Four friends gathered around a table.

Four friends gathered around a table and glasses of amaretto. This is where quality begins. We don’t need the promise of new people or dancing or the streets. What we need is to talk. To be open about this world we are living in and the experiences we are having. It is Russia and it is also Thanksgiving. This is already a clash of cultures beyond the fact that we are all from different countries. And yet rather than taking the knife of division and cutting open our diversity, we embrace our commonality and that is truth. That we are more similar than we will ever know. And even the racial issues and economic issues that we discuss, which divide this world we live in, those too are the creations of our mind. The division is not reality. It is the unity that is reality. 

It has almost been a year in this country. And in that year I have come to realize that what once seemed so strange and distant can, in time, come to feel more real and “normal” than much other I have experienced. It is strange. But at the same time, not so strange. Why should it be so foreign? Again, the divisions are in my mind. If I embrace what is around me and stop trying to create a semblance of my native home, then I will soon find that which surrounds me as home.

If you look back, not to the very beginning, but to the beginning which has brought me here, it is almost impossible to imagine that this reality would be mine. Not just Russia, but these people, this moment, this conversation. How far I have come, how much I have changed, and yet my love for this place remains the same. That first image, of darkness, of mud, of desperate children. Now this, a successful job, a community, palaces around me. It is almost laughable. There is darkness and desperation certainly, but this idea that life over here is so different just isn’t true. It isn’t true at all.

I think of Dad. How he said the biggest shock was how normal it all seemed. Exactly. It is normal. Perhaps not my normal, or rather my native normal, but people are going to live. They aren’t going to muck around in another era forever. Reality isn’t static. That is the key to all of this. Reality is dynamic. The people of this country are shaping their reality. And that reality is shaping this country. So of course it is normal. Of course it is relatable. We are all human, and, essentially, we all want and need the same things. Essentially.

It is two in the morning. It is time to head home. The crisp air hits me as I walk out the door. My own breath swirls around me in a fog, drifting towards the night sky. I follow its trail and look at the stars for the first time in a long time. I live here. The empty streets seem so tranquil at this hour. The half-moon’s reflection glitters off of the lapping current of the Fontanka River. I am surrounded by palaces and facades and bridges. I catch my mind wandering between the memories of these places and the utter awe that such magnificence has somehow become normal to me. Liteyny – my old commute. The Hat – jazz and farewells to friends I will never see again. Nevsky – well Nevsky is just everything. The Radisson, where Alex played the piano all those years ago. There is too much running through my mind to hold on to all the memories. And yet, I feel myself at peace. I haven’t felt that in a long time.

This is what I have been looking for. Like Pirsig said, “Zen is the “spirit of the valley,” not the mountaintop. The only Zen you find on the tops of mountains is the Zen you bring up there.” So all of this wrestling I have been doing. All the challenges I have given myself. All of the mountains I have climbed. They are part of this peace, but they are never the places I would find my peace. It is here. On the empty streets. At night. When I least expect it.

And you have to ask yourself, how do I hold onto this feeling? How can I stay this way forever? But perhaps that isn’t the point. Because it is these moments that allow you to reflect. And you can only reflect once you have travelled. So you must appreciate them and continue on your path. Because these moments are just part of the journey and not necessarily the destination itself. We are always wrestling. Always challenging. Always climbing the mountain of this ever changing reality called life.

The Kommunalka: Where Hitchcock & Dostoevsky Meet

Russian talk radio echoes around the courtyard. A cat sits perched on a windowsill, gazing at the small flock of pigeons picking at a pack of old bread that some babushka has generously thrown out. A young girl sits at her vanity mirror putting on make-up in the apartment directly across. I’m convinced the top-floor flat is a greenhouse rather than a living space, with the explosion of greenery pouring out the windows. I see strangers in the stairwell, some going up, some coming down. An old man leans out his window, cigarette in hand, a cloud of smoke swirling around the cold, still air. And here am I, perched on my own spacious windowsill, book in hand, feeling like Jimmy Stewart straight out of Hitchcock’s Rear Window. I’m not sure what makes me happier, this montage of Russian life playing out before me, or the fact that I am no longer a homeless vagabond in this city.

Dosteovskogo 36 is the address. And if you’re wondering whether Dostoevsky himself lived on the street, then you’d be correct in that assumption. Just two blocks up the road sits the flat-turned-museum where the beloved Russian prophet crafted The Brother’s Karamazov and later passed away. There is something special about this place. Not just its historic significance, but a peaceful corner of this often chaotic city where real people live, and where I find myself content.

I’ve called this spot home for just 2 weeks now. After 6 months of office living and another 3 months couch-surfing in the homes of generous friends, the era of homelessness if finally over. I’ve learned a lot throughout this exhausting yet adventurous process. I’ve learned that despite people’s claims that you must hire an outrageously expensive agent to find a decent flat, you can, in fact, do it on your own. Granted, it will require a lot of time scrolling through social media groups, visits to one too many terrifying apartments, and some haggling. And somehow navigating the whole system in Russian.

