MOSCOW -- For a few weeks in 2012, Yury had a family: His wife, Katya, had given birth to a girl.
But when Yury took his ailing baby daughter to the hospital two months after she was born, he learned that she was HIV positive, and his world began to collapse. After he was tested and came up positive, he said, Katya told him that she had given him the virus -- and had known she had it while pregnant but kept it secret from him out of fear.
A month later, their daughter was dead. Katya, who refused to take antiretroviral therapy to prop up her ailing immune system, died last year.
"We didn't separate or run away from each other. We went to the end," said Yury, a 40-year-old auto mechanic from a gritty Moscow suburb who preferred not to be identified by his surname. "I've come to terms with it all. How can I blame the person who gave me a daughter?"
Russia's HIV epidemic passed a grim milestone in January as the country registered its millionth HIV-positive citizen -- double the number in 2010. About 200,000 of that million have died since HIV was first registered in Russia in 1987.
With less than one percent of the population of Russia's 142 million infected, the situation is less dire than epidemics that have ravaged Sub-Saharan Africa. And yet while the rate of new HIV infections across the world is ebbing, in Russia it is on the rise.
Russia accounts for the lion's share of infections in a Eurasian region, which UNAIDS -- the United Nations' program on HIV/AIDS -- says is the "only region in the world" where the HIV epidemic has "continued to rise rapidly." More than 93,000 new cases were registered in 2015 -- compared, for example, to 44,000 new diagnoses in 2014 in the United States, whose population is more than twice as large.
Yury does not know how Katya contracted HIV, but his own story fits into a trend that some leading experts say President Vladimir Putin's government must face up to fast: The number of Russians infected through straight sex is rising.
Vadim Pokrovsky, the longtime head of the Federal AIDS Center and an expert who has been tracking the disease's progress in Russia for almost three decades says the epidemic is advancing beyond traditional high-risk groups and spilling into general circulation.
Pokrovsky said that infections through heterosexual contact accounted for 45 percent of overall infections in 2015, compared with 10 percent 10 years ago.
He believes Russia stands at a critical juncture: The government should forsake what he casts as conservative policies that deviate from established global practice in the fight against HIV.
"I think it is now spreading into the heterosexual population," Pokrovsky told RFE/RL. "We can no longer keep on saying 'nyet-nyet' [Russian for "No-No"]. We have to urgently take measures."
'HIV Belt'
For years, the chief mode of transmission in Russia has been intravenous drug use, which boomed after the Soviet collapse as the social fabric frayed and factories shut down or slashed workers' jobs, particularly in industrial towns in the Urals and Siberia. Rampant drug abuse tore through cities on the heroin trail from Afghanistan westward in the 1990s and 2000s, forming something of an "HIV belt" across central Russia where the virus remains most prevalent today.
Pokrovsky believes the situation is moving from a "concentrated epidemic" among at-risk subgroups such as injecting drug users to a "generalized epidemic" -- defined by the World Health Organization as a situation with "HIV prevalence consistently exceeding 1 percent among pregnant women."
INFOGRAPHIC: Living With HIV AIDS
Pokrovsky said that in over 15 of Russia's 82 regions, more than one out of every 100 women who becomes pregnant has HIV.
"The trouble at the moment is that the number of people contracting HIV through heterosexual sex is rising," Pokrovsky said. "We cannot say that these transmissions are connected to the traditional vulnerable groups."
Other experts say there has been no major shift in the way HIV is spreading in Russia.
In e-mailed comments to RFE/RL, UNAIDS said that "the majority of the new HIV cases in Russia remain concentrated among key populations -- particularly injecting drug users and their sexual partners."
But almost all agree on the need for urgent action in Russia, where several factors -- including the persistent stigma attached to homosexuality, a strained health-care system, a lack of education about risks, government pressure on NGOs, and logistical problems that critics say have been created or aggravated by the state -- are making the HIV/AIDS problem worse.
Rising Concern?
There are some signs of new attention from the government, and the media that serve it, to an issue that was long considered peripheral.
