Title :
Prospekt
St. Petersburg, 11 pm
Young prostitutes in mini-bus – in Russian
Hi girls!
Hi.
Aaah, nice and warm in here!
Have a seat. Make
yourselves comfortable.
What are you after?
I need a condom.
What… just one?
Yeah, she needs condoms.
Green ones. And I want
the red ones. Lots of them.
It seems quiet today…
No, there were loads of girls,
it’s just that business is going well.
So tell me, then,
how are you? How’s life?
You call this a life?
Life with drugs is a life? It’s not a life.
You should quit.
It’s not that easy.
Have you tried?
No, actually, I haven’t.
You haven’t?
I haven’t... because
I know I’d start up again.
So why should I suffer?
1
V.O.
Worldwide an estimated 42 million people are living with HIV, most of
them on the African continent. However, with Russia and the Republics of
the former Soviet Union, the virus has opened a new front in its deadly
campaign.
Russia has now the fastest growth rate of HIV infection in the world.
Today, more than 1 Million people within its borders live with the
virus, and if the increase continues at this rate the figure could rise
to 12 Million by 2020.
Titles:
Laika Pictures presents
SEX, NEEDLES AND ROUBLES
V.O.
For most Russians, relative economic and political freedom has come at a
high price. Unemployment is rife, the housing situation is precarious,
and access to healthcare and social services is limited.
But where formal economies stagnate, shadow economies have mushroomed.
With the collapse of the Soviet Union, tight social control vanished and
crime, corruption and prostitution spread rapidly. A cross border trade
of arms and drugs led to a huge influx of heroin from central Asia.
Heroin and home-made amphetamine cocktails have become increasingly
popular among the Russian youth. Unlike in the West, where recreational
drugs are usually snorted or swallowed, in Russia almost all substances
are injected.
Needle sharing is therefore the main cause for the unfettered advance of
the epidemic.
The overwhelming majority of those infected with HIV are injecting drug
users under 30, and in most cases, sexually active. Consequently in
recent years the epidemic has spread beyond high-risk groups.
Prostitution and unsafe sex have contributed to a rapid increase of HIV
infections among the general population. Yet this threat to ordinary
Russians is often ignored.
Titles:
Camera Pierre Boffety
Sound Damien Turpin
Editing Mariko Montpetit
Still photography John Ranard
Music Sarah Sarhandi
a film by Chloë Mercier
V.O.
In many parts of Russia it has taken foreign organisations to implement
harm reduction programmes, in an attempt to stem infection through the
sharing of syringes.
Since 1997 Alexander Tsekhanovitch has run the ‘Doctors of the World’
needle exchange programme in St Petersburg. His organisation offers
advice and help for drug users, a criminalised and stigmatised
2
population who avoid public hospitals in fear of prosecution and
discrimination.
Alexander Tsekhanovitch – in French
Title:
Alexander Tsekhanovitch
Project Director
Humanitarian Action, St.Petersburg
No one was denying the problem in Russia.
The problem is a little more
- I don’t know how to define it –
but it’s not just the simple fact
of denying the HIV cases.
And I remember at the time,
when the first cases of
the children’s mass contamination
broke out in the hospitals across southern Russia,
everybody talked about it, and it was recorded.
B&W Picture
Title:
Volgograd, 1998
Alexander Tsekhanovitch – in French (continued)
I think the problem goes a lot deeper,
and lies in the mentality of post-communist Russia
– it’s complicated to define.
But this is how it is in the current Russian society.
A human being is abstract.
And on top of that, there’s this tendency
to stigmatise those who aren’t like the majority.
That’s where the problem lies, with years of
communism, and centuries of the orthodox religion.
It’s always the group,
the community, the majority, the rules.
When you’re different,
not only you’re different, you are bad.
3
Nicolaï – in Russian
Title:
Nicolaï
Former Owner of a Prostitution Agency
I returned from military service
during the time of Perestroika.
Of course, the country was in total chaos.
All of a sudden, people were losing their jobs.
They didn’t know where to turn.
V.O.
We met Oksana on Old Nevsky Prospekt. It was two in the morning. She was
waiting for clients but business was slow, so she agreed to talk to
Andrei and Aleksey, two young musicians from St Petersburg who were
helping make this film.
Oksana, Aleksey and Andrei – in Russian
Title:
Oksana, 28
When I was about fifteen or sixteen,
I moved in to live with a very rich man.
I lived with him for six years,
away from my parents.
Then, he was no more.
You mean he was killed?
Yes. Killed.
Fifteen, sixteen... That
would be round about 1993?
Yes. That’s what happened then.
Many of my girlfriends
were in the same position...
…their boyfriends
got killed, or sent down.
There were people left to help us out,
but they couldn’t help forever.
We had to decide
what to do with ourselves.
4
Nicolaï – in Russian
St. Petersburg saw an upsurge in prostitution
around the time of Perestroika.
Everyone began talking
and writing about it.
It became quite an acceptable thing to do.
A lot of agencies began to operate.
Adverts started to appear in the press.
There were more than 300 agencies
openly involved in the business.
Many of the girls
coming into St. Petersburg
weren’t able to afford the rent,
or to pay for their education.
Nowhere wanted to take them on.
So prostitution was the only
road they could go down.
I know that most of them
didn’t want to do it.
Necessity forced them to.
Oksana, Aleksei and Andrei – in Russian
Do you remember the first time?
Of course I remember.
Of course.
And the feeling?
The feeling? Well, you know,
I’d got myself very drunk.
It was with a Frenchman.
It lasted an hour.
I arrived home, totally hysterical.
I stayed in the bathroom for two hours.
I get hysterical like that from time to time.
5
Drugs help calm me down.
Are you still shooting up?
Yes.
V.O.
With the opening of the market for western goods, the entire country was
gripped by a fever for everything new. Soviet icons were toppled. Signs
of American fast-food chains hung where red stars and busts of Stalin
were previously fixed. Former Soviet bureaucrats swapped their Russian
limousines for more expensive German models. In Metro stations
pensioners appeared selling Marlboros, children were found begging in
front of lavish boutiques. Trendy night-clubs popped up everywhere,
inviting Russia into a new pleasure culture.
However, it soon became clear that the market economy was not the
panacea it was promised to be, and appeared to benefit only a select
few. The majority were left struggling.
Alexander Tsekhanovitch – in French
In 1995 we opened
a medical centre for street children,
but rapidly we realised that a lot
of the children were drug addicts.
We reported this to Paris,
and in Paris they said: “Listen guys,
what’s waiting for you is an HIV explosion.”
I remember at the beginning of the project,
the first institutional structure that
we started to cooperate with
was the biggest hospital for
infectious diseases - the Botkin Hospital.
And it wasn’t a secret that,
at the time, Botkin Hospital was
one of the biggest drug dealing places in town.
Dealers would come to sell drugs and
people were shooting-up at the hospital.
You can imagine how the staff was struck with horror.
They were handing in their notice because
they didn’t know how to deal with these people.
6
B&W Picture
Titles:
Botkin Hospital, 1998
Ukraine, 1997
Nizhny Novgorod, 1998
Title:
Dr. Aza Rakhmanova
HIV Maternity Ward
Botkin Hospital, St. Petersburg
V.O.
Aza Rakhmanova is St Petersburg’s chief health officer. Though part of a
structure which has alienated drug users from the public health system,
Aza understands the urge to develop unconventional and innovative
measures to control the epidemic.
Aza Rakhmanova – in Russian
The first wave of our HIV epidemic was
women who had contact with foreign students,
especially from African countries.
The second wave was our homosexuals.
But the third wave, it is drug users.
And this is very hard.
It is so hard to work with drug users,
It is so hard to give support to drug users,
it is so hard to stop HIV amongst them.
For this sometimes I think:
is it possible or not, to fight?
B&W Picture
Titles:
Rostov na Donu, 1998
Title :
Dr. Vadim Pokrovski
Head of the Russian Federal AIDS Centre
V.O.