So here we are. A very modern and spacious room located in a very old, soviet style “kommunalka” or communal apartment. It is an experience, it is reasonably cheap, it is perfect. Kommunalkas are remnants of this country’s communist history. Palaces and extravagant homes of the aristocracy were taken by the people and divided into smaller flats, usually shared with strangers. Families were given a single room in the apartment where all of the living took place, while a large kitchen, toilet and bathroom were shared amongst all the inhabitants. While, for obvious reasons, this type of living is phasing out, in the historic center you can still find many kommunalkas. Often the occupants are older people who have been living there for decades, as well as young people on a budget. Our kommunalka is comprised of four rooms, a shared kitchen and a shared bathroom. While it isn’t totally clear exactly who lives there and who is just a visitor, there seems to be a family in one room, a young woman in another, and an invalid mother and caretaker daughter in the third. And then us – two American girls entering into this strange Soviet way of life.

Perhaps it is the result of such prolonged homelessness, or perhaps it is my western mind adapting to the culture I am living in, but I can’t imagine myself happier in any other home. 

Cosmopolitan: Not Just Celebrities, Sex and Gossip

Cosmopolitan isn't exactly considered the classiest of magazines. While some argue that it holds a key place in the history of the women's movement in the West, despite your chosen brand of feminism, it clearly promotes the objectification of women. But rather than launch into a rant on gender equality, I'd like to give Cosmopolitan a shout out this month. As one of the most famous and widely read women's magazines, Cosmopolitan has massive global influence. What celebrities we love. What clothes we wear. How we date. What crash diet will finally give us the body we've always wanted. In some way, most women are consciously or subconsciously swayed by this media empire. 

With such reach (and general lack of shame), Cosmo also has the opportunity to tackle some of the most taboo and controversial issues facing women. In Russia, HIV/AIDS is not a topic the general population likes to talk about. This disease is associated with drug use, prostitution, and societal groups that most people just don't want to deal with. The idea that a young, beautiful and "normal" woman could also be HIV+ seems almost impossible. These stereotypes and fears about HIV perpetuate a lack of understanding about the disease and encourage discrimination. Whether someone is infected with HIV through their own action or the actions of others, the ultimate truth is that these individuals are still people who need to be treated equally and given support. This is what has the power to fight HIV, not fear. 

Anastasia Mokina, a key advocate of the EVA family, has an open HIV status and shares her story to help break down stereotypes regarding HIV in Russia. Cosmo approached Anastasia and EVA about participating on a piece about HIV for the October edition of Cosmo in Russia. It is a wonderful opportunity in reshaping fears and misconceptions about HIV, and in giving the disease a new face in this country. 

Read more on the EVA site here: http://en.evanetwork.ru/about/news/news_146.html

Ukraine Adopts New Drug Policy

The war on drugs is a major setback to those working within harm reduction and the public health sphere. While the concept of reducing drug use is nice in theory, the war on drugs has proven to be extremely ineffective in actually reducing this epidemic. Worldwide, drug use is criminalized on various levels, meaning that there is no regulation of substances, and those who use drugs do so in fear and without safe practices. As HIV, especially within Russia and much of Eastern Europe, is linked closely with drug use, strict criminalization of drugs and lack of effective harm reduction (i.e. methadone therapy, needle exchange, etc) not only increases the health risks of those using the drugs, but also the spouses and children within their lives. Socially significant diseases such as HIV, TB and hepatitis feed on the unsafe practices of drug users. As the history of the war on drugs has shown us, putting people in prison for using and dealing drugs is not an effective way to actually reduce drug use or to curb the diseases spread through it. What has been shown as effective are needle exchange centers, sterile drug injection sites and methadone therapy. While these methods are controversial, even among the former drug users whom I work with, it cannot be disputed that within the sphere of public health they are essential. 

Ukraine, a country plagued by drug use and the social diseases associated with it, recently changed its drug policy. The new policy is no longer about "combatting drugs" but rather "addressing drugs." While Russia is far off from adopting such a progressive stance, it is positive to see our neighbors using evidence-based methods to help people rather than wage an endless war with no hope of success.

Read more about the new policy: http://www.narkopolityka.pl/en

Nepal

I used to plan everything.

My first solo trip through Europe - every flight, connection, bus, hostel - all perfectly lined up. I’m sure I even had a daily itinerary of tourist activities planned out months in advance. At that time, planning was half of the excitement for me. The anticipation of where I would be and what I would be doing.

But something changed.

I specifically remember meeting a girl in Italy who had plans to travel for a year. When I asked her where she planned to travel, she nonchalantly said she wasn’t sure. She didn’t even know where she was going next week. She would meet people, get recommendations, and check the cheapest flights online. She would live this way for an entire year. It was something like modern society’s attempt at a nomadic lifestyle. It inspired me. It terrified me.

Perhaps it is disorganization, a lack of time, or the realization that I can’t control everything in my life – but I don’t plan like I used to. I’m no travelling nomad – but other than an arriving and departing plane ticket, my two weeks in Nepal was a virtual blank slate. And it was that lack of planning that brought me to the Tamang Village outside of Dulikhel, Nepal.

