caused by
found that 30 to 80 percent of cases are misdiagnosed. transfusions of HIV-infected blood, but the danger is
Moreover, other studies indicate the effectiveness of somewhat greater in the USSR because the Soviets
prevention and treatment measures are surprisingly have used less sanitary practices and fewer safeguards
low, and thus many illnesses become unnecessarily
severe or chronic.
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in handling blood. For example, they continue to use
nondisposable transfusion supplies. However, results
of recent mass AIDS testing of blood donors suggest
that infection through transfusion will be quite limit-
ed, because only seven HIV-positive tests were found
in the first 9.8 million blood donors tested. Since mid-
1988 the Soviets have claimed to be testing substan-
tially all the blood supply." Also, fortunately for the
Soviets, they have not used imported blood products,
which resulted in HIV infection for some countries in
the early 1980s.
Nevertheless, as a result of five to 10 years of
exposure to potentially contaminated transfusions, a
number of AIDS infections probably have occurred.
An authoritative Soviet spokesman stated that trans-
fusions accounted for six of the first 64 acknowledged
cases of HIV infection among Soviet citizens. The
first Soviet AIDS death was caused by a contaminat-
ed transfusion received by a young girl in Volgograd,
a city largely closed to foreigners.
picture remains unclear, but the danger of contracting
AIDS from transfusions is still likely to be limited.
Multiuse Hypodermics. The USSR is also uniquely
threatened with some limited AIDS infection through
medical injections contaminated with infected blood.
Disposable needles have been available only in the
limited facilities for the elite. The sterilization of
reusable needles is often improper because of the
frequent lack of proper equipment. However, accord-
ing to medical experts, the threat posed by these
obsolete practices is limited by the fact that the HIV
virus dies quickly on exposure to air or even in an
imperfect sterilization. In addition, studies of medical
" Despite the effort to protect the medical blood supply, some
exposure to HIV infection through medical transmission cannot be
entirely ruled out. For example, Soviet reports of an infant death
from AIDS in the Ukraine and a false AIDS scare in Siberia in
November 1988 raised the possibility that other infants could have
been infected through obsolete medical practices. The reports noted
that blood from the babies that could have been added to the
pediatric unit's "internal plasma bank" and one mother's excess
breast milk was shared with other infants; procedures such as these
would not have been protected by the Soviets' AIDS testing
program.F___1
accidents with HIV-contaminated blood show that,
except for rare instances, a larger amount of viral
material is needed to accomplish an HIV infection
than is transmitted through most medical procedures.
Abortion and Contraception. In general, the Soviets
do not practice contraception. Instead, the average
Soviet woman will have six abortions-in her lifetime,
and some women as many as 20. This rate is seven
times the US rate and 12 times the average rate for
Western Europe. Because the standard Soviet abor-
tion procedure frequently damages the genital area, it
could be another factor increasing susceptibility to the
HIV virus. A major source of the problem is the
failure of the Soviet economy to manufacture good
quality contraceptive devices in sufficient quantity.
Soviets contemptuously term their domestically pro-
duced condoms "galoshes," and many refuse to use
them. However, even as consumer acceptance in-
creases with fear of AIDS, a Soviet health official
claims Soviet condom production of 200 million per
year is only a fifth of the need calculated by medical
authorities.
The Regime's Approach to Controlling AIDS
From the leadership's first formal briefing in Febru-
ary 1987 to the August Politburo decision authorizing
several legislative and program measures, the Soviet
approach to AIDS became progressively more serious
and energetic. The measures adopted affect criminal
law, education, medical treatment, and screening for
AIDS. FI
The Soviet AIDS effort, according to a July 1988
interview with a senior Soviet health official, has been
packaged in a 20-year plan extending to the year
2005. No measures beyond the current testing and
research program were revealed, but a further expan-
sion of activities may be planned to deal with the
growth of the disease expected by most senior offi-
cials. In line with this long-term approach, senior
Soviet officials anticipate that anti-AIDS activities-
previously funded from ad hoc borrowings from
25X1
?5X1
25X1
25X1
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 Declassified in Part - Sanitized Copy Approved for Release 2013/02/06: CIA-RDP89TO1451 R000600770001-5
Figure 3. The Soviets' spokesman on AIDS. Dr.