Vadim Prokrovskiy has been the most vocal critic of the government’s
short-sighted approach to the AIDS problem. He warned that Russia will
soon see tens of thousands of deaths resulting from AIDS.
7
Vadim Pokrovski – in Russian
One method of preventing the spread of HIV
is through harm reduction.
This means the use of chemical
Substitutes such as methadone.
or the implementation of so-called
“syringe-exchange” programmes.
The main objective of such programmes
is not so much exchange itself,
since, in reality, it is impossible to
provide all drug users with syringes.
Rather, it’s about introducing
them to safer ways of taking drugs.
B&W Picture
Titles:
Astrakhan, 2002
Needle exchange
Tolyatti, 2002
Tolyatti, 2004
Alexander Tsekhanovitch – in French
In 1996, the decision was made to start the project
and our first bus was opened in January 1997.
I’m going to explain how it works in the bus.
Here it’s a little narrow but I would say
everything is made wisely.
We have here all the supplies
needed for the day.
And there, they can choose the syringes
that we’re able to give them.
We give out syringes,
condoms, sterilised water,
alcohol wipes, needles
and cotton wool.
There’s also a great demand for
psychological support.
8
So we offer psychological consultations
to the drug users, as well as to parents,
because often they come
to ask for advise and help
on how to deal with their children.
Apparently everything is okay.
She was really happy.
It’s a really important moment,
because often when people
find out they are negative
they think they can go off
and do whatever they like.
On the contrary, it’s a moment where you
have to think how not to catch this “thing”...
V.O.
Oksana is sure that she has not caught the “thing”, despite years of
drug injecting and despite the dangers of her profession.
Oksana, Aleksei and Andrei – in Russian
No... Say you’re boiling up the
drug with someone in the same spoon…
Even if you’re using different syringes
the virus doesn’t get destroyed by the heat.
What do you mean?
Well, not immediately...
And the boiling point of the
Heroin solution isn’t 100 degrees.
I’m not talking about 100 degrees.
I know that it’s destroyed at 80.
Anyway… it’s not a 100% guarantee…
…that all the virus present is destroyed.
Alexander Tsekhanovitch – in French
The majority of the street prostitutes in
St. Petersburg are girls who consume drugs.
9
So they were coming to the big bus
to exchange their syringes and to get condoms.
But we quickly realised that the big bus
wasn’t enough, so now we’ve got two buses:
the big bus with the harm reduction
programme for drug addicts in general,
and the mini-bus where
we work with the prostitutes.
Young prostitutes in mini-bus – in Russian
Hey, Anya’s here!
Watch yourself…
Hi Anya
Hiya
With breaks, of course
See, our Anya’s tried to give up.
She’s spent so much money,
Still, she couldn’t give up.
But in ten years I’ve only
once been into a clinic.
What? You’ve been
shooting-up for 10 years?
Title:
Anya, 26
So you were saying
you’ve tried the 12-step programme?
Why don’t you go to the meetings?
I’m still going…
It’s just… you can go into a clinic
but first you’ve got to get off the stuff.
I don’t think I’d be able to do that.
You go all the time?...
Yes...
At this stage… well, it doesn’t
matter if you’re off it or not.
10
But to go into the clinic, further with the
programme, first you’ve got to stop.
And I know deep down that I won’t be able to.
I need to go into a clinic for that.
So it’s one big circle.
Hang on… there is a drug rehab centre...
We had a girl who came in yesterday…
Her husband had gone along there…
He was told the treatment wasn’t free
but they allowed him to wait in a queue, and…
well… I can’t say for certain
but we’ll give you the number next time…
You can phone them and find out for yourself.
You might even get the treatment for free.
Thanks for that.
So you’ll be here next Monday?
Monday.
But you don’t know exactly when.
You know what it’s like...
If there are girls around we wait.
If not, we move on.
Some want to chat for
five minutes, others an hour.
Then it depends on where we start.
Today we had to pick up the
reporters from the other bus.
We usually start with you guys.
Then we go on to the rest.
For me it’s actually better
later… at about this time
Right then… See you Monday.
11
Title:
Moscow
V.O.
With Russia as a former superpower, and with aspirations to re-instate
the country as a major player on the international stage, Russian
politicians have given matters of economy prevalence over social issues.
And AIDS has been a nuisance for those who have attempted to boost
Russia’s prestige and attract foreign investment.
Moscow’s mayor Yuri Lushkov, for instance, has banned harm reduction
programmes in his city. He argues that they would lure young people into
drug addiction. The potential visibility of needle exchanges in Moscow
may also be a disincentive.
However, others implicitly welcomed the epidemic, as a biological
solution to a social problem. Many specialists educated under the Soviet
public health system were trained to believe that after their first
injection, drug users have only a few years to live, and are ‘hopeless’
cases who do not care whether they live or die. Dr. Aleksei Mazus, head
of the Moscow Anti-AIDS centre, appears to endorse this way of thinking.
Title:
Clinic of the Moscow Anti-AIDS Centre
Aleksey Mazus – in Russian
Title:
Dr. Aleksey Mazus
Director of the Moscow Anti-AIDS Centre
Why should you give them
cotton wool to absorb their drugs?
Why should you give them
lids to boil the drugs up?
Where is the sense in
disinfecting a disposable syringe,
when you can buy one in any chemist?
What is the point of harm reduction programmes
when all they do is exchange syringes
or instruct people about how to use
a disposable syringe as a multi-use one?
What is the point when you can buy
syringes at your every turn?
Young prostitutes in mini-bus – in Russian
43… so 86 in total.
12
Title:
Julia, 22
St-Petersburg
And one more from her.
Chuck it in, Anya.
Tim Rhodes – in English
Title:
Dr. Tim Rhodes
Russian Behaviour Research Project
Imperial College London
An additional fact of not making syringe-exchange legal in the context
of a city like Moscow is that it probably adds to the fear that drug
users might already have about carrying needles and syringes. If there
is a political atmosphere which doesn’t make harm reduction acceptable
or which talks about syringe exchange or syringe distribution as being
problematic, then I think that maintains a kind of political and social
atmosphere of discrimination to some extent.
Young prostitutes in mini-bus – in Russian
Title:
Ksenia
I try to use my own syringes
but sometimes I have
to use them 2 or 3 times.
That can also have its consequences.
Do you always use sterilised water?
Water?... yeah. Boiled.
That’s not the same as sterilised.
Tap water, even if its boiled…
Listen, if you can’t get hold of sterilised water,
It’s better to buy bottled water.
It’s been filtered at the very least.
But non-carbonated!
Which needles are you after?
The ones with the handles.
No, I’ve put the syringes in already.
I meant the needles.
Fat ones.
13
Number 5’s... 6’s?
You know... the double
ones... you see them on sale.
We haven’t got those ones.
But number 6’s we’ve got.
Can I have a look?
I’ve heard that small needles aren’t any good.
Why’s that?
Something happens with the veins.
Actually, no, that’s a myth.
It isn’t true that ‘the bigger the needle, the better’.
Where do you inject yourself?
Into the groin.
Not your arms?
No, I don’t want to.
That’s dangerous,
because if something
happens to the veins in your arms,
you can at least cut them out.
What’s dangerous about injecting into the groin
is that that’s where your vital organs are.
It’s up to you to decide, of course.
Tim Rhodes – in English
Pharmacy-based syringe distribution is not necessarily enough. There’s a
lot of other reasons why drug injectors might go to a syringe-exchange.
Serine-exchanges provide more than just needles and syringes. They’re
more then a mobile chemist. They provide advice, they provide
counselling, they provide referral access into drug treatment. And
that’s often forgotten.
B&W Picture
Titles :
Needle exchange bus
St.Petersburg, 1998
Astrakhan, 2002
14
Alexander Tsekhanovitch – in French
For a drug addict -the syringe-
it might be a bit cynical,
but it’s a hook with which we catch drug addicts
to start engaging with them,
encouraging them to begin
thinking about their life.
I think it’s the universal way
to establish a contact.
Young prostitutes in mini-bus – in Russian
Title:
Masha
Maya
Your husband is also a drug user?
