Disease, Suicide and Drugs
Part 1 of 'The Vanishing Russians' Times 9/11/2006

Russians are dying in record numbers from disease, suicide and substance abuse.

Male mortality
The average Russian man lives to about 59 and is much more likely to die before 60 than men in other industrialized nations.

Kstinovo, Russia — Welcome to Kstinovo, population one.
Antonina Makarova, 78, spends her days watching news and soap operas in her peeling wooden dacha, the only inhabited structure in two lanes of sagging cottages that once were a village. Her nearest neighbor, 80-year-old Maria Belkova, lives in adjacent Sosnovitsy, population two. But she can't hear anymore, and all in all, Makarova finds the television better company.

"All the houses here were filled with people. There was a cheese factory. But now everyone else has died. God has taken care of them, and he's still making me suffer," Makarova said. "Even the thieves have disappeared."

The Tver region, along the upper reaches of the Volga River 130 miles north of Moscow, is dotted with more than 1,400 villages such as Kstinovo labeled nezhiloye — depopulated. Since 1989, the number of people here has shrunk by about 250,000 to about 1.4 million, with deaths outnumbering births more than 2 to 1.

The Tver region is far from unusual in this country.

Russia is rapidly losing population. Its people are succumbing to one of the world's fastest-growing AIDS epidemics, resurgent tuberculosis, rampant cardiovascular disease, alcohol and drug abuse, smoking, suicide and the lethal effects of unchecked industrial pollution.

In addition, abortions outpaced births last year by more than 100,000. An estimated 10 million Russians of reproductive age are sterile because of botched abortions or poor health. The public healthcare system is collapsing. And many parents in more prosperous urban areas say they can't afford homes large enough for the number of children they'd like to have.

The former Soviet Union, with almost 300 million people, was the world's third-most populous country, behind China and India. Slightly more than half of its citizens lived in Russia. The country has lost the equivalent of a city of 700,000 people every year since the collapse of the Soviet Union in 1991, only partially offset by an influx of people from other former Soviet republics.

A country that sprawls across one-eighth of the globe is now home to 142 million people.

The losses have been disproportionately male. At the height of its power, the Soviet Union's people lived almost as long as Americans. But now, the average Russian man can expect to live about 59 years, 16 years less than an American man and 14 less than a Russian woman.

Sergei Mironov, chairman of the upper house of Russia's parliament, said last year that if the trend didn't change, the population would fall to 52 million by 2080.

"There will no longer be a great Russia," he said. "It will be torn apart piece by piece, and finally cease to exist."

That may be an overstatement, but there are serious questions about whether Russia will be able to hold on to its lands along the border with China or field an army, let alone a workforce to support the ill and the elderly.

The government, flush with revenue from record prices for the country's oil exports, has started to respond. President Vladimir V. Putin this year pledged payments of $111 a month to mothers who elected to have a second child, plus a nest egg of $9,260 to be used for education, a mortgage or pensions. He also called for renewed efforts to attract ethnic Russians still living in the former Soviet republics.

"Russia has a huge territory, the largest territory in the world," Putin said. "If the situation remains unchanged, there will simply be no one to protect it."

'This Infection in Us'
The economic earthquake of Russia's transition from communism to capitalism plunged tens of millions into poverty overnight and changed the value systems upon which many had planned their lives.

A small minority, mostly in urban centers such as Moscow and St. Petersburg, were able to exploit the absence of rules in the chaotic 1990s to become fabulously wealthy. But such a profound social transition, coming at the end of a century of war, revolution and ruthless social experimentation, condemned a great many more to a deep malaise.

Those who lost out have proved susceptible to drinking, smoking and other habits that killed millions of Russians even in the best of times. In more extreme cases, they kill themselves.

The suicide rate jumped nearly 50% during the 1990s; half a million people killed themselves from 1995 through 2003. Russians fling themselves from balconies, slash their wrists or simply walk out in the snow on a bitter night. Russia's suicide rate, at about 36 per 100,000 people, is second only to that of Lithuania, according to the Serbsky National Research Center for Social and Forensic Psychiatry. In some remote areas of Russia, the rate exceeds 100 per 100,000.

Nikolai Zavada, a 21-year-old musician who goes by the name Serial Self-Killer, posted a song on www.mysuicide.ru, a well-known website that was later shut down because of public pressure:

I'm going out.
And it doesn't matter whether it's up or down.
Or who's holding your hand, an angel or otherwise....
The cold has worn me out.

"People have a lack of hope," Zavada said in an interview. "That all their efforts are in vain. And also, they have a feeling of eternal emptiness."