After a few days in Kathmandu, Lauren, Daniel and I decided we should get out of the city and do some trekking. While monsoon season brought with it warnings of washed out trails and the unpleasant prospect of leeches, we desperately wanted to escape the chaos of Kathmandu’s claustrophobic, dirty, yet colorful Thamel quarter. We pulled out the guidebook and started reading.

The plan: two days in Nagarkot – two days in Dulikhel. I sent a few emails and we left the following afternoon.

Hotel at the End of the Universe, Nagarkot.

Perched on the top of the mountain – there was little more than fresh air, dogs, a vast green expanse, and a small temple. Our two days were spent simply hiking, relaxing, eating, and bit of temple-side amateur yoga. We were out of the city and finally surrounded by that beloved Nepalese nature. We met school children on our hikes who daily trekked over five miles back and forth to school , we met leeches, we met breathtaking views of the Kathmandu valley.

Departing Nagarkot after two days, we set off on an ambitious 10+ mile hike that would bring us to our next town – Dulikhel. We had our backpacks and a hand-drawn map that I couldn’t make rhyme or reason of. I felt confident we would reach Dulikhel by dark. Perhaps serendipitously, only a short while after lunch, those seasonal monsoon rains began to fall. And they didn’t stop. We held out for an hour, then gave into the fact that we would have to take a taxi.

We were shuttled down the mountain, then promptly up another to find ourselves in Dulikhel. After asking several locals where our guesthouse was located, we began to drive out of the city and higher up the mountain. 15 minutes later we were in a place that could hardly be called a village, with no more than 7 small building lined along the dirt road. A whitewashed home with streams of colorful prayer flags stood in the center. This was our home-stay.

When I signed us up for a home-stay I didn’t really know what I was doing. I was thinking something like home cooked meals in a family-run guesthouse. What I didn’t quite realize was that we would be living with the family in their home, eating meals with them, and learning about their culture and daily life. My last minute decision to stay at the Tamang Family Home-stay wasn’t in error though. Just a few days with this family taught me that people across the world aren’t so different after all and that we struggle with many of the same issues – though in varied ways.

On a morning hike to a massive hilltop Buddha, led the husband of the Tamang family, we got to talking about many things, including my work. In general, most people were slightly confused by the fact that I am American, but I live in Russia and work as a volunteer intern for an NGO. But this man was no stranger to NGO work, especially that which related to health and women’s issues. He went on to tell me about how his family was involved in, and really the leaders of, several development projects within their small community. The first was established by his mother-in-law. An uneducated woman who had spent her entire life within this small agricultural community. She saw how everyday the women, regardless of age or health would work in the fields and sometimes even spend their days gathering wood in the forest. As they aged, this work was increasingly difficult, but it was their basic means of survival and couldn’t be avoided. The truth was though, that this was no way of life and something needed to change in their community. Despite a total lack of education, she decided to establish a women’s collective within her community. Together, the collective of women could support one another and develop alternative methods of income that would diversify their means of survival. Today, the collective has 100 members and are starting a small business where the women will make hand-made bags for sale in Kathmandu and abroad.

As a feminist and a hopeful gender studies MA student, seeing an uneducated woman from a small, rural and very traditional community identify a major need specific to women and to develop a solution to that problem which says that life as it is for women in this community is not enough is incredibly inspiring. In my own setting, within Russia, I can see that while women have education, they lack autonomy in their relationships with men. The consequences of this play out in many ways such as increased risk of HIV, domestic violence, and lack of support to develop themselves as individuals and within their careers. It goes on, but life for Russian women as it is today is also not adequate.

The homestay family is also working with international donors to establish a local clinic in the village and eventually an orphanage. A girl from the village is receiving medical training in London so that she can eventually return to Nepal to run the local clinic.

What I had imagined as no more than a home cooked meal and quaint guest house, was instead the sharing of cultures and the sharing of ideals. That someone from such a different context could devote their life to the promotion of women’s issues in a way similar to my own dedication made a people whose language, culture and standard of living are so different than mine, seem oddly familiar and comforting. It wasn’t my home for more than two days, but it could have been.

Free Tibet

“We need to smile and have all of our documents in order at the checkpoint. If the Chinese guards don’t like someone’s attitude, they can just take them out back and beat them. It happens all the time.”

Hello Tibet.

All around me are plateaus and craggy peaks framed by an electric blue sky so crisp and bright I can hardly take my eyes off of it. Rainbows of prayer flags streak their way across the horizon. Our single-lane road winds its way up the surrounding peaks looking more like the path of a mountain goat than a highway. There is no sign of civilization - save us, the road, and the occasional nomadic yak herder. We are four – Tibetan guide, Tibetan driver, and two travelers reuniting in this strange place after one year apart. We have 5 days, two backpacks, a few snickers bars, and an aging Land Cruiser that will carry us to the boarder of Tibet and Nepal.

During these 5 days I will come to understand that I am in one of the most beautiful places on Earth surrounded by a beautiful people. I will come to understand that neither these people nor this place is free. I will understand what foreign occupation looks like. I will also understand what severe altitude sickness looks like. 