Yes.
And you share the same syringe?
Just the spoon.
You know that you can also get infected that way?
Yes, of course.
But you can be as careful as you like…
And it can get you all the same.
You think it’s just fate?
Well... kind of…
What you do isn’t important…
Well, you can try to protect yourself…
If you look after yourself you can avoid
getting into some pretty serious situations.
That’s true. But I don’t take
drugs with dirty demons.
Yeah? We always do it at home, don’t we?
We don’t hang around the stairwells.
All the same… HIV is transferred
through blood, and not through dirt...
15
Tim Rhodes – in English
There’s a problem in many cities of drug users not wanting to carry
needles and syringes because they have a fear of being arrested. So for
example in apartments, you will find hidden behind the gas meters,
people’s needles and syringes, which they try and store at the place
where they buy their drugs. Because, you know, they think that’s safer
to store their needles and syringe behind the gas meters, and they think
that’s safer than carrying clean needles and syringes on their person
because of the fear of arrest. And you speak to drug dealers and they
say that happens, they say : « Yeah… you know, it's up to people
themselves… If people want to use needles and syringes which have been
left behind in my house by other drug users that buy drugs from me, then
that's their choice, it does happen. »
Nicolaï – in Russian
I don’t know whether the police were
in control of the business at the very start.
They didn’t control us, that’s for sure.
Back then, the majority of agencies
were controlled by criminal gangs.
My understanding is that these
criminal gangs partially left the business…
…it must be several years ago now.
Then the police took over,
the street-girl business in particular.
Now that area is controlled
entirely by the police.
Young prostitutes in mini-bus – in Russian
And when the police come along,
it’s hard to earn what you need.
There are more police at the weekend?
Yeah, they want our money.
They drive up and down the road,
pick us up, and take us to the station.
If I’ve got money, I go with them.
If not, they come back an hour later.
So they take your money…
Do they use your services?
No, services not at all.
16
But money – yeah. Every day.
Why can’t they just take
your money on the street?
Well, no… on Saturdays
we clean the station.
Is it dirty there?
You can’t clean that place.
Title:
Police Division no.5
Central district of St. Petersburg
V.O.
During the round of arrests in Central St-Petersburg, prostitutes enter
the police van as if entering a taxi.
Police van with prostitutes – in Russian
Maybe we don’t have to go too far?
We’re going to the station.
Do you know which of you
lot were working yesterday?
The bastards really had it in for us;
tried to grab my mobile
and took all the money I had.
Smashed my friend’s head against the wall.
The ginger one.
He’s not one of our lot.
What?
Not one of our lot.
You deny everything, the lot of you.
Go and have a word with him.
Keep the door shut!
Just go!
And you, what are you looking at?
17
I said close the door!
I’ll get in for god’s sake!
She’s not going anywhere!
As if she’s going to run away!
Come in girls!
Movies! Free movies!
So where did you confiscate this lot from?
This can’t be your own stuff.
You spend all your money on booze!
You couldn’t buy it on your salary!
That’s enough back there!
Is that your best joke or something?
Smile, Sasha! You’re being filmed!
Just you wait, and you’ll see what my smile is like.
But why pick on me?
There are other girls in the back...
Do you want me to
lock you in the cage?
Is that where you want to be?
No, that’s not what we want.
We have such nice policemen
they lock us up in the cage.
Maybe I’ll give my interview from there.
If we don’t give them their
money, then we’ve had it!
No, on the whole, I like the police.
Especially Sasha.
How lucky he is tonight!
Come on, Sasha,
why are you getting so angry?
...our microphone in a fur coat.
O, mi amore!
18
We could tell you such interesting stories.
One dollar please!
Oksana, Aleksei and Andrei – in Russian
We pay each car 100 roubles.
Ah, so they don’t ask for that much...
Do you know how many cars there are?
But they all have their own…
No.
So it’s any cop that comes along?
No, there are two divisions
the 5th and the 6th.
The 5th is the one...
On Ligovsky.
Each division has eight cars.
So 16 cars at 100 roubles a shot.
That’s 1600 roubles a night.
You can’t try to hide or something?
Oh, we hide.
Tim Rhodes – in English
The relationship between the police and narcology and HIV prevention
services, I think is one of the most important in terms of weather or
not, harm reduction will be effective.
Alexander Tsekhanovitch – in French
We started to think on how to work
with policemen in a constructive way.
After some reflection
we came to the conclusion that,
policemen are also
victim of the social system,
- just like drug addicts -
except from the other side.
They are socially unsuccessful people,
who have often come from the suburbs.
19
They are under atrocious
pressure from their superiors.
They are under pressure from their families,
because their salary is very small,
So we got in touch with the psychology department
of the police headquarters of St. Petersburg
to give a formation on preventive
work with the local policemen.
The senior Police Chiefs understand,
they just tell us to go ahead and do the work.
But the local policeman irritated with his life
and filled with complexes,
is the greatest danger for the drug users.
Oksana, Aleksei and Andrei – in Russian
Its not fuck everything but… family, children?
I mean, surely there’s some
kind of maternal instinct in you?
You’re talking shit!
I’m talking shit?
What about life,
for fuck’s sake. Life!
You know, honestly…
I do get that kind of thing…
But it’s so fleeting.
You’re so high…
so euphoric... you’re already…
You’re trying to say you get such
thoughts only when you’re high?
You never get it in a sober moment?
What’s this sober moment you’re on about?
When you’re on a comedown, then.
When you’re on a comedown,
you do think about children.
Of course, when you’re on a comedown
you think: “God. I’ve got to stop this.”
I’ve just got this notion
that dying isn’t so difficult...
20
But to die foolishly…
that’s to say if you haven’t left…
To die foolishly is…
foolish.
In the sense that it’s
foolish to die foolishly.
I just reckon that dying from drugs is a pretty foolish thing to do,
don’t you think?
Well, I don’t know.
I think it might be more foolish
to simply exist foolishly
– senselessly – until you are 80
than it is to die from drugs at 25.
Also true, of course.
Young prostitutes in mini-bus – in Russian
Title
Tanya
:
There was this programme
on Channel One saying that
all children from infected
mothers end up with HIV.
You probably haven’t
understood it right. Let me explain.
Every pregnant woman now
goes through antiretroviral therapy.
You sister should simply go
down to the hospital early on.
But it’s some tiny percentage...
No, if she has the antiretroviral treatment
the chance of transmission is just 2%.
And the treatment’s free
for all pregnant women.
V.O.
It is a painful exercise for every addict to think about his or her own
life. Yet for girls who get pregnant the stakes are much higher.
Many only find out in the maternity ward that they are HIV positive. As
part of ante-natal treatment, women are being tested without their
knowledge and are presented with the shocking result.
21
The government’s mass screening policy of risk groups, which was adopted
in 1987, has swallowed large parts of the limited budget assigned to HIV
prevention.
Aza Rakhmanova – in bad English
September 2003, only.
Maybe before, we don’t know.
But we investigated this woman,
only in September 2003
because she was pregnant.
And because she decided to keep her child,
we investigated this woman.
Because it is very important to know
what kind of medical support we
must give this pregnant woman
to prevent transmission to the child.
And we are going to discuss
about HIV with this woman
because very soon,
her child will be born.
And her name is Nathalia.
She got infected with HIV maybe one year ago,
because her husband is a drug user.
And she’s been married only one year.
For this, she receives mother-to-child
transmission prevention therapy.
Aza Rakhmanova – in Russian
We have to protect your son,
so that he will be healthy.
He will be your hope and support.
Thank you very much.
22
V.O.
In the long term, however, Aza Rakhmanova has little more to offer than
hope. She presides over an under-funded institution that points to yet
another alarming feature of Russia’s AIDS problem:
Its health system is in no position to cope with the imminent flood of
patients that will seek help with fully-fledged AIDS in only a few years
time. Currently the problem is still manageable, since 90% of all HIV
cases were contracted after 1999. But already, the current annual budget
only covers the costs for 500 patients to be treated. In 2007 there will
be an estimated seven million infected.
