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Fight or flight Russians living with HIV navigate mobilization and emigration

Source: Meduza

Story by Sergey Faldin for The Beet. Edited by Eilish Hart.

According to Vladimir Putin, Russia’s chaotic mobilization ended about two weeks ago (just in time for the fall conscription drive), but its effects are far from over. Fearing the military’s dragnet, hundreds of thousands Russians have fled abroad, upping the pressure on nearby countries that have already absorbed tens of thousands of newcomers since February 24. Though some draft-age men who left Russia are now returning home, they are likely the exception to the rule, given the threat of prosecution for draft dodging and the fact that, according to legal experts, the mobilization is technically still in effect. Meanwhile, reports of the Russian authorities’ negligence abound: men who should have been exempt from service were swept up in the draft, dozens of conscripts have died without ever being deployed, and ill-prepared recruits are being slaughtered in Ukraine. In this context, potential draftees have faced a choice between fighting — on the frontlines or with Russia’s military bureaucracy — or fleeing abroad. For those with serious health conditions, this decision is especially fraught. For The Beet, journalist Sergey Faldin reports on how Russians living with HIV have navigated the risks of mobilization and emigration. 

Some of the names in this story have been changed or omitted for safety reasons. 

This article first appeared in The Beet, a weekly email dispatch from Meduza covering developments across Eurasia. Sign up here to get the next issue delivered directly to your inbox.

A week into Russia’s “partial” mobilization, the country’s leading human rights lawyer, Pavel Chikov, shared the following messages from his Telegram subscribers: 

“Sverdlovsk region. My brother is 38. HIV+. The military officer simply said, ‘Do you give a damn where you die?’” 

“Moscow. They’re taking my friend, 30 years old, who has HIV. He brought documents, but the enlistment office doesn’t care.” 

“St. Petersburg. I have [late-stage] HIV. The enlistment officer insulted me and did not even look at my medical history.” 

Officially, most Russians with HIV/AIDS are medically exempt from military service. But this doesn’t happen automatically. It requires undergoing a battery of medical tests and obtaining paperwork confirming your diagnosis. 

“Before the [full-scale war], people who declared their HIV-positive status to the military enlistment office didn’t have any problems receiving a category D military certificate [‘unfit for service’],” said Anton Eremin, a Russian infectious disease doctor who fled to Paris after the February invasion. “If the enlistment office knew about your status, you weren’t subject to conscription — end of the story.” 

But what happens to people who fail to report their HIV status to the enlistment office? And what about those who lack official paperwork or don’t even know they have the virus? “For the enlistment office, if it’s not in the documents — it doesn’t exist,” Anton warned. 

‘Nobody cared that I have HIV’

Russia ranks among the countries with the most people living with HIV. According to official statistics, the number of registered HIV cases in Russia surpassed 1.1 million in 2021.

“The situation was already difficult before the war,” a thirty-something HIV activist from Moscow told The Beet. “Treatment was available only in big cities. As preventive measures, AIDS centers advised matrimonial sex. So-called HIV ‘experts’ still deny basic WHO [World Health Organization] principles, like U = U [short for undetectable equals untransmittable].” 

Over the past five years, Russia has officially recorded between 85,000 and 100,000 new HIV infections annually. Most likely, the actual number of infections is substantially higher. “The number of people living with HIV is growing all the time, yet the budget for treatment remains almost unchanged,” a Russia-based volunteer from Life4Me+, a non-profit working to prevent the spread of HIV, hepatitis C, and tuberculosis, told The Beet. 

Today, however, Russian HIV patients face a new challenge. Against the backdrop of the war and, more recently, the mobilization, many are afraid to leave Russia because they don’t know whether they’ll be able to access treatment in other countries. 

Kolya, a 29-year-old taxi driver in Moscow with early-stage HIV, told The Beet that he feels stuck in Russia because of a lack of knowledge about whether treatment will be readily available abroad. (Meanwhile, HIV/AIDS patients are reporting shortages of crucial antiretroviral medications across Russia.)

Andrey from Moscow, 33, didn’t receive a summons but decided to report to the enlistment office anyway. Andrey’s medical records were outdated and he knew that he could be drafted at any moment if he didn’t take action. “They put me in a room with other conscripts and started talking about the money our families would receive … nobody cared that I didn’t receive a summons or that I have HIV.” After rounds of negotiations with nurses, he was released after being told to secure the paperwork confirming his HIV status. 

For now, at least, people with HIV can rest assured that the law is on their side — as long as they have documents to prove their diagnosis. Amid the mobilization, this has led to a surge on the black market for falsified medical records, with forged HIV certificates selling for anywhere from $190 to $880, Novaya Gazeta Europe reported.

“I heard about people who are attempting to infect themselves with HIV so as not to go to war, but that’s ridiculous,” said Olga, an HIV activist from St. Petersburg. “You can’t just contract a virus in a day.” (Accurate testing for HIV antibodies is typically only possible weeks, if not months, after exposure.) 

Still, in a country where laws can be rewritten on a whim, putting your trust in the system could cost you everything. “If you have the option to leave, I recommend leaving,” says Roman Polyakov, an HIV-positive Russian journalist based in Spain. “Even if you have all the proper documents, I wouldn’t place any hopes in the crooked Russian legal system.” 