Days 1 & 2

Arrival in Lhasa. The air is cool, clean and dry. After the absurd smog of Beijing, it is like breathing for the first time. We meet Kaelsang, our Tibetan guide. 22 years old. Speaks Tibetan, Mandarin, Hindi and English with incredible skill. Has never received formal higher education. Is a Thangka artist during the off-season (what is Thangka? http://en.wikipedia.org/wiki/Thangka). Over a rooftop dinner of spicy potatoes and yak curry soup, Kaelsang points out the major landmarks of Lhasa as well as Chinese soldiers monitoring the city from rooftop lookouts and a number of check-points that starting springing up throughout the city in 2008. This is around the same time that the government took his passport as well as the passports of most other Tibetans. How can he so freely speak about this? He shouldn’t, but it hasn’t stopped him yet.

We visit Potala Palace and Jokhang Temple. These UNESCO sites are certainly filled with foreign tourists, such as ourselves, but there are also crowds of Tibetan Buddhists who count their prayer beads, spin prayer wheels, and pilgrims who prostrate themselves upon the ground. There is devotion here unlike anything I have ever witnessed in a church or cathedral. There are just a handful of monks within these walls, some sitting and studying, others working and speaking with visitors. Kaelsang explains that the Chinese have put extreme limits on the number of Tibetans who can become monks and nuns. These places, which once were filled with them, now have small, aging populations. Not only is this devastating both culturally and religiously, but also because these monks hold immense knowledge (many know up to 8 languages – what?!)

Day 3

Out of the city and into the mountains. We pass a holy mountain where the Tibetans practice sky burial. Since the Chinese have banned sky burial, Tibetan people have taken to painting images of the sky burial pylons on the mountain. Near the top, there is a small shrine draped with prayer flags. We hike out to it and find a Tibetan man with a beautifully adorned baby goat being bottle-fed. He is delighted by our unexpected presence as we are by his. Our drive takes us past emerald glacier lakes, snowy peaks, and fields of bright yellow flowers to the Kumbum Stupa and the Pelkor Chode Monastery - famous for its 100,000 Buddhas. The town is quiet and the tourists are few. We climb the stupa clockwise, ducking into the many shrines to see images of Buddha, each representative of a different aspect of Buddha. At dinner we watch our driver take on the restaurant owner in a game of finger billiards. They shout, whistle, sprinkle flour upon the board, and laugh most of all. The driver is undefeated by the end of the night. Kaelsang toasts to international friendship. We are sharing our cultures and trying to learn more about one another. It is good karma.

Day 4

After an early morning visit to the Tashilhunpo Monastery, seat of the Panchen Lama and home to the world’s largest bronze statue – a 30 meter bronze Buddha whose hands are large enough to hold a full grown adult, we are back on the road with much ground to cover. Rather than fill the rural highways with policemen to monitor driving speeds, the Chinese have established check-points. At each check-point you are given a slip of paper that states the approximate time you should reach the next check-point. If you show up any earlier than the listed time you will be fined per minute. But rather than follow the recommended speed, we drive how we want, only two stop a mile or so before the check-point for ten minutes. While a bizarre process, we get the opportunity to walk in fields with Yaks, share absurd amounts of watermelon with old Tibetan men, tour samba mills, and use some extremely questionable bathrooms.

Including driving check-points, we pass through one of many passport control check-points. Stationed in the middle of nowhere (although most of Tibet could be considered the middle of nowhere), but conveniently close to the Everest Base camp entrance, Kaelsang tells us “We need to smile and have all of our documents in order at the checkpoint. If the Chinese guards don’t like someone’s attitude, they can just take them out back and beat them. It happens all the time here.” With nerves high and unconvincing smiles, we file into the check-point. A Tibetan guide with a group of Chinese tourists we’d been caravanning with is denied passage through the checkpoint due to document issues. We show our paperwork. Hope for the best. We are allowed through. There is a general sigh of relief and about a mile from the check-point, near the entrance to the Everest Base Camp road, we stop the Land Cruiser to take a few deep breaths. The last check-point before Nepal. Home stretch.

Day 5

We are at 5250 meters. A full 100 meters higher than Everest Base Camp. It is early morning and we are covering the last stretch before the Nepal border. Lauren isn’t handling the altitude well – headache and nausea is an understatement of her symptoms. I have to stop laughing at her jokes because I can’t seem to catch my breath afterwards. The air is thin up here. There is a sense of sadness that this is our last day of our flyby tour of Tibet. We have become good friends with our driver and guide and feel like there is still so much to do and see in this country. Lauren sleeps off her nausea. Our guide and driver sing Tibetan tunes. I stare out the window constantly gasping at the beauty of these pristine mountains, valleys, villages and nomadic settlements. Suddenly, we’ve stopped. Kaelsang asks if we would like to visit the meditation cave of Yogi Milarepa (the only man to reach enlightenment without having studied as a monk). It isn’t a place they bring tourists to, but he has a feeling we will like this place. Clearly we go.