Vadim Pokrovski – in Russian
But already in 3 to 4 years time,
This distinction between
those who should be treated
and those who can be treated
will create very serious
problems for patients,
and for their doctors, who will be
faced with the very difficult decision:
who to treat, and who not to treat.
Aza Rakhmanova – in bad English
Oh, her CT4 count...
It’s not bad.
536 CT4 count.
It is not bad.
But she has Tuberculosis (TB),
and not only TB but Myocarditis.
And the HIV is at the stage B1,
in international classification.
She’s the mother.
And she’s very afraid that
her daughter will die.
She was severely ill. Ten days ago,
she was in intensive care.
But now she is better, and I told her
that she will be well.
23
Because it is very important
to give emotional support.
Not only medicine,
but emotional support.
Alexander Tsekhanovitch – in French
Currently, if I’m not
mistaken, in St Petersburg,
300 people receive
antiretroviral therapy.
So I can’t say that there’s no triple-therapy.
But we have to note that there
is not a single drug user among them.
It’s normally, mostly for children
and a few other people, but non-addicts.
Aleksey Mazus – in Russian
We do allow drug addicts
to receive HIV treatment.
But that depends on
the type of drug addict.
Aza Rakhmanova and Doctor – in Russian
They don’t want to talk?
No, they don’t want to.
There’s still a few up here left to ask.
Right.
Ward 8, with the two pregnant girls…
Voice of Aleksey Mazus over hospital scene – in Russian (continued)
If we allocate funds for
treating people with HIV
we have to be very sure that
the treatment will do them good.
This means that they
have to, well... want to live.
24
Aza Rakhmanova with patients – in Russian
How did you get infected with HIV?
Were you a drug addict?
Yes.
And now?
No.
You stopped injecting
when you got pregnant?
No.
So you carried on?
No, I gave up earlier.
A long time ago,
and then you gave up,
and got married.
No.
OK, so having got pregnant,
you decided to have the baby.
And now you want to be healthy,
give birth to a normal baby,
and never do drugs again.
Yes.
That’s what I thought.
And the others, you were
infected in the same way?
Aza Gasanovna! A girl has just agreed to talk.
Give me a minute.
OK. She’ll wait for you.
How did your husbands get infected?
They slept around.
Tim Rhodes – in English
We know that drug injectors generally are slower in making sexual
behaviour changes, or using condoms regularly that they are in making
changes in their drug injecting behaviour. So we know why that is : it’s
because the majority of the population generally don’t use condoms so
why would drug injectors be any different.
25
Igor Kon – in Russian
Title :
Professor Dr. Igor Kon
Institute of Ethnology and Anthropology
Russian Academy of Sciences
Before 1996, the attitude towards
sexual education was quite favourable.
In all opinion polls, about 80% of adults
were for the introduction of sexual education.
So the Ministry of Education attempted
to develop pilot programmes.
But, as is so often the case in Russia,
no steps were taken to prepare the public for these
programmes, either politically or psychologically.
As a result people became confused
and the situation was seized upon by
Orthodox fundamentalists, communists,
and all opponents of liberal reforms.
As a matter of fact, the campaign was backed,
both ideologically and financially,
by American fundamentalists,
the notorious PRO LIFE Movement.
And in the end, the little that
was being done was stopped.
Adrian Renton – in English
Title:
Dr. Adrian Renton
Department of Social Science and Medicine
Imperial College London
The privatisation of the economy has also meant that it’s very difficult
for the Russian government to raise taxes and to raise sufficient taxes
in order to pay their public sector workers a living wage. When you’re
working in a situation where public sector workers are not being paid a
living wage the problem of actually mobilising them to address what is a
politically, quite a difficult issue to address, becomes extremely
large.
Alexander Tsekhanovitch – in French
When we talk about
the government structure,
26
and the civil servants
of a state in full transition,
- because Russia is still in transition -
for these simple civil servants,
the idea of the civil society, the normal society,
is very far away.
Even if they openly claim somewhat
democratic ideas and values,
in their thoughts, they’re
very far away from it.
For them, what matters
is to gather as much
money as possible - full stop.
Adrian Renton – in English
Always in public health terms there has been a tendency to ignore a
problem until you have significant numbers of cases. Politicians who are
concerned with their political cycles, make decisions within the context
of producing results within the time frames for which they are
operating. The epidemics of HIV are operating on forty, fifty year time
frames potentially, and it’s very difficult for the current mechanisms
for political decision making to act in a way which is effective because
there is no payback, often, within the time frame for the electoral
cycle.
Igor Kon – in Russian
“When a society neglects the health
and well-being of its own children,
rejecting its own
and international experience
for the sake of mistaken
national interests and moral principles,
that society is doomed
to stagnation and extinction.
Leading western experts speak of
this danger in the most serious terms.
Et survivi Anima Mea”
27
Voice of Alexander Tsekhanovitch over Oksana – in French
A year ago, officially,
we moved from the stage
of a concentrated epidemic,
to that of a generalised epidemic.
This means that when it was
still at the concentrated stage,
it was concentrated within
the drug using community only.
Amongst the drug users,
there are many young women
who are prostitutes.
And we know for a fact
that a quarter or a fifth of
these women are HIV positive.
We know very well the
risk that their clients practise
and we understand very well,
that with a little time,
Alexander Tsekhanovitch – in French (continued)
the virus will spread in huge quantities,
from this concentrated category.
It’s already started, but
what’s awaiting us is even worst.
Oksana, Aleksei and Andrei – in Russian
To love.
To friendship,
to our… what is it?...
accidental encounter?
Well, yes.
Horrible, of course.
Disgusting!
You’ve got the chocolate?
I wasn’t moralising, by the way
28
Voice of Aleksey Mazus over mini-bus scene – in Russian
We have to bear in mind that
in terms of the broader picture,
it’s like Don Quixote
attacking his windmills
since the problem of drug addiction
and prostitution go hand in hand.
Drug addicts will go out onto the streets.
This unorganized prostitution will always exist.
Working with this group is extremely difficult
and, in my view, not wholly effective.
Aleksey Mazus – in Russian
Of course, it should be stated that
such work needs to be carried out.
No one is saying that we should
close our eyes to this problem.
Vadim Pokrovskiy – in Russian
Clearly, our work with
drug users must not stop,
but I think the main part of our work should
now be amongst the heterosexual population
so that it doesn’t become another huge
high-risk group, as has happened in Africa.
V.O.
Only twelve years ago South Africa too saw less than one percent of its
adult population infected. Now that rate is twenty times higher.
So serious is the situation, and alarming the future, this epidemic can
no longer be ignored. Even the most conservative politicians have
realised that AIDS is more than just a drug-takers’ problem. It is a
threat to the Russian population at large.
With the majority of those infected being under 30, AIDS has hit the
very generation that will have to rebuild Russia’s ailing economy in the
years to come. The political dimension of AIDS can therefore no longer
be denied.
Last May Vladimir Putin was the first president to mention AIDS in a
state-of-the-nation speech. He raised the hopes of campaigners that the
Russian government would at last become serious about the problem.
29
However, the route from PR-savvy speeches to effective prevention is
very long and littered with countless empty gesturing and stony
complacency.
As long as influential figures like Aleksey Mazus are reluctant to
collaborate with NGO’s, as long as needle exchange programmes are closed
down by the police, as long as money is spent on mass screening instead
of treatment and education, AIDS will continue to spread like wild fire
among the Russian population. Because each night, across Russia, girls
like Oksana, Julia, Nastya, and Olga, will continue to exchange sex for
money, money for drugs, needles with each other, and blood in those
needles. And who are their clients? Bankers, tourists, metal workers,
husbands, lovers, brothers… And by 2025 19 million Russian people could
be HIV positive.
Young prostitutes in mini-bus – in Russian
Title :
Janna, 24
Do you have any regular clients?
Of course.
Any foreigners?
Finns mostly.
Do you use condoms with all of them?
I was given a female condom once!
Hey, there’s clients outside...
Right, time to go… See you.
