Alcohol, Narcotics, and Tobacco

Russia's rate of alcohol consumption, traditionally among the highest in the world and rising significantly in the 1990s, is a major contributor to the country's health crisis, as well as to low job productivity. Rated as Russia's third most critical health problem after cardiovascular diseases and cancer, alcoholism has reached epidemic proportions, particularly among males. In the twentieth century, periodic government campaigns against alcohol consumption have resulted in thousands of deaths from the consumption of alcohol surrogates. The latest such campaign was undertaken from 1985 to 1988, during the regime of Mikhail S. Gorbachev (in office 1985-91). Although some authorities credited reduced alcohol consumption with a concurrent drop in Russia's mortality rate, by 1987 the production of samogon (home-brewed liquor) had become a large-scale industry that provided alcohol to Russians while depriving the state of tax revenue. When restrictions were eased in 1988, alcohol consumption exceeded the pre-1985 level. According to one study, between 1987 and 1992 annual per capita consumption rose from about eleven liters of pure alcohol to fourteen liters in 1992; current consumption is estimated at about fifteen liters. (According to World Health Organization standards, consumption of eight liters per year is likely to cause major medical problems.)

A 1995 Russian study found that regular drunkenness affected between 25 and 60 percent of blue-collar workers and 21 percent of white-collar workers, with the highest incidence found in rural areas. Because alcohol remains cheap relative to food and other items, and because it is available in most places day and night, unemployed people are especially prone to drunkenness and alcohol poisoning. In 1994 some 53,000 people died of alcohol poisoning, an increase of about 36,000 since 1991. If vodka is unavailable or unaffordable, Russians sometimes imbibe various combinations of dangerous substances. The Russian media often report poisonings that result from consumption of homemade alcohol substitutes. Production of often-substandard alcohol has become a widespread criminal activity in the 1990s, further endangering consumers. Alcohol consumption

among pregnant women is partly responsible for Russia's rise in infant mortality, birth defects, and childhood disease and abnormalities.

Smoking, a widespread habit, especially among women and teenagers, compounds Russia's health crisis. Chain-smoking is endemic in Russia; in 1996 an estimated 55 percent of Russians were regular smokers, and health authorities believed that the figure was rising. However, rather than urge patients to quit, doctors often recommend the purchase of American cigarettes, which are more expensive but have less tar and nicotine than Russian brands. When import restrictions ended in the early 1990s, the American cigarette industry found a large new market in Russia. A modest government antismoking campaign paralleling Gorbachev's anti-alcohol campaign in the late 1980s had little effect. In January 1996, cigarette advertising in the print media was prohibited, and smoking in theaters and workplaces generally was restricted to designated locations.

The increasing incidence of drug abuse was belatedly acknowledged by the Russian government as a public health problem. In 1995 an estimated 2 million Russians used narcotics, more than twenty times the total recorded ten years earlier in the entire Soviet Union, with the number of users increasing 50 percent every year in the mid-1990s. In the Soviet era, drugs were viewed officially as a capitalist vice, but that attitude disappeared soon after the Soviet Union dissolved. Russia legalized drug use (but not possession or sale) in 1991. According to experts, laws against possession are not dissuasive. Narcotics use has spread to new elements of society in recent years, including alcoholics seeking a new means of escape. Russian experts rate the new class of Russian businesspeople as the group with the highest percentage of drug users; for them, success often includes the ability to purchase the most expensive narcotic. The drug scene, once dominated by students and intellectuals, now includes large numbers of housewives and workers. Synthetic drugs now are manufactured in small laboratories by professional chemists; some

are easily fabricated by amateurs as well. Legally produced drugs often are stolen and move into the black market.

Medical treatment and educational programs now include hot lines in major cities and walk-in clinics that provide advice and treatment on an anonymous basis. Some schoolteachers have begun class discussions of drug-related issues and have distributed antidrug literature to students. Nevertheless, Russia's drug problem remains largely intractable. Many addicts overdose, and some who cannot afford heroin inject themselves with other substances that cause illness or death.

Aids

Acquired immune deficiency syndrome (AIDS) likely was brought to the Soviet Union by students from countries with high levels of incidence of the disease. In 1987, after the first case of AIDS was confirmed in Russia, the Supreme Soviet of the Soviet Union passed the strictest anti-AIDS law in the world, making the knowing transmittal of the infection a criminal offense punishable by up to eight years in jail. A 1995 law, which has been criticized vehemently for its human rights implications and the cost of its administration, stipulates that all visitors remaining more than three months must prove that they are not infected with the AIDS-causing human immunodeficiency virus (HIV).

The government has established a diagnostic and screening infrastructure for AIDS prevention and control at the central and subnational levels. This system has been criticized heavily, however, because it tests only populations with little chance of infection, and because it fails to allocate scarce funds to root causes of AIDS transmittal such as infection from hospital procedures and reuse of hypodermic needles. The release of statistics on the incidence of AIDS and other sexually transmitted diseases has been extremely slow. In late 1995, the Ministry of Health reported that 1,023 Russians, including 278 children, had been registered as having HIV, and that to that point 160 Russians, of whom seventy-three were

children, had died of AIDS. Before 1992 several mass infections of children occurred in medical facilities.

Official diagnoses of HIV increased 50 percent from 1993 to 1994. However, according to an official of the Imena AIDS support group, which is devoted to rehabilitation of HIV victims, the official statistics are understated at least tenfold because Russians in the groups most at risk--prostitutes, homosexuals, and drug users--have reason to fear that results will not remain confidential and so refuse AIDS testing. Although the 1990 Law on Prevention of AIDS mandates confidentiality of medical records, in practice jobs often are lost and social services denied after a positive diagnosis. The highest incidence of HIV is in Moscow, St. Petersburg, Rostov-na-Donu, Volgograd, and the Republic of Kalmykia, the last three of which have medical facilities where unsanitary procedures have resulted in mass transmission of the virus. The majority of reported HIV-positive individuals are drug users.

As in the Soviet period, the public receives little information about precautions against AIDS or the identity of the high-risk categories in society, and AIDS sufferers meet much intolerance in Russian society. Because the disease has been associated with foreigners, government officials and the public have ignored the need for preventive measures among Russians. AIDS transmittal is increased by a chronic shortage of condoms (which Soviet medical officials euphemistically called "Article Number 2") and by the lack of disposable hypodermic syringes in hospitals and clinics, which results in the repeated use of unsterilized needles.

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