The small village is perched on the edge of cliffs that descend into a green valley dotted with patches of yellow flowers and groups of yak. The cave is no bigger than a closet and about half the height. Milarepa spent six years in this cave meditating. He ate nettles. Wrote poetry. Studied. My back hurts after about 5 minutes in the cave. I cannot even imagine. We walk clockwise around the temple. The crisp morning air blows down into the valley rustling through nettle bushes and lines of prayer flags. Children run out of their homes and take our hands leading us back to the Land Cruiser.

Farewell Tibet.

Dill. Potatoes. Smetana. Mildew. I breathe it in deeply.

White buildings show their age in the stained veins of grout that hold together a myriad of sun-bleached bricks. Overgrown grass harbors armies of gnats and mosquitoes. Fresh, crisp air is clouded by that all too familiar soviet scent. Dill. Potatoes. Smetana. Mildew. I breathe it in deeply. I itch a mosquito bite.

One of the other volunteers turns to me, and quickly whispers in Russian “I’m kind of nervous. Are you nervous?” No, not this time. But I do remember once being nervous about it. How will we communicate? What will they think of me? What will I think of them? It is like being 19 again and stepping off of a bus in the middle of nowhere, Ukraine and instantly being bombarded by children. Children with whom you can’t communicate, children who have a lifetime of hardship, children who simply want attention. Yes, I was nervous then. Perhaps terrified is a better word. But now – this place, this smell, this language, these children – I understand them. While it is my first time at the Infectious Disease Orphanage, it is a situation I know well.

The children stream out of the building, glad for the fresh air and the freedom -delighted to have visitors. A game of soccer starts. A group of teenage girls immediately gathers around one of the regular volunteers who acts as their mentor. Boys bike around the sidewalks. I start a small English lesson with two girls who are eager learn new words, perhaps mostly out of their desire to understand Selena Gomez and Justin Bieber songs better. It is a simple morning – but it is what these children need.

Despite the obstacles I have encountered trying to volunteer at other local HIV orphanages, the Infectious Disease Orphanage was eager to have volunteers. Some of us are HIV+ adults who will serve a crucial role in mentoring these youth and teaching them about what it means to live with HIV. Some of us are simply people who care and want to support these children is what ways we can. Together we will visit several times a month, spending the day in conversation with these children, playing with them, teaching them.

Within the Russian Federation, the oldest generation of youth born with HIV are now entering their teenage years. Currently, no specific services or programs exist to help transition them from childhood into adulthood in terms of living with this disease. In a few years they will have to switch from receiving medical care from a pediatrician, usually who has managed their case for the entirety of their life, to visiting the Center of AIDS in their region. Needless to say it is not a welcoming or friendly place. Beyond this, they lack adult role models who can show them how to lead a successful life managing their HIV. For young girls, this is especially important. As they move closer to having their own children, preventing mother to child transmission means preventing a new generation from being born with HIV. This means they need not only proper health education, but support from mentors and peers. 

Favorite moment from my day at the orphanage: A 15-year old girl with whom I had been talking for about 30 minutes suddenly asked me, "Is that your real hair color?" I've never met anyone in Russia who was excited about my hair color. When I told her it was natural and that many people in the US have dark hair and features, she was so delighted. She proceeded to tell me that her parents came from Turkey and the Caucasus - which is why she was darker than the other children. In a country rampant with racism, it was beautiful to give her a reason to be proud of how she looked and where she came from.    

Budapest

It has been one month since my trip to Budapest for the OSI Youth Initiative Conference, and I am still reliving each wonderful day spend there. From major inspiration gained from global youth activists at the conference to a vibrant city full of history and life, I'm not quite done with Budapest yet. Here is a window into my week spend there.

This is Budapest

Youth Initiative Conference - OSI

City view from the Basilica 

Travel Partners

Katya - our local guide and Roma expert. Also, a major inspiration!

City Market

Adoption Reform in Russia

After months of organizing the petition, and years of work from select activists, E.V.A. has succeeded in pushing adoption reform through the Ministry of Health, which is now willing to support the petition and present the reform to the Duma (Russian parliament). Take a look at this article from a Russian newspaper (translated into English by yours truly) which talks about the reform, its history and future implications. This is key in providing orphans, specifically those with HIV, a brighter future. It is also a step in ending discrimination and stigma towards HIV+ people within Russia and granting them the rights they deserve.

The Russian Ministry of Health is ready to give people living with HIV and hepatitis B the right to adopt children. Human rights activists and patient associations have long worked towards this solution, and, according to these groups, current forms of treatment completely eliminate the risk of infection for children. The government is now ready to support this initiative.

A letter from the Ministry of Health was sent to both the Russian Ministry of Education and a representative of the women’s patient organization, “E.V.A.”, Alexandra Volgina. In the document, Alexander Goliusov, deputy head of the Department, recalls that adoptive parents and guardians could not be people, “suffering from infectious diseases who are undergoing medical treatment.” In most cases, people only fall under this label during the acute period of their illness. But, with chronic viral hepatitis B & C, this acute period can last for several years, and with HIV, clinical examination continues throughout life. “Patients, who adhere to proper medical and preventative procedures are generally restored to good, functional health,” recognizes the Ministry of Health. “Simply because such patients are undergoing medical treatment cannot be the criteria on which adoptive parents are evaluated.” The letter writers state that the document was sent to the Government Office with the goal of removing HIV and hepatitis B & C from the list of diseases that prohibit a person from adopting children.