End Credits
Prospekt
St. Petersburg, 11 pm
Young prostitutes in mini-bus – in Russian
Hi girls!
Hi.
Aaah, nice and warm in here!
Have a seat. Make
yourselves comfortable.
What are you after?
I need a condom.
What… just one?
Yeah, she needs condoms.
Green ones. And I want
the red ones. Lots of them.
It seems quiet today…
No, there were loads of girls,
it’s just that business is going well.
So tell me, then,
how are you? How’s life?
You call this a life?
Life with drugs is a life? It’s not a life.
You should quit.
It’s not that easy.
Have you tried?
No, actually, I haven’t.
You haven’t?
I haven’t... because
I know I’d start up again.
So why should I suffer?
1
V.O.
Worldwide an estimated 42 million people are living with HIV, most of
them on the African continent. However, with Russia and the Republics of
the former Soviet Union, the virus has opened a new front in its deadly
campaign.
Russia has now the fastest growth rate of HIV infection in the world.
Today, more than 1 Million people within its borders live with the
virus, and if the increase continues at this rate the figure could rise
to 12 Million by 2020.
Titles:
Laika Pictures presents
SEX, NEEDLES AND ROUBLES
V.O.
For most Russians, relative economic and political freedom has come at a
high price. Unemployment is rife, the housing situation is precarious,
and access to healthcare and social services is limited.
But where formal economies stagnate, shadow economies have mushroomed.
With the collapse of the Soviet Union, tight social control vanished and
crime, corruption and prostitution spread rapidly. A cross border trade
of arms and drugs led to a huge influx of heroin from central Asia.
Heroin and home-made amphetamine cocktails have become increasingly
popular among the Russian youth. Unlike in the West, where recreational
drugs are usually snorted or swallowed, in Russia almost all substances
are injected.
Needle sharing is therefore the main cause for the unfettered advance of
the epidemic.
The overwhelming majority of those infected with HIV are injecting drug
users under 30, and in most cases, sexually active. Consequently in
recent years the epidemic has spread beyond high-risk groups.
Prostitution and unsafe sex have contributed to a rapid increase of HIV
infections among the general population. Yet this threat to ordinary
Russians is often ignored.
Titles:
Camera Pierre Boffety
Sound Damien Turpin
Editing Mariko Montpetit
Still photography John Ranard
Music Sarah Sarhandi
a film by Chloë Mercier
V.O.
In many parts of Russia it has taken foreign organisations to implement
harm reduction programmes, in an attempt to stem infection through the
sharing of syringes.
Since 1997 Alexander Tsekhanovitch has run the ‘Doctors of the World’
needle exchange programme in St Petersburg. His organisation offers
advice and help for drug users, a criminalised and stigmatised
2
population who avoid public hospitals in fear of prosecution and
discrimination.
Alexander Tsekhanovitch – in French
Title:
Alexander Tsekhanovitch
Project Director
Humanitarian Action, St.Petersburg
No one was denying the problem in Russia.
The problem is a little more
- I don’t know how to define it –
but it’s not just the simple fact
of denying the HIV cases.
And I remember at the time,
when the first cases of
the children’s mass contamination
broke out in the hospitals across southern Russia,
everybody talked about it, and it was recorded.
B&W Picture
Title:
Volgograd, 1998
Alexander Tsekhanovitch – in French (continued)
I think the problem goes a lot deeper,
and lies in the mentality of post-communist Russia
– it’s complicated to define.
But this is how it is in the current Russian society.
A human being is abstract.
And on top of that, there’s this tendency
to stigmatise those who aren’t like the majority.
That’s where the problem lies, with years of
communism, and centuries of the orthodox religion.
It’s always the group,
the community, the majority, the rules.
When you’re different,
not only you’re different, you are bad.
3
Nicolaï – in Russian
Title:
Nicolaï
Former Owner of a Prostitution Agency
I returned from military service
during the time of Perestroika.
Of course, the country was in total chaos.
All of a sudden, people were losing their jobs.
They didn’t know where to turn.
V.O.
We met Oksana on Old Nevsky Prospekt. It was two in the morning. She was
waiting for clients but business was slow, so she agreed to talk to
Andrei and Aleksey, two young musicians from St Petersburg who were
helping make this film.
Oksana, Aleksey and Andrei – in Russian
Title:
Oksana, 28
When I was about fifteen or sixteen,
I moved in to live with a very rich man.
I lived with him for six years,
away from my parents.
Then, he was no more.
You mean he was killed?
Yes. Killed.
Fifteen, sixteen... That
would be round about 1993?
Yes. That’s what happened then.
Many of my girlfriends
were in the same position...
…their boyfriends
got killed, or sent down.
There were people left to help us out,
but they couldn’t help forever.
We had to decide
what to do with ourselves.
4
Nicolaï – in Russian
St. Petersburg saw an upsurge in prostitution
around the time of Perestroika.
Everyone began talking
and writing about it.
It became quite an acceptable thing to do.
A lot of agencies began to operate.
Adverts started to appear in the press.
There were more than 300 agencies
openly involved in the business.
Many of the girls
coming into St. Petersburg
weren’t able to afford the rent,
or to pay for their education.
Nowhere wanted to take them on.
So prostitution was the only
road they could go down.
I know that most of them
didn’t want to do it.
Necessity forced them to.
Oksana, Aleksei and Andrei – in Russian
Do you remember the first time?
Of course I remember.
Of course.
And the feeling?
The feeling? Well, you know,
I’d got myself very drunk.
It was with a Frenchman.
It lasted an hour.
I arrived home, totally hysterical.
I stayed in the bathroom for two hours.
I get hysterical like that from time to time.
5
Drugs help calm me down.
Are you still shooting up?
Yes.
V.O.
With the opening of the market for western goods, the entire country was
gripped by a fever for everything new. Soviet icons were toppled. Signs
of American fast-food chains hung where red stars and busts of Stalin
were previously fixed. Former Soviet bureaucrats swapped their Russian
limousines for more expensive German models. In Metro stations
pensioners appeared selling Marlboros, children were found begging in
front of lavish boutiques. Trendy night-clubs popped up everywhere,
inviting Russia into a new pleasure culture.
However, it soon became clear that the market economy was not the
panacea it was promised to be, and appeared to benefit only a select
few. The majority were left struggling.
Alexander Tsekhanovitch – in French
In 1995 we opened
a medical centre for street children,
but rapidly we realised that a lot
of the children were drug addicts.
We reported this to Paris,
and in Paris they said: “Listen guys,
what’s waiting for you is an HIV explosion.”
I remember at the beginning of the project,
the first institutional structure that
we started to cooperate with
was the biggest hospital for
infectious diseases - the Botkin Hospital.
And it wasn’t a secret that,
at the time, Botkin Hospital was
one of the biggest drug dealing places in town.
Dealers would come to sell drugs and
people were shooting-up at the hospital.
You can imagine how the staff was struck with horror.
They were handing in their notice because
they didn’t know how to deal with these people.
6
B&W Picture
Titles:
Botkin Hospital, 1998
Ukraine, 1997
Nizhny Novgorod, 1998
Title:
Dr. Aza Rakhmanova
HIV Maternity Ward
Botkin Hospital, St. Petersburg
V.O.
Aza Rakhmanova is St Petersburg’s chief health officer. Though part of a
structure which has alienated drug users from the public health system,
Aza understands the urge to develop unconventional and innovative
measures to control the epidemic.
Aza Rakhmanova – in Russian
The first wave of our HIV epidemic was
women who had contact with foreign students,
especially from African countries.
The second wave was our homosexuals.
But the third wave, it is drug users.
And this is very hard.
It is so hard to work with drug users,
It is so hard to give support to drug users,
it is so hard to stop HIV amongst them.
For this sometimes I think:
is it possible or not, to fight?
B&W Picture
Titles:
Rostov na Donu, 1998
Title :
Dr. Vadim Pokrovski
Head of the Russian Federal AIDS Centre
V.O.
