One in 100 adults is now reported to have the virus, writes Chris Stephen in Moscow.
Russia and eastern Europe are in the grip of an AIDS explosion which is growing unchecked, said a United Nations report released last week.
The report said the disease had already moved rapidly through drug users and prostitutes, and is poised to move into the population at large. "Upwards of one out of every 100 adults living in these countries is now estimated to be carrying the virus," the report said. Projections say Russia alone has more than one million people with HIV or AIDS, but the highest infection rate of all is with EU hopeful Estonia.
The disease has spread like wildfire in Russia, from being almost unknown in the late 1990s to the present epidemic. Official figures here say it has increased from 11,000 cases in 1998 to 245,000 last summer, but UN estimates said the figure is more than four times larger, based on projections from sample surveys.
"It is already too late to speak of avoiding a crisis in eastern Europe and the CIS [Commonwealth of Independent States\]," said Mr Kalman Mizsei, a senior official with the UN Development Project, authors of the report. "Only 12 years ago South Africa too saw less than 1 per cent of its adult population infected - now that rate is 20 times higher." The UN said the governments of the region must do more to get the message out.
Russia has no AIDS awareness campaign on either television or on billboards, and little attempt to educate the population about the dangers. Cash strapped authorities have little money to spend on AIDS prevention, and Russia has little tradition of self-help groups coming forward to fill the gap.
The Orthodox Church, meanwhile, has made little attempt to use its widespread support to get the message out. The church has little tradition of pastoral care and there is no widescale programme to encourage AIDS awareness.
Russia's experience of the disease has been tragic - and preventable. Until the late 1990s the country's relative isolation meant the disease was rare. Then health experts noticed clusters of sufferers springing up, and not just in Moscow. Cities across the country have been hit, puzzling experts because these were places foreign visitors rarely visited.
The reason was soon clear - those suffering from the disease were overwhelmingly drug users. Russia is awash with cheap opium and heroin, a result of being on the main drug trade routes between the Far East and Europe.
Drug users took few precautions. Not only would they habitually share needles, but they would also put their needles in the same pot of opium. Some users would put a drop of someone's blood into the opium pot, believing it would purify the opium. Consequently, one AIDS sufferer could infect an entire group.
In 2000 Russia and eastern Europe registered the fastest one-year growth of the disease ever recorded - up 40 per cent to 700,000. Since then it has continued to grow. "Growth rates reported over the last several years in Estonia, Russia and Ukraine are among the world's highest," said the report.
Drug users are not the only group infected. Prostitutes have been found with the disease in increasing numbers. And overcrowded prisons, where one in 10 inmates already has TB, are also incubators of the disease. On any night, up to 70,000 women sell themselves for sex in Moscow, many of them doing it once a week or less to bring in money to poverty-stricken homes.
The infection rate is three times the national average in several oil and gas towns in Siberia, where there is money to spare and where prostitution is rife. Most suffer without treatment. The report said only 7,000 of Russia's 80,000 registered AIDS sufferers are getting treatment.
The picture is not totally bleak. The UN reports that health awareness programmes have worked in cutting infection rates in Poland, the Czech Republic and Slovakia. But further east the problem is worse. Poverty is a common link between drug use, prostitution and high prison populations.
A World Bank report last September said the epidemic also threatens the economy. It concluded: "In the face of non-action we will see reduced levels of economic growth, increased levels of poverty." Just before Christmas, American and Russian politicians marked World AIDS Day by unveiling a giant banner in Moscow which was made up of postcards from children infected with AIDS. But the government has yet to follow up with a serious public information campaign.
Health workers in Moscow say the one group which has not recorded a fast increase in the disease is homosexuals. One UN officer said it appeared they had learned from the epidemic among homosexuals in the West in the 1980s and 1990s.