According to the Institute of Epidemiology, there are 8 million people suffering from different forms of hepatitis in Russia. In turn, the Federal Center of AIDS said that there are 700,000 people officially registered as living with HIV. Experts recognize that there are, in fact, many more people infected with HIV.

The Ministry of Health changed its position on this issue after two trials. In 2010, Svetlana Izambayeva, a resident of Kazan who was diagnosed with HIV, successfully challenged the law banning HIV+ people from adopting children and was allowed to adopt a child. After the court victory of Mrs. Izambayeva, patient organizations began collecting signatures demanding the change of internal rules from the Ministry of Health. They prescribed that the presence of these diseases is not a legitimate reason to deny adoptive rights. In 2012, a similar court case was won in Petrozavodsk, by a patient who was infected with viral hepatitis during surgery.

As explained by the human rights organization “Agora,” which was involved in both of proceedings, denial of adoptive rights came from a government decree in 1996. Paul Pins, head of the organization “Agora” explained, “this document was created at a time when HIV or hepatitis meant certain death. Now, with access to proper treatment, people with these diseases can live.”

“I know a lot of people with these diagnoses who have already taken in foster children,” Alexandra Volgina told Kommersant. “People did the best that they could to work around the adoption ban: arranging it under their parents or a healthy spouse. No problems have occurred with these children.” According to her, about 600 people have signed a proposal allowing people with these diagnoses to adopt.

“Cancelling the ridiculous ban is absolutely the right decision,” says Lyudmila Petranovskaya, a psychologist of social order for the Development Center. “Currently, the law does not even allow people living with HIV to adopt children who also have the same diagnosis.”

“If the Ministry of Health believes that the diseases of the adoptive parents are not a danger for adopted children, then this option will be considered,” said Alexey Levchenko, a spokesman for the Deputy Prime Minister for Social Affairs, Olga Golodets. He recalled that in February 2012 the government implemented a decree authorizing adoption rights for people receiving treatment for stage I and II cancer. “Thus, this new initiative is in line with recent decisions of the government,” concluded Levchenko.

Томск

Tomsk is one of the oldest cities in Siberia and is home to about half of a million people.

This city and region is also home to one of the world's worst epidemics of multi-drug resistant Tuberculosis. Because EVA addresses not only HIV, but also other socially significant diseases such as  TB, this region and the work being done there is crucial. Tomsk suffers high rates of intravenous drug use which fuel the spread of diseases like HIV and TB. Patients who are co-infected with HIV and TB face a difficult road to restored health. TB treatment can take years to complete and often involves a period of clinical isolation and a daily cocktail of TB medication. Those with multi-drug resistant TB (MDR-TB), or in some cases drug-resistant TB (XDR-TB), face the uncertainty that any treatment will effectively cure them. When you add HIV to the mix, treatment regimes and side effects become more complicated and difficult to deal with.

Partners in Health has worked in the Tomsk region since 1998 addressing TB and MDR-TB. One of the greatest challenges is adherence to treatment. When patients have gaps in treatment, strains of the disease develop resistance to certain medications, fueling the growth of MDR and XDR TB. Partners in Health works to improve adherence especially among vulnerable populations such as the homeless, those in poverty, and those with substance abuse problems. Their work is proof that elimination of a disease and putting the breaks on an epidemic starts not with integrated members of society, but with those who are often ignored and rejected from our everyday lives. If we can learn how to educate and cure these people, then certainly we can reach our friends, our co-workers, the man in the grocery store or the woman working at the bank.

Take a look at their work here: http://www.pih.org/country/russia/about

This year EVA received a grant from StopTB which is being implemented by my friend and colleague, Natasha. As a Tomsk native and former employee of Partners in Health, her experience and knowledge about TB and evidence-based methods in addressing this disease are unparalleled. As EVA seeks to reach women suffering from HIV/TB co-infection we are investing in outreach to vulnerable groups in society. And, as a network organization, our work spreads beyond the Leningrad region and across most of Russia.

A recent report done in Tomsk showed a rapid increase of HIV infection rates during the 2013 year. In 2012, 338 cases of HIV were newly diagnosed. Within the first three months of 2013, 372 new cases were diagnosed. 82% of these individuals were intravenous drug users. These numbers are a red flag for those working in the sphere of HIV. While the rest of the world has stabilized or decreased their rate of HIV growth, Russia's status as the country with the fastest growing rate of HIV in the world isn't about to go away anytime soon.

The facts are grim. And while we would all love to see TB and HIV go the way of guinea worm (thanks to the Carter Foundation!), eradication seems like a distant dream. All the more reason to invest. Even if adherence among the general population and, especially, vulnerable groups, it difficult - it is possible.