Russia's transformation from a society that guaranteed employment means that millions of people, especially in the provinces, "have become surplus; they do not have a place in the current economy," said Andrei Demin, president of the Russian Public Health Association, a non-governmental advocacy group.

"They do not protest openly. They protest inside," he said. "And the most extreme form of protest is just dying."

Others tried to adapt, and still failed. Birth-rates declined, not only because couples such as those elsewhere in Europe elected to have fewer children, but because they couldn't afford to have large families.

Roman Kiptenko, 35, has a family, his health and two university degrees, but his life is turning out far differently than he had imagined. The national parks institute where he worked disintegrated in the Soviet collapse. He now works as a technical director in a friend's advertising company in Moscow. But the firm is small and its future uncertain. His wife was laid off last spring from her job as a dental office manager.

Kiptenko has begun to realize that they might never do better than the $330-a-month apartment — a cramped living room adjoining a tiny kitchen — where they live with their 10-year-old daughter. Kiptenko and his wife sleep on a pullout sofa. Their daughter's bed in the corner seats guests by day, her toys stacked neatly to one side. Clothing is stacked in cupboards next to Kiptenko's computer.

"At first, situations would come up when my wife would talk about wanting another child," he said. "But gradually, she stopped raising those questions."

Alexei Chaika, another Moscow resident, blamed the heart attack he suffered at 27 on stress from his job as a transportation manager for a construction company. Recovering at a clinic in the capital, he said he had worked every day until 11 p.m., and every weekend for months on end, all for a salary of $525 a month.

"At work, the tension is very high, and you have to quarrel with people," he said. "Somebody hits me on the back of my head; I hit someone lower than me; he hits somebody else."

Although the problems are surfacing in the post-Soviet period, some argue that their cause can be found in communism's willful destruction of generations of the country's most capable and adaptable people.

"Seventy-five years of Bolshevik life in this country led to the formation of a tribe of people which was cultivated to listen to orders, and fulfill them," said Alexander Gorelik, a St. Petersburg physician. "Stalinism," he said, "aimed for the planned and gradual physical destruction of the most moral, the most creative group of the population. There is such a thing as a will for life. And the whole trouble is that the Russian public in general, and especially the male population, has a big deficiency in this area."

Vyacheslav Pushkarev, a Russian Orthodox priest who oversees several congregations in Siberian villages now too small to have a full-time cleric, said the Soviet system destroyed bodies and spirits in equal proportion.

"We are left with this infection in us, this sickness of degradation in everything around us because we were all part of it," he said. "We're living in a huge bowl here, and we're all getting boiled together."

Drowning in Alcohol
Many a Russian village that once might have been the subject of an idyllic painting of ruddy-cheeked peasants leading tired horses through the fields are now part of a twilight world of illness, drunkenness and stunning lethargy. Moscow has the second-largest concentration of billionaires in the world. But one-fifth of all Russians live on less than $38 a month, many of them in the countryside. The collapse of collective farming and the failure to replace it with viable private agriculture has left thousands of villages in limbo, their residents living on minuscule government stipends, odd jobs, kitchen gardens — and vodka.

There is a long history of alcohol abuse in Russia. Soviet President Mikhail S. Gorbachev tried to tackle the problem 20 years ago by limiting the production and distribution of liquor. Male life expectancy increased three years. But consumption levels shot back up as soon as the controls were eased. The average Russian drinks five gallons of pure alcohol a year, causing an estimated 900,000 deaths over the last decade from acute alcohol poisoning, fights and accidents, according to figures released by Tatyana Yakovleva, head of the Russian parliament's healthcare committee. Others suffer permanent brain damage or liver damage from homemade alcohol.

"People drink, and they drink a lot, and they drink for a long time, because they can't help but drink," said Yuliya Kovgan, 25, her voice trembling as she struggled to sit without falling over in a potato field on the edge of Ryazanovshchina, a Siberian village northeast of Irkutsk.

She was surrounded by a few dozen seed potatoes, an empty shot glass, a bottle of industrial-grade alcohol and her reeling brother, an unemployed roofer. Standing to the side in an old housecoat was Larisa Berezhnaya, her 53-year-old mother, tapping a grimy foot and affecting a disdainful air; it became apparent that she was drunk too.

"This is our life; we call it normal. We plant potatoes, we dig them out, and that's it," Berezhnaya shrugged. "There's nothing for people here."

A few decades ago, Ryazanovshchina was a collective farm center with thriving livestock operations and about twice its current population. Men would go into the forests to fell timber all summer and the women would celebrate their homecoming with samovars of tea in the street. But without the support of the Soviet state, one by one the farms failed.