Recently, newspapers such as Komsomolskaya Pravda, a popular pro-Kremlin tabloid, have carried stories with headlines like: "HIV can happen to anyone: go out and get tested!"
Prime Minister Dmitry Medvedev declared the situation a matter of "national security" in March, and on October 20 signed off on a five-year strategy to combat the crisis through 2020.
But despite the indications of increased concern, activists, doctors, and NGO workers fear that the new government plan remains hamstrung by the same conservative, go-it-alone approach that has stymied efforts to rein in the epidemic so far.
Among other things, the strategy prioritizes raising awareness, with the help of NGOs, among "key groups of the population." But in a common point of criticism, Pokrovsky said the strategy fails to clarify how the government plans to work with key HIV risk groups such as injecting drug users, sex workers, and gay or bisexual men.
"No one has answered the question of how we are going to warn people about the circulation of HIV among drug users -- although about 20 percent of intravenous injecting drug users already are infected," said Pokrovsky. "Nothing is said about how to prevent the infection of the remaining 80 percent."
"The same goes for sex workers," he told RFE/RL. "There is not a word about prevention among them. Everyone knows there are many of them. But there are no special programs planned for this group. The same goes for men who have sex with men."
The state "just does not pay enough attention to prevention -- prevention is very weak in Russia," Pokrovsky said, adding that this is reflected in government funding to fight HIV. "If 18 billion rubles ($278 million) are spent on treatment, only 400 million rubles ($6 million) go to prevention."
Zero Tolerance
There are no well-known state outreach organizations or programs working with high-risk groups. This is the exclusive preserve of largely foreign-funded NGOs such as the Andrey Rylkov Foundation For Health and Social Justice -- the only group in Moscow that distributes clean needles, contraceptives, and medication to drug users, the main group incubating and spreading the virus.
The Rylkov foundation receives no financing from the Kremlin and relies on grants from abroad. In July, the group was labeled a "foreign agent" under legislation signed by Putin early in his third term in 2012 that pressures and marginalizes many NGOs with foreign funding.
Foundation activists also encounter street harassment. In October 2013, police threatened to arrest activists who had traveled to a pharmacy in a rundown district in southeast Moscow where they handed out clean needles, bandages, condoms, and ointments. The police ordered them to disperse, prompting them to move to a new location where they continued their work.
Although 1 million Russians have been registered with HIV in the last 30 years, Pokrovsky estimates there could be another 500,000 living with the virus who have not been identified -- many of them injecting drug users.
"Over half of our cases are contracted through drug use," said Elena Orlova-Morozova, a doctor at the Moscow Region AIDS Center. "It is very hard to identify HIV in this group and make progress with this group. Drug use is criminalized here and there is no talk of decriminalizing it."
"Drug users therefore are scared, of course, and cannot go to state buildings [such as hospitals] to be monitored," she added.
Activists also criticize Russia's refusal to legalize heroin substitution therapy which has been used widely across the world -- including in authoritarian countries such as Iran -- to wean drug users off heroin by giving them orally imbibed methadone.
Anya Sarang, head of the Andrei Rylkov Foundation, dismissed Medvedev's strategy as more of the same policy that has brought the epidemic this far. She suggested that one big obstacle to improvement is the growing prominence during Putin's third term of conservative ideas, anti-Western sentiment, and views espoused by the Russian Orthodox Church leadership.
"I guess the Health Ministry is still trying to figure out the 'Russian' and more godly way to deal with the problem since they are not in favor of internationally accepted, evidence-based prevention programs such as needle and syringe distribution and opioid substitution therapy," Sarang said.
'My Son Died Today'
LaSky, an HIV NGO that works with homosexual and bisexual men in Moscow, has not been labeled a foreign agent despite receiving money from abroad. But it has had to adapt to other restrictive legislation passed during Putin's third term.
On a November afternoon, Aleksandr, 29, a shop director who moonlights at LaSky, pasted "18+" stickers onto fliers and pamphlets about HIV and homosexuals so as to avoid being accused of violating a 2013 law that criminalizes the spread of gay "propaganda" to minors.