Vadim Prokrovskiy has been the most vocal critic of the government’s
short-sighted approach to the AIDS problem. He warned that Russia will
soon see tens of thousands of deaths resulting from AIDS.
7
Vadim Pokrovski – in Russian
One method of preventing the spread of HIV
is through harm reduction.
This means the use of chemical
Substitutes such as methadone.
or the implementation of so-called
“syringe-exchange” programmes.
The main objective of such programmes
is not so much exchange itself,
since, in reality, it is impossible to
provide all drug users with syringes.
Rather, it’s about introducing
them to safer ways of taking drugs.
B&W Picture
Titles:
Astrakhan, 2002
Needle exchange
Tolyatti, 2002
Tolyatti, 2004
Alexander Tsekhanovitch – in French
In 1996, the decision was made to start the project
and our first bus was opened in January 1997.
I’m going to explain how it works in the bus.
Here it’s a little narrow but I would say
everything is made wisely.
We have here all the supplies
needed for the day.
And there, they can choose the syringes
that we’re able to give them.
We give out syringes,
condoms, sterilised water,
alcohol wipes, needles
and cotton wool.
There’s also a great demand for
psychological support.
8
So we offer psychological consultations
to the drug users, as well as to parents,
because often they come
to ask for advise and help
on how to deal with their children.
Apparently everything is okay.
She was really happy.
It’s a really important moment,
because often when people
find out they are negative
they think they can go off
and do whatever they like.
On the contrary, it’s a moment where you
have to think how not to catch this “thing”...
V.O.
Oksana is sure that she has not caught the “thing”, despite years of
drug injecting and despite the dangers of her profession.
Oksana, Aleksei and Andrei – in Russian
No... Say you’re boiling up the
drug with someone in the same spoon…
Even if you’re using different syringes
the virus doesn’t get destroyed by the heat.
What do you mean?
Well, not immediately...
And the boiling point of the
Heroin solution isn’t 100 degrees.
I’m not talking about 100 degrees.
I know that it’s destroyed at 80.
Anyway… it’s not a 100% guarantee…
…that all the virus present is destroyed.
Alexander Tsekhanovitch – in French
The majority of the street prostitutes in
St. Petersburg are girls who consume drugs.
9
So they were coming to the big bus
to exchange their syringes and to get condoms.
But we quickly realised that the big bus
wasn’t enough, so now we’ve got two buses:
the big bus with the harm reduction
programme for drug addicts in general,
and the mini-bus where
we work with the prostitutes.
Young prostitutes in mini-bus – in Russian
Hey, Anya’s here!
Watch yourself…
Hi Anya
Hiya
With breaks, of course
See, our Anya’s tried to give up.
She’s spent so much money,
Still, she couldn’t give up.
But in ten years I’ve only
once been into a clinic.
What? You’ve been
shooting-up for 10 years?
Title:
Anya, 26
So you were saying
you’ve tried the 12-step programme?
Why don’t you go to the meetings?
I’m still going…
It’s just… you can go into a clinic
but first you’ve got to get off the stuff.
I don’t think I’d be able to do that.
You go all the time?...
Yes...
At this stage… well, it doesn’t
matter if you’re off it or not.
10
But to go into the clinic, further with the
programme, first you’ve got to stop.
And I know deep down that I won’t be able to.
I need to go into a clinic for that.
So it’s one big circle.
Hang on… there is a drug rehab centre...
We had a girl who came in yesterday…
Her husband had gone along there…
He was told the treatment wasn’t free
but they allowed him to wait in a queue, and…
well… I can’t say for certain
but we’ll give you the number next time…
You can phone them and find out for yourself.
You might even get the treatment for free.
Thanks for that.
So you’ll be here next Monday?
Monday.
But you don’t know exactly when.
You know what it’s like...
If there are girls around we wait.
If not, we move on.
Some want to chat for
five minutes, others an hour.
Then it depends on where we start.
Today we had to pick up the
reporters from the other bus.
We usually start with you guys.
Then we go on to the rest.
For me it’s actually better
later… at about this time
Right then… See you Monday.
11
Title:
Moscow
V.O.
With Russia as a former superpower, and with aspirations to re-instate
the country as a major player on the international stage, Russian
politicians have given matters of economy prevalence over social issues.
And AIDS has been a nuisance for those who have attempted to boost
Russia’s prestige and attract foreign investment.
Moscow’s mayor Yuri Lushkov, for instance, has banned harm reduction
programmes in his city. He argues that they would lure young people into
drug addiction. The potential visibility of needle exchanges in Moscow
may also be a disincentive.
However, others implicitly welcomed the epidemic, as a biological
solution to a social problem. Many specialists educated under the Soviet
public health system were trained to believe that after their first
injection, drug users have only a few years to live, and are ‘hopeless’
cases who do not care whether they live or die. Dr. Aleksei Mazus, head
of the Moscow Anti-AIDS centre, appears to endorse this way of thinking.
Title:
Clinic of the Moscow Anti-AIDS Centre
Aleksey Mazus – in Russian
Title:
Dr. Aleksey Mazus
Director of the Moscow Anti-AIDS Centre
Why should you give them
cotton wool to absorb their drugs?
Why should you give them
lids to boil the drugs up?
Where is the sense in
disinfecting a disposable syringe,
when you can buy one in any chemist?
What is the point of harm reduction programmes
when all they do is exchange syringes
or instruct people about how to use
a disposable syringe as a multi-use one?
What is the point when you can buy
syringes at your every turn?
Young prostitutes in mini-bus – in Russian
43… so 86 in total.
12
Title:
Julia, 22
St-Petersburg
And one more from her.
Chuck it in, Anya.
Tim Rhodes – in English
Title:
Dr. Tim Rhodes
Russian Behaviour Research Project
Imperial College London
An additional fact of not making syringe-exchange legal in the context
of a city like Moscow is that it probably adds to the fear that drug
users might already have about carrying needles and syringes. If there
is a political atmosphere which doesn’t make harm reduction acceptable
or which talks about syringe exchange or syringe distribution as being
problematic, then I think that maintains a kind of political and social
atmosphere of discrimination to some extent.
Young prostitutes in mini-bus – in Russian
Title:
Ksenia
I try to use my own syringes
but sometimes I have
to use them 2 or 3 times.
That can also have its consequences.
Do you always use sterilised water?
Water?... yeah. Boiled.
That’s not the same as sterilised.
Tap water, even if its boiled…
Listen, if you can’t get hold of sterilised water,
It’s better to buy bottled water.
It’s been filtered at the very least.
But non-carbonated!
Which needles are you after?
The ones with the handles.
No, I’ve put the syringes in already.
I meant the needles.
Fat ones.
13
Number 5’s... 6’s?
You know... the double
ones... you see them on sale.
We haven’t got those ones.
But number 6’s we’ve got.
Can I have a look?
I’ve heard that small needles aren’t any good.
Why’s that?
Something happens with the veins.
Actually, no, that’s a myth.
It isn’t true that ‘the bigger the needle, the better’.
Where do you inject yourself?
Into the groin.
Not your arms?
No, I don’t want to.
That’s dangerous,
because if something
happens to the veins in your arms,
you can at least cut them out.
What’s dangerous about injecting into the groin
is that that’s where your vital organs are.
It’s up to you to decide, of course.
Tim Rhodes – in English
Pharmacy-based syringe distribution is not necessarily enough. There’s a
lot of other reasons why drug injectors might go to a syringe-exchange.
Serine-exchanges provide more than just needles and syringes. They’re
more then a mobile chemist. They provide advice, they provide
counselling, they provide referral access into drug treatment. And
that’s often forgotten.
B&W Picture
Titles :
Needle exchange bus
St.Petersburg, 1998
Astrakhan, 2002
14
Alexander Tsekhanovitch – in French
For a drug addict -the syringe-
it might be a bit cynical,
but it’s a hook with which we catch drug addicts
to start engaging with them,
encouraging them to begin
thinking about their life.
I think it’s the universal way
to establish a contact.
Young prostitutes in mini-bus – in Russian
Title:
Masha
Maya
Your husband is also a drug user?