A EVA member and friend is proof of this. A former drug user who was co-infected with HIV & TB, this gentleman somehow defied the odds and survived addiction, TB and HIV. While he will forever take HIV treatment, he lives a healthy life as an advocate and testament to the power of investment. This is why we do what we do.

Because I Said I Would

"The sun finds a way to shine into even the deepest parts of the forest.  

It is a metaphor for all of us who are working to restore hope and 

dignity around the world. 

In the history of the AIDS response there have been, and still exist, many 

obstacles to overcome but our path is clear—we work together to get results 

for all people. 

To the millions who have come together with compassion and determination, 

we say, your blood, sweat and tears are changing the world." 

-Introduction to the 2012 UNAIDS World AIDS Day Report

I've had many conversations during my first three months in Russia about why I am here and about the sustainability of my work. It is a question I often asked myself during my summers in Ukraine and a question I continue to ask myself today. It takes no stretch of the mind to understand that great need exists within this country and within this region. Local NGOs need continued international support and collaboration despite current political difficulties. NGOs need long-term employees and volunteers to invest in their work. Women need effective health care and social services that will meet them where they are at. Whether they are career women, mothers, sex-workers, or drug-users; they need a system that will not discriminate, that will not make access to health services an obstacle course; they need a system that will treat them with dignity. Children need education. They need to know how to lead healthy lifestyles, how to live and interact with those that are different than them; they need to know that they have the power overcome cycles of poverty and substance abuse. Children need families - whether they be biological, traditional, adoptive, single-parent, grandparents, or made up of peers - this love and support is crucial to their development.  

While this might be a simplification of the many complex issues Russia and Eastern Europe face, no one can deny that these needs exist. So then how am I any more qualified to answer them than the next person? Truthfully, I'm not. Certainly language proficiency and regional experience give me a slight edge, but it definitely doesn't mean that I have any answers. My goal is not to give answers to the complex problems that have existed with Russia for decades, if not centuries, but rather to learn and support existing efforts. While my learning has been exponential, it is still only a drop in the bucket of all there is to understand. 

Beyond my recognition of need and my desire to engage these issues in order to better understand them, I am here because I said I would be - and I don't take commitment lightly. After my first summer spent in Ukraine, I felt as though I had been given a beautiful and rare glimpse into a culture and region that I previously knew very little about. Not to mention falling in love with every single one of the children in the orphanage. I knew that I was not done with Eastern Europe and that Eastern Europe was not done with me. And I still feel that way. I have made a commitment to invest in this work and in this region for at least part of my life. This is that part of my life. 

my capability stretches only as far as my understanding

Having spent each summer during my university years working in orphanages throughout Ukraine, I’ve seen my share of children’s homes. Every facility is different - from the buildings themselves to the style of care provided. As predominantly social orphans, these children carry emotional/psychological trauma, feelings of abandonment, and mental conditions stemming from fetal alcohol syndrome and/or chemical dependency. With the rapid spread of HIV and other socially significant diseases throughout Russia and across Eastern Europe, there are now a growing number of children who face a life, not just of emotional damage, but also life with a chronic disease.

The baby orphanage is located just outside of Saint Petersburg’s city center and focuses its care on children 5 days to 4 years old. All of these children were born to HIV+ mothers and were exposed to infection during pregnancy. Some will be HIV+ while others may have escaped infection. Often, their mothers are drug-users, which exposes them to a range of other issues including Hepatitis C, premature birth, and chemical dependency. Mothers or other family members bring these children to the orphanage, but most often the babies are left in maternity wards and at just five days old are transferred there. They live their first four years within the baby orphanage, the only HIV+ baby orphanage in all of Saint Petersburg. After this age, they go to a different orphanage within the city depending on their HIV status and mental/physical condition.

Having been denied access to the orphanage as volunteers, an interview with Dr. Slava, the main doctor of the baby orphanage, was organized. This interview would allow us to gain insight into the services of such an institution as well as develop our understanding of the challenges facing HIV+ children.

I confess I had some bitterness in my heart after the orphanage director said we were not allowed to volunteer, and I assumed a rather pessimistic view of the whole institution. Instead, what I discovered was a truly incredible facility that put all of my expectations to shame. Dr. Slava met with us for about two hours – answering our questions and taking us on a tour. The orphanage has a small pool, an infrared sauna, a salt room that helps with breathing/lung health, a psychotherapy room, and a story room. Children are on a daily rotation between the facilities and receive more focused attention during this time. While Dr. Slava noted that adoption is truly the best option for these children, they will most likely receive better medical care if they stay at the orphanage – a fact I certainly do not question. The structure of the HIV orphanage allows for constant monitoring and special medical support, as many of these children are affected not only by HIV, but by other medical issues as well.

Despite strong medical support, there is still the question of social support. The average child shares their parents with only a few other siblings, while at the orphanage, 15 children must share just one teacher and one assistant. Not only that, but living within a system where everything is brought directly to you – from food and clothes, to doctors and peers, there is little understanding of decision making and the basic life skills needed outside of the orphanage walls. As Natalie and I partner with EVA to develop the children’s project, our focus will not be on the physical needs of orphans, as these needs are generally well met, but rather on developing social programs that teach and challenge these children so that life after the orphanage is not a constant struggle for survival.