Valentin Pokrovskiy became the principal scien-
tific authority after the death in 1987 of Dr.
Viktor Zhdanov, the Soviets' r t internationally
known AIDS expert
Health Ministry funds-will now be funded by a
special appropriation. A special health and scientific
bureaucracy has been created to manage and execute
these measures (see inset). The cost of these activities
may be becoming burdensome from the Soviet per-
spective when compared with the limited current
extent of AIDS.
Educating the Public
Soviet scientists and health officials have begun a
public education program on the danger of AIDS.
Once the top leadership accepted the seriousness of
the problem, education efforts were dramatically in-
creased. AIDS hotlines were set up in Moscow and
Leningrad. Following international examples, Soviet
officials distributed large numbers of leaflets on
AIDS. Two million were delivered in Moscow, and 8
million more were sent across the country. On a late-
night TV variety show, the young AIDS expert
Vadim Pokrovskiy (son of the Academy of Medical
Sciences president) explained the details of "safe sex"
to the audience
AIDS has revitalized the push for greater sex educa-
tion in the USSR. The education bureaucracy had
been reluctantly drafting a secondary school sex
education curriculum since it had been ordered in the
1984 education reform decree. In October 1987, the
Minister of Education intervened to throw out what
he considered a weak draft and demanded quick
action on a more hard-hitting product. The Leningrad
Komsomol press has sharply criticized "sexual illiter-
acy" and advocated the distribution of materials
suitable for adults on reproduction, birth control, and
AIDS. In recent statements, Soviet health officials
have complained of a loss of momentum in the
education campaign against AIDS, although they
claim an expanded media campaign is currently under
development.
In the Soviet environment many high-risk people have
gone into hiding to avoid persecution, and communi-
cation with them is difficult. The Soviets do not
appear to be reaching such people through the kinds
of methods that have worked in the West, including
using outreach social workers, voluntary nongovern-
mental organizations, or media appeals targeted at
vulnerable groups. Moreover, the messages delivered
to the public have been often vague about the specific
behavior needed to prevent AIDS compared to similar
materials in the West.
Hardline Approach for High-Risk Groups
Homosexuals, prostitutes, and drug addicts are being
rounded up for mandatory testing and, if found to be
infected, are threatened with prosecution under the
new AIDS law, which makes exposing someone to
AIDS a crime punishable by five years in prison and
infecting someone punishable by eight years. Authori-
ties are also using this law to force those people found
to be AIDS carriers to pledge to refrain from sexual
activity for five years. In September, Valentin Pok-
rovskiy predicted that persistent defiance by infected
persons would result in their confinement. (Three
months later a Ukrainian woman received the first
four-year term under the 1987 law.) He expressed
admiration for the effectiveness of the Cuban quaran- 25X1
tine of infected persons and predicted the USSR
might have to follow this example.
At the same time, recent reports indicate that stron-
ger measures to curtail prostitution are being taken in 25X1
some areas. Some republic governments have enacted
100 ruble fines for prostitution. The fines are not
large in relationship to potential earnings, but affirm
the illegal nature of the practice. According to press
reports from Moscow, Leningrad, Tbilisi, and Frunze,
prostitutes have been driven out of some of the hotels
of major cities and resorts.
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 Declassified in Part - Sanitized Copy Approved for Release 2013/02/06: CIA-RDP89TO1451 R000600770001-5
Figure 4
Organizations Involved in the Fight Against AIDS
Council of Ministers
Nikolai Ryzhkov,
Chairman
Ministry on Health
Operational
Group on
AIDS
Hospital Wards
for AIDS Patients
Moscow, Leningrad
Minister of Health
Yevgeniy 1. Chazov
Main Sanitary
Administration
Aleksandr Kondrusev,
Chief State Sanitary
Officer
Quarantinable Infections
Main Administration
Mikhail Narkevitch
Russian Republic Ministry
of Health
Anatoliy Potapov, Minister
and 12 Other
Republic Ministries
Central Research
Institute of Epidemiology
Valentin I. Pokrovskiy,
Director
AIDS Epidemiology and
Prevention Laboratory
Vadim V. Pokrovskiy,
Chief
Blood Transfusion
Centers
Source: This organization chart is adapted from material supplied
by the USSR Ministry of Health to a visiting US Government
delegation, July 1988.