Rights groups and Western governments say the law marked a major setback for gay rights in Russia, encouraging prejudice and adding to the stigma attached to the lesbian, gay, bisexual, and transgender (LGBT) community in Russia, where homosexual relations were a crime in the Soviet era.
Ilya, a 20-year-old gay man who has attended counseling sessions at LaSky, has felt the stigma firsthand since he contracted HIV in December 2015 and was disowned by his family, which is prominent in his Siberian hometown.
When he called his mother with the news of the test result, she said "my son died today" and hung up the phone.
Ilya, who did not want his last name published, said he became depressed and fell behind on his studies at a Moscow university. When exam time came in May he asked for an extension, citing his HIV status and a doctor's note, but was swiftly expelled, he said.
"In Russia, HIV-infected people are not seen as people who need help and are sick, but as people deliberately spreading the plague," said Ilya.
Activists at LaSky say the lack of information about HIV is a major problem. Aleksandr, a gay man from a Volga River town who preferred not to be identified by his surname, said he had no idea when he contracted HIV in 2013 that sexually active gay and bisexual men are at a high risk of infection.
"This information is nowhere, no one talks about it, no one knows anything about it," he said.
Activists say sex education in schools is grossly insufficient. At his high school, Aleksandr said, there was just one lecture that talked about condoms -- and it focused on using them to prevent unwanted pregnancy.
"There was nothing specifically about HIV," he said. "No one in the regions gets that. As a rule, they say superficially that there are sexually transmitted infections and you need to use a condom."
LaSky offers support in getting around a major logistical hurdle for many HIV sufferers in Moscow: The state guarantees free medical treatment for citizens, but only in the locale whether they officially reside -- and many Russians who live in the capital formally remain residents of their hometowns.
After Aleksandr tested positive for HIV, he had to travel back home -- 400 kilometers east of the capital -- for time-consuming treatment. He tried to hold onto his job by asking in advance for time off, but eventually was forced to resign. He has now managed to get registered for treatment by registering at the Moscow Region AIDS Center with LaSky's help.
Champagne, Not Condoms
Activists criticize some of the awareness campaigns that do exist, such as state-sponsored signs at Moscow train stations that make no mention of the use of condoms as a preventive measure.
One public-service poster sponsored by the Moscow government says simply, "Ignorance puts you in the risk group," without further explanation. Another suggests that adhering to traditional family values is key, warning: "Infidelity puts you in the risk group."
Pavel Lobkov -- a TV presenter who broke a taboo last year when he disclosed his HIV-positive status on the air on World AIDS Day, December 1 -- said condoms should be far more accessible.
"They should be handing them out free of charge in clubs where there is a heightened sexual atmosphere, or at rave parties, and so on," Lobkov told RFE/RL in an interview.
"When in a normal shop a pack of 12 condoms costs as much as a bottle of Soviet champagne, a couple of 18-year-olds will buy the champagne and not those boring condoms."
Lobkov said that "there were outreach programs for many years" -- but that times have changed.
"In the 1990s, I remember in all gay clubs or rave clubs there were free condoms at the bar," he said. They've disappeared now. They should be in your face" he said.
But social conservatives who have gained influence during Putin's public push for adherence to what he and the Russian Orthodox Church cast as traditional values tend to oppose such measures.
Lyudmila Stebenkova, a long-time Moscow legislator who heads the city Duma's public health committee, called on November 15 for a ban on the distribution of free condoms.
Stebenkova, who has won awards from the church, said condoms only offer 80 percent protection from infection and that their free distribution inculcates "irresponsible sexual behavior."
In a follow-up Facebook post, Stebenkova attacked foreign NGOs whose methods she called "strange and even irresponsible: giving out one-use needles to drug addicts and propagandizing condoms, which they give out even to schoolchildren."
"In Moscow we decided to go down a different route: the propaganda of healthy living and family values," she wrote.