Last winter, villagers say, someone burned down a neighbor's hay shed when she wouldn't give a bottle on credit. In a nearby town, a drunk grandmother threw a crying infant out the window of her fifth-floor apartment. Pushkarev, the regional archpriest, confided that the church in nearby Tikhonovka was not functioning because "the priest is on a drunken rampage."

Olga Kolotygina, 36, one of several women who have assumed leadership of the Ryazanovshchina town council, estimates that no more than half a dozen men among the village's 160 people are sober and " trying to improve their lives."

Much more typical is the filthy two-room shack at the end of a street where Lyudmila Borisova, 16, is looking after her three younger siblings. Her mother moved to the next town with her boyfriend, leaving the children behind. While Borisova earns money by tending cattle in a pasture outside town, her siblings wander the village gathering handouts. They retire each night to a pair of bare mattresses. Borisova says she doesn't blame her mother for leaving, and she'll do the same when she can.

"There's nothing good here," she said.

AIDS Strikes the Young
It has been five years since Svetlana Glukhova was diagnosed as HIV-positive, but she says she still has no idea whether she needs drug therapy. Doctors at the only AIDS center in her city do not have the necessary laboratory equipment to decide that.

She does know that even when she took her first AIDS test, the sores on the fingers she once used to inject heroin already were failing to heal.

The United Nations says Russia has more people infected with HIV than any other country in Europe, due in part to "extraordinarily large numbers of young people who inject drugs."

But the disease has spread widely through the population, and more than half of all new cases result from heterosexual intercourse. Officially, more than 300,000 Russians are infected with HIV or have AIDS, but the U.N. says the number could easily be much higher.

The problem is not as serious as Africa's. The difference, experts say, is that African birth-rates are high enough to replace those who die. Not so in Russia. Compounding the problem, the prevalence of AIDS among young people threatens to add to the population decline by killing them before they can bring a new generation into the world.

Murray Feshbach of the Woodrow Wilson International Center for Scholars in Washington, one of the world's leading experts on Russian health and demographics, said in a study that 80% of Russian AIDS patients are younger than 30. In the West, it's nearly the reverse: 70% are older than 30. That means 5 million to 10 million Russian teenagers could contract the disease within a few years, federal health officials say. The Russian Military Medical Commission has recorded a twenty-fivefold increase in the number of HIV-positive military conscripts in the last five years, Feshbach said.

"Even optimistically, you're looking at 250,000 deaths a year from AIDS alone in 2020, and pessimistically, we're talking about 650,000 a year," Feshbach said. " Deaths among adults between the ages of 25 and 49 would be particularly devastating," he said.

The Russian government pledged in 1995 to provide free AIDS treatment. But more than a decade later, only about 5,000 people are getting anti-retroviral drug therapy.

Putin announced a twentyfold increase in funding this year, providing $120 million for the treatment of perhaps 15,000 AIDS patients.

A coalition of nongovernmental organizations known as the Global Fund is allocating another $120 million to treat as many as 50,000 additional patients through 2010.

But the World Health Organization said in June that shortages in AIDS drugs had developed in several regions, apparently resulting in interruptions in treatment and possibly some deaths.

Akrom A. Eltom, the agency's AIDS program leader in Moscow, said patients who had been coaxed with great difficulty into a healthcare system that strongly stigmatized them might not return, endangering their health and encouraging the development of drug-resistant strains of the disease.

Glukhova said AIDS patients in the city of Tula, the arms manufacturing center 112 miles southwest of Moscow where she lives, would be ostracized if they went public. She said she wouldn't dare talk to Russian news media without covering her face.

"If I uncover my face, I will be eaten alive at the bus stop tomorrow," she said in an interview. "I will lose my job, without any doubt."

Glukhova headed a support network of fellow HIV patients in Tula until international funds ran out in 2004. She said doctors told her they estimated that 1,000 people in Tula — population 600,000 — needed drug therapy for AIDS, but only 10 were getting it — and only partial treatment at that.

"When I asked the doctors in the AIDS center about this therapy, they just shrugged their shoulders. Because when I told them I heard there are three drugs you're supposed to take, they had a notion of what I was talking about, but they don't have access to it. The maximum they can offer you is just one drug," Glukhova said.

Sitting in a dimly lighted cafe that doubles as a dance hall on Saturday nights, Glukhova wiped away tears and said she was watching her friends slowly die.

"One person I know, he was trying to stifle all his pangs by injecting and injecting himself with drugs. He couldn't even get up from his bed anymore, but he continued to call his friends and ask for more drugs," she said. "When I said to him, 'Let me take you to the hospital, let me try to get something for you,' he waved me away. Some people have such moments of despair that they just don't have the guts to struggle for their life anymore."