Yes.
And you share the same syringe?
Just the spoon.
You know that you can also get infected that way?
Yes, of course.
But you can be as careful as you like…
And it can get you all the same.
You think it’s just fate?
Well... kind of…
What you do isn’t important…
Well, you can try to protect yourself…
If you look after yourself you can avoid
getting into some pretty serious situations.
That’s true. But I don’t take
drugs with dirty demons.
Yeah? We always do it at home, don’t we?
We don’t hang around the stairwells.
All the same… HIV is transferred
through blood, and not through dirt...
15
Tim Rhodes – in English
There’s a problem in many cities of drug users not wanting to carry
needles and syringes because they have a fear of being arrested. So for
example in apartments, you will find hidden behind the gas meters,
people’s needles and syringes, which they try and store at the place
where they buy their drugs. Because, you know, they think that’s safer
to store their needles and syringe behind the gas meters, and they think
that’s safer than carrying clean needles and syringes on their person
because of the fear of arrest. And you speak to drug dealers and they
say that happens, they say : « Yeah… you know, it's up to people
themselves… If people want to use needles and syringes which have been
left behind in my house by other drug users that buy drugs from me, then
that's their choice, it does happen. »
Nicolaï – in Russian
I don’t know whether the police were
in control of the business at the very start.
They didn’t control us, that’s for sure.
Back then, the majority of agencies
were controlled by criminal gangs.
My understanding is that these
criminal gangs partially left the business…
…it must be several years ago now.
Then the police took over,
the street-girl business in particular.
Now that area is controlled
entirely by the police.
Young prostitutes in mini-bus – in Russian
And when the police come along,
it’s hard to earn what you need.
There are more police at the weekend?
Yeah, they want our money.
They drive up and down the road,
pick us up, and take us to the station.
If I’ve got money, I go with them.
If not, they come back an hour later.
So they take your money…
Do they use your services?
No, services not at all.
16
But money – yeah. Every day.
Why can’t they just take
your money on the street?
Well, no… on Saturdays
we clean the station.
Is it dirty there?
You can’t clean that place.
Title:
Police Division no.5
Central district of St. Petersburg
V.O.
During the round of arrests in Central St-Petersburg, prostitutes enter
the police van as if entering a taxi.
Police van with prostitutes – in Russian
Maybe we don’t have to go too far?
We’re going to the station.
Do you know which of you
lot were working yesterday?
The bastards really had it in for us;
tried to grab my mobile
and took all the money I had.
Smashed my friend’s head against the wall.
The ginger one.
He’s not one of our lot.
What?
Not one of our lot.
You deny everything, the lot of you.
Go and have a word with him.
Keep the door shut!
Just go!
And you, what are you looking at?
17
I said close the door!
I’ll get in for god’s sake!
She’s not going anywhere!
As if she’s going to run away!
Come in girls!
Movies! Free movies!
So where did you confiscate this lot from?
This can’t be your own stuff.
You spend all your money on booze!
You couldn’t buy it on your salary!
That’s enough back there!
Is that your best joke or something?
Smile, Sasha! You’re being filmed!
Just you wait, and you’ll see what my smile is like.
But why pick on me?
There are other girls in the back...
Do you want me to
lock you in the cage?
Is that where you want to be?
No, that’s not what we want.
We have such nice policemen
they lock us up in the cage.
Maybe I’ll give my interview from there.
If we don’t give them their
money, then we’ve had it!
No, on the whole, I like the police.
Especially Sasha.
How lucky he is tonight!
Come on, Sasha,
why are you getting so angry?
...our microphone in a fur coat.
O, mi amore!
18
We could tell you such interesting stories.
One dollar please!
Oksana, Aleksei and Andrei – in Russian
We pay each car 100 roubles.
Ah, so they don’t ask for that much...
Do you know how many cars there are?
But they all have their own…
No.
So it’s any cop that comes along?
No, there are two divisions
the 5th and the 6th.
The 5th is the one...
On Ligovsky.
Each division has eight cars.
So 16 cars at 100 roubles a shot.
That’s 1600 roubles a night.
You can’t try to hide or something?
Oh, we hide.
Tim Rhodes – in English
The relationship between the police and narcology and HIV prevention
services, I think is one of the most important in terms of weather or
not, harm reduction will be effective.
Alexander Tsekhanovitch – in French
We started to think on how to work
with policemen in a constructive way.
After some reflection
we came to the conclusion that,
policemen are also
victim of the social system,
- just like drug addicts -
except from the other side.
They are socially unsuccessful people,
who have often come from the suburbs.
19
They are under atrocious
pressure from their superiors.
They are under pressure from their families,
because their salary is very small,
So we got in touch with the psychology department
of the police headquarters of St. Petersburg
to give a formation on preventive
work with the local policemen.
The senior Police Chiefs understand,
they just tell us to go ahead and do the work.
But the local policeman irritated with his life
and filled with complexes,
is the greatest danger for the drug users.
Oksana, Aleksei and Andrei – in Russian
Its not fuck everything but… family, children?
I mean, surely there’s some
kind of maternal instinct in you?
You’re talking shit!
I’m talking shit?
What about life,
for fuck’s sake. Life!
You know, honestly…
I do get that kind of thing…
But it’s so fleeting.
You’re so high…
so euphoric... you’re already…
You’re trying to say you get such
thoughts only when you’re high?
You never get it in a sober moment?
What’s this sober moment you’re on about?
When you’re on a comedown, then.
When you’re on a comedown,
you do think about children.
Of course, when you’re on a comedown
you think: “God. I’ve got to stop this.”
I’ve just got this notion
that dying isn’t so difficult...
20
But to die foolishly…
that’s to say if you haven’t left…
To die foolishly is…
foolish.
In the sense that it’s
foolish to die foolishly.
I just reckon that dying from drugs is a pretty foolish thing to do,
don’t you think?
Well, I don’t know.
I think it might be more foolish
to simply exist foolishly
– senselessly – until you are 80
than it is to die from drugs at 25.
Also true, of course.
Young prostitutes in mini-bus – in Russian
Title
Tanya
:
There was this programme
on Channel One saying that
all children from infected
mothers end up with HIV.
You probably haven’t
understood it right. Let me explain.
Every pregnant woman now
goes through antiretroviral therapy.
You sister should simply go
down to the hospital early on.
But it’s some tiny percentage...
No, if she has the antiretroviral treatment
the chance of transmission is just 2%.
And the treatment’s free
for all pregnant women.
V.O.
It is a painful exercise for every addict to think about his or her own
life. Yet for girls who get pregnant the stakes are much higher.
Many only find out in the maternity ward that they are HIV positive. As
part of ante-natal treatment, women are being tested without their
knowledge and are presented with the shocking result.
21
The government’s mass screening policy of risk groups, which was adopted
in 1987, has swallowed large parts of the limited budget assigned to HIV
prevention.
Aza Rakhmanova – in bad English
September 2003, only.
Maybe before, we don’t know.
But we investigated this woman,
only in September 2003
because she was pregnant.
And because she decided to keep her child,
we investigated this woman.
Because it is very important to know
what kind of medical support we
must give this pregnant woman
to prevent transmission to the child.
And we are going to discuss
about HIV with this woman
because very soon,
her child will be born.
And her name is Nathalia.
She got infected with HIV maybe one year ago,
because her husband is a drug user.
And she’s been married only one year.
For this, she receives mother-to-child
transmission prevention therapy.
Aza Rakhmanova – in Russian
We have to protect your son,
so that he will be healthy.
He will be your hope and support.
Thank you very much.
22
V.O.
In the long term, however, Aza Rakhmanova has little more to offer than
hope. She presides over an under-funded institution that points to yet
another alarming feature of Russia’s AIDS problem:
Its health system is in no position to cope with the imminent flood of
patients that will seek help with fully-fledged AIDS in only a few years
time. Currently the problem is still manageable, since 90% of all HIV
cases were contracted after 1999. But already, the current annual budget
only covers the costs for 500 patients to be treated. In 2007 there will
be an estimated seven million infected.