Venereal Disease
Clinics
Sanitary Epidemiological
Stations
State Committee on
Science and Technology
Boris Tolstykh,
Deputy Chairman,
Council of Ministers
Interministerial
Committee on AIDS
Aleksandr Kondrusev,
Chairman
Ivanovskiy Institute
of Virology
Dmitri Lvov, Director
Academy of Medical
Sciences
Valentin 1. Pokrovskiy,
President
Department of Hygiene,
Microbiology, and
Epidemiology
Valentin I. Pokrovskiy,
Academic Secretary
Institute of
Immunology
Rakhim M. Khaitov,
Director
Scientific Advisory
Committee on AIDS
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 Declassified in Part - Sanitized Copy Approved for Release 2013/02/06: CIA-RDP89TO1451 R000600770001-5
Organizing a Bureaucracy To Battle AIDS
In the past year, the regime has started organizing a
bureaucracy of scientific and health professionals to
oversee its fight against AIDS. Preeminent among
them, although not involved directly in running the
program, is Yevgeniy Chazov, the dynamic and politi-
cally powerful Minister of Health who formerly
managed the health care of the high elite and had
won a Nobel Prize for his work in official peace
activities. He played the key role in selling the
leadership on the ambitious and expensive health
reform plan adopted last year. The leadership's shift
to a serious approach to AIDS closely corresponded
in time to his appointment in March 1988.
As Soviet officials explained to a US delegation in
July, AIDS policy is nominally developed and coordi-
nated by an Interministerial Council on AIDS com-
posed of the Health Ministry and other major partici-
pants in anti-AIDS measures including the Academy
of Science, Academy of Medical Sciences, the phar-
maceutical industry, Interior Ministry, and the KGB.
This body is supposedly under the umbrella of the
State Committee for Science and Technology, al-
though it is chairmaned by Deputy Health Minister
Aleksandr Kondrusev and is probably dominated by
ChazovJ
For many reasons, including concern about AIDS, the
regime seems especially concerned about controlling
the expansion of drug abuse. The Soviet press uses the
specter of AIDS in its admonitions against drug use in
general. Soviet officials and medical personnel have
feared that reduced alcohol availability would lead to
a switch to drugs. The exact figures are subject to
doubt, but police officials were quoted in the national
press that drug addiction was up 2.5 times, while
alcoholism declined 17 percent since the start of the
antialcohol campaign in 1985. Measures were taken
in September to ease the frustrations of Soviet drink-
ers by increasing the supplies of beer and wine. A
high-profile campaign is currently under way to cur-
tail drug supplies, although most of the drugs used in
the USSR are not the kind that are used intra-
venously.
Kondrusev, as Chief State Sanitary Officer, is also in
charge of overseeing the implementation of activities
against AIDS through an AIDS Control Unit within
the Ministry's Department of Quarantine Diseases.
This unit coordinates the 15 union republic health
ministries and the planned network of 1,000 testing
centers, 40 research institutes, and three AIDS hospi-
tal units.
Playing high profile roles in the media and also in
research and policy development are Valentin Pok-
rovkiy, president of the Academy of Medical Science
and director of the Central Epidemiological Institute
and his son, Vadim Pokrovskiy, chief of the Insti-
tute's Laboratory for the Epidemiology of AIDS.
Valentin has become the regime's most conspicuous
spokesman on AIDS. Vadim's unit maintains a cen-
tral computerized data base for all AIDS test results
and is responsible for their evaluation. He is probably
in his early thirties and has made frequent appear-
ances to explain AIDS, often to primarily younger
audiences.
Cutting Off Foreign Sources of Infection
The regime is trying to eliminate as many foreign
AIDS carriers as possible without disrupting lucrative
trade or tourism. Since early 1987, the regime has set
out to test all foreign students in the USSR and any
person remaining over 90 days in the country (except
diplomatic personnel). Incoming students from abroad
must have passed an AIDS test before leaving their
home countries. AIDS carriers are being summarily
expelled or denied entry into the country, except for a
few said to be refugees. The regime has not imposed
AIDS testing on short-term visitors, however, because
of the dampening effect this would have imposed on
much desired trade, tourism, and foreign exchange.
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 Declassified in Part - Sanitized Copy Approved for Release 2013/02/06: CIA-RDP89TO1451 R000600770001-5
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