‘It’s a great privilege to be able to leave.’

Maksim Malyshev, 45, was diagnosed with HIV in 1997 after extensive drug use. Back then, antiretroviral therapy (ART) — used to treat HIV — wasn’t available in Russia. “It used to be a terrifying diagnosis,” he told The Beet. “In the EU and U.S., people were only starting to talk about possible treatments. In Russia, there was nothing. My only dream then was to live to see the new millennium. It’s a miracle that I’m still alive.” 

Along with the advent of HIV/AIDS treatment in Russia came stigmatization, Maksim recalled: “Each [government-run] AIDS center had a committee that decided who’d get therapy. If you had to choose between Maksim Malyshev, a drug addict, and a pregnant woman, the choice was not in my favor.” Such drastic measures resulted from a funding deficit and a spike in cases across the country. 

Today, Maksim works for the Andrey Rylkov Foundation, an NGO helping drug users and HIV patients in Russia. He decided to leave for Georgia in March with his wife and daughter. He’s now running a mental health community center in Tbilisi. 

“The availability of ART in Georgia wasn’t my top priority,” he said, reflecting on his decision to leave Russia. “I bought three-months worth of generic drugs. And I still had a two-month prescription issued at the AIDS center. This gave me a whole five months of treatment.” 

Having worked with HIV patients since the early 2000s, Maksim had many contacts and knew he could continue his treatment in Georgia, Turkey, or Armenia if needed. “It’s a great privilege to be able to leave Russia. A lot of people don't have that option,” he explained. “I’m not a rich person, but I have accumulated social capital, which I can rely on.”

Still, HIV treatment in Georgia is not automatically available for newcomers — even for someone with such an extensive network. To receive treatment, Maksim must apply for a residence permit or seek help from local NGOs. “But I don’t want to use that resource,” he said. “There are people who need it more than I do.” 

‘I’m afraid I’ll be stoned.’

Georgia recorded its first HIV infection in 1989, and the number of cases grew throughout the 1990s and 2000s. “Labor migrants mostly brought it to Georgia from Russia, Ukraine, and Eastern Europe,” explained Nikoloz Chkhartishvili, the deputy director of the National AIDS and Immunology Center in Tbilisi. At the time, most cases were associated with intravenous drug use. 

Nikoloz recalled that the Georgian government implemented intervention programs after independence to fight the spread of HIV/AIDS and received support from the WHO’s Global Fund starting in 2004. In 2018, Georgia transitioned to domestic funding and committed itself to making treatment available to everyone. 

“[Today], there are some 8,000 HIV patients in the country in total, and 83 percent are known positives,” said Nikoloz. By comparison, there are upwards of 32,000 HIV-related deaths in Russia annually.

According to Nikoloz, his AIDS center has only received 50 requests from Russians with HIV since March. “In Georgia, citizens and residents can get free care, which includes ART drugs, clinical consultations, and lab tests. But that’s not the case for Russians coming to Georgia,” he told The Beet. “They can also get access to treatment, but it will cost them money.” 

“Russians who come to Tbilisi have money, so it’s easier for them to get access to therapy: they can either buy generic drugs in pharmacies or order packages by mail directly from Russia,” he added. 

Asked whether this year’s influx of Russians and Ukrainians would affect Georgia’s healthcare system, Nikoloz seemed worried. “There are no HIV screening programs for newcomers. People just come here, and that’s it,” he said. 

“The real problem is lack of diagnostics,” added Zhenya Zhukov, the founder of Emigration For Action, an NGO Russian emigres founded in Tbilisi to help Ukrainian refugees. “In Russia, many people don’t know they have the virus and need treatment.” 

According to Nikolai Levshitz, who runs a popular informational Telegram channel for Russians in Georgia, anti-LGBTQ+ attitudes remain a significant barrier to accessing HIV services, including in healthcare settings. “There are strong homophobic sentiments in [Georgian] society,” he said. 

For many in Georgia, the events of July 2021 are still fresh: far-right protesters attacked the headquarters of LGBTQ+ activists in Tbilisi, injuring more than 50 journalists and forcing the cancellation of a planned Pride march. One cameraman who was severely injured died, days later. 

“I’m afraid, if I ask where the AIDS center is, I’ll be stoned,” said one of the interviewees in a study conducted by the Tbilisi-based Equality Movement on access to HIV/AIDS services for transgender people and immigrants in Georgia. 

The language barrier has proven to be a challenge, as well. “We had several patients who needed HIV treatment,” Zhenya recalled. “We couldn’t find any local AIDS centers because most have websites written in Georgian. When I called the Healthcare Ministry and asked if they speak English, they said, ‘No!’ and hung up.”

* * * 

Speaking at a press conference on October 31, Vladimir Putin said that Russia’s mobilization has ended, but he has yet to issue a corresponding decree. Chikov, the rights lawyer, said an official “demobilization” order probably isn’t in the cards.

“This regime is full of people without a drop of truth, logic, or consistency,” Maksim said when asked about the draft’s purported end. “I think it’s a PR move.”