Vadim Pokrovski – in Russian
But already in 3 to 4 years time,
This distinction between
those who should be treated
and those who can be treated
will create very serious
problems for patients,
and for their doctors, who will be
faced with the very difficult decision:
who to treat, and who not to treat.
Aza Rakhmanova – in bad English
Oh, her CT4 count...
It’s not bad.
536 CT4 count.
It is not bad.
But she has Tuberculosis (TB),
and not only TB but Myocarditis.
And the HIV is at the stage B1,
in international classification.
She’s the mother.
And she’s very afraid that
her daughter will die.
She was severely ill. Ten days ago,
she was in intensive care.
But now she is better, and I told her
that she will be well.
23
Because it is very important
to give emotional support.
Not only medicine,
but emotional support.
Alexander Tsekhanovitch – in French
Currently, if I’m not
mistaken, in St Petersburg,
300 people receive
antiretroviral therapy.
So I can’t say that there’s no triple-therapy.
But we have to note that there
is not a single drug user among them.
It’s normally, mostly for children
and a few other people, but non-addicts.
Aleksey Mazus – in Russian
We do allow drug addicts
to receive HIV treatment.
But that depends on
the type of drug addict.
Aza Rakhmanova and Doctor – in Russian
They don’t want to talk?
No, they don’t want to.
There’s still a few up here left to ask.
Right.
Ward 8, with the two pregnant girls…
Voice of Aleksey Mazus over hospital scene – in Russian (continued)
If we allocate funds for
treating people with HIV
we have to be very sure that
the treatment will do them good.
This means that they
have to, well... want to live.
24
Aza Rakhmanova with patients – in Russian
How did you get infected with HIV?
Were you a drug addict?
Yes.
And now?
No.
You stopped injecting
when you got pregnant?
No.
So you carried on?
No, I gave up earlier.
A long time ago,
and then you gave up,
and got married.
No.
OK, so having got pregnant,
you decided to have the baby.
And now you want to be healthy,
give birth to a normal baby,
and never do drugs again.
Yes.
That’s what I thought.
And the others, you were
infected in the same way?
Aza Gasanovna! A girl has just agreed to talk.
Give me a minute.
OK. She’ll wait for you.
How did your husbands get infected?
They slept around.
Tim Rhodes – in English
We know that drug injectors generally are slower in making sexual
behaviour changes, or using condoms regularly that they are in making
changes in their drug injecting behaviour. So we know why that is : it’s
because the majority of the population generally don’t use condoms so
why would drug injectors be any different.
25
Igor Kon – in Russian
Title :
Professor Dr. Igor Kon
Institute of Ethnology and Anthropology
Russian Academy of Sciences
Before 1996, the attitude towards
sexual education was quite favourable.
In all opinion polls, about 80% of adults
were for the introduction of sexual education.
So the Ministry of Education attempted
to develop pilot programmes.
But, as is so often the case in Russia,
no steps were taken to prepare the public for these
programmes, either politically or psychologically.
As a result people became confused
and the situation was seized upon by
Orthodox fundamentalists, communists,
and all opponents of liberal reforms.
As a matter of fact, the campaign was backed,
both ideologically and financially,
by American fundamentalists,
the notorious PRO LIFE Movement.
And in the end, the little that
was being done was stopped.
Adrian Renton – in English
Title:
Dr. Adrian Renton
Department of Social Science and Medicine
Imperial College London
The privatisation of the economy has also meant that it’s very difficult
for the Russian government to raise taxes and to raise sufficient taxes
in order to pay their public sector workers a living wage. When you’re
working in a situation where public sector workers are not being paid a
living wage the problem of actually mobilising them to address what is a
politically, quite a difficult issue to address, becomes extremely
large.
Alexander Tsekhanovitch – in French
When we talk about
the government structure,
26
and the civil servants
of a state in full transition,
- because Russia is still in transition -
for these simple civil servants,
the idea of the civil society, the normal society,
is very far away.
Even if they openly claim somewhat
democratic ideas and values,
in their thoughts, they’re
very far away from it.
For them, what matters
is to gather as much
money as possible - full stop.
Adrian Renton – in English
Always in public health terms there has been a tendency to ignore a
problem until you have significant numbers of cases. Politicians who are
concerned with their political cycles, make decisions within the context
of producing results within the time frames for which they are
operating. The epidemics of HIV are operating on forty, fifty year time
frames potentially, and it’s very difficult for the current mechanisms
for political decision making to act in a way which is effective because
there is no payback, often, within the time frame for the electoral
cycle.
Igor Kon – in Russian
“When a society neglects the health
and well-being of its own children,
rejecting its own
and international experience
for the sake of mistaken
national interests and moral principles,
that society is doomed
to stagnation and extinction.
Leading western experts speak of
this danger in the most serious terms.
Et survivi Anima Mea”
27
Voice of Alexander Tsekhanovitch over Oksana – in French
A year ago, officially,
we moved from the stage
of a concentrated epidemic,
to that of a generalised epidemic.
This means that when it was
still at the concentrated stage,
it was concentrated within
the drug using community only.
Amongst the drug users,
there are many young women
who are prostitutes.
And we know for a fact
that a quarter or a fifth of
these women are HIV positive.
We know very well the
risk that their clients practise
and we understand very well,
that with a little time,
Alexander Tsekhanovitch – in French (continued)
the virus will spread in huge quantities,
from this concentrated category.
It’s already started, but
what’s awaiting us is even worst.
Oksana, Aleksei and Andrei – in Russian
To love.
To friendship,
to our… what is it?...
accidental encounter?
Well, yes.
Horrible, of course.
Disgusting!
You’ve got the chocolate?
I wasn’t moralising, by the way
28
Voice of Aleksey Mazus over mini-bus scene – in Russian
We have to bear in mind that
in terms of the broader picture,
it’s like Don Quixote
attacking his windmills
since the problem of drug addiction
and prostitution go hand in hand.
Drug addicts will go out onto the streets.
This unorganized prostitution will always exist.
Working with this group is extremely difficult
and, in my view, not wholly effective.
Aleksey Mazus – in Russian
Of course, it should be stated that
such work needs to be carried out.
No one is saying that we should
close our eyes to this problem.
Vadim Pokrovskiy – in Russian
Clearly, our work with
drug users must not stop,
but I think the main part of our work should
now be amongst the heterosexual population
so that it doesn’t become another huge
high-risk group, as has happened in Africa.
V.O.
Only twelve years ago South Africa too saw less than one percent of its
adult population infected. Now that rate is twenty times higher.
So serious is the situation, and alarming the future, this epidemic can
no longer be ignored. Even the most conservative politicians have
realised that AIDS is more than just a drug-takers’ problem. It is a
threat to the Russian population at large.
With the majority of those infected being under 30, AIDS has hit the
very generation that will have to rebuild Russia’s ailing economy in the
years to come. The political dimension of AIDS can therefore no longer
be denied.
Last May Vladimir Putin was the first president to mention AIDS in a
state-of-the-nation speech. He raised the hopes of campaigners that the
Russian government would at last become serious about the problem.
29
However, the route from PR-savvy speeches to effective prevention is
very long and littered with countless empty gesturing and stony
complacency.
As long as influential figures like Aleksey Mazus are reluctant to
collaborate with NGO’s, as long as needle exchange programmes are closed
down by the police, as long as money is spent on mass screening instead
of treatment and education, AIDS will continue to spread like wild fire
among the Russian population. Because each night, across Russia, girls
like Oksana, Julia, Nastya, and Olga, will continue to exchange sex for
money, money for drugs, needles with each other, and blood in those
needles. And who are their clients? Bankers, tourists, metal workers,
husbands, lovers, brothers… And by 2025 19 million Russian people could
be HIV positive.
Young prostitutes in mini-bus – in Russian
Title :
Janna, 24
Do you have any regular clients?
Of course.
Any foreigners?
Finns mostly.
Do you use condoms with all of them?
I was given a female condom once!
Hey, there’s clients outside...
Right, time to go… See you.
End Credits