In 1996 Dr. Slava was working in a general hospital and noticed an increasing number of HIV+ children being born. At this time there was no proper facility for them, and so, if abandoned by their parents, they were left to live within the hospital walls. Realizing the growing need for an orphanage designed specifically for HIV+ children, Dr. Slava helped establish the baby orphanage. The orphanage currently houses 150 children who were born to HIV+ mothers. All children are provided with treatment depending on their HIV status and rehabilitation for those born with chemical dependency.

Current statistics show 300 HIV+ children living within Saint Petersburg, 140 of which are orphaned. A number of these children have been adopted, and others participate in the Russian foster care system, but in general, rates of adoption are extremely low. One of our key questions was how to tackle the overwhelming issue of stigma and discrimination that exists towards HIV+ people within the Russian Federation. Dr. Slava’s response was to ask our translator what she knew and thought about HIV/AIDS. She responded simply that it is dangerous and should be feared. Case and point – the population we are working with is uneducated. In all honesty, I was largely uneducated before joining EVA. While I cannot say that I wish HIV upon myself or anyone else, I can say that I do not live in fear of HIV, and I have no paranoia around contracting HIV while in Russia. I am educated, and I have the resources to protect myself.

So then what does life look like for the majority of these children who will not be adopted nor will enter the foster care system? Their future is certainly unknown. The oldest among these are in their early teens and live in different orphanages throughout the city. They will be the first youth in Russia to grow up with HIV and to graduate the orphanage system. How will they be prepared to enter the world - to independently monitor their own HIV treatment, to live as adults within a culture that does not accept them? As a believer in education as opportunity, I think much depends on their current orphanage. Those that have HIV, but live with no mental disabilities (namely fetal alcohol syndrome) are able to attend regular public school. Of course they must keep their HIV status closed to protect them from discrimination, but a chance at an education means a chance at a future. For those that live with not only HIV, but who face mental challenges as well, the future is not so bright. They are educated within orphanage schools, meaning they do not receive an equally rigorous or respected education.

The orphanage in Ukraine, where I first began my work in Eastern Europe in 2008, also housed children who were labeled as mentally disabled. While many were born with fetal alcohol syndrome, the levels of disability ranged greatly despite being grouped under the same umbrella. Some children had visible challenges and learning disabilities, while others experienced more emotional effects. Regardless of the level of their disability (and in may cases I questioned that they had any level of disability), they were educated within the orphanage school and not a regular public school. Without a respected education and with the label of “mentally disabled” on their medical documents, these children would face a challenging future with little opportunity of a sustainable career or aspiration. For those children at the baby orphanage who also find themselves labeled as “mentally disabled” they will have to fight the stigma of HIV, the stigma of their mental condition, and life without proper education. It is easy to imagine the perpetuation of poverty and substance abuse in their futures.

Our interview with Dr. Slava was, on some levels, encouraging, especially knowing the level of medical care these children currently receive. On other levels it was rather disheartening. While we knew volunteering on a weekly basis was not a current option due to the political climate, we wanted to know the ways in which we could help the orphanage and the system as a whole. Expecting requests for things like clothes, donations and technology, I was surprised to hear that the most needed support was for the HIV+ mothers of these children.

These children live within a flawed system. Money can give them excellent medical services. Money can give them some sort of education. Money can give them psychological support. But, money cannot give them a family. While the baby orphanage does its best to socialize these children and expose them to the real world, there are some elements of childhood development that are only found within the home. Even if Natalie and I were able to volunteer on a regular basis with these children, it is only a grain of sand in the spectrum of their life experiences. What is needed most of all, is to prevent mother to child transmission of HIV in the first place. If HIV+ women understand the resources available to them and feel that they can access them safely, comfortably, and without any discrimination, then the chances of passing HIV to their children dramatically decreases. Whether they are drug users, sex workers, or exist within other vulnerable groups, these women need to be reached and supported. Their education is a real and sustainable answer that does not simply put a band-aid on such a deeply rooted issue.

I am not Russian. I am not an orphan. I am not HIV-positive. I know that my capability stretches only as far as my understanding. As I daily seek to develop that understanding through E.V.A. and through Sunergos, honest conversations with experts such as Dr. Slava are crucial. While there is no easy answer and no simple fix, it is important to know that the work we are doing through E.V.A. a key piece within the holistic solution of this issue. We will continue to partner with E.V.A.’s efforts to reach these HIV+ women within society’s margins, participating in test and treat events, awareness campaigns and developing the infrastructure and funding that make this work possible. We will also continue to build our Children’s Project, which seeks to improve social programs for HIV+ orphans, decrease stigma and discrimination, and encourage in-country adoption.

If we can find these women and children, daily invest in their lives and in the organizations which serve them, then perhaps we can truly begin to slow the looming crisis of HIV in Russia.

PS - We've been invited to return to the orphanage in May to meet the children and spend some time with them!

Today I miss Ukraine. I miss the children who will always be my children.