Russia had its first official case of HIV in 1986, a time in which the "gay cancer," as it was then sometimes called elsewhere, had already reached epidemic proportions in some other countries. That case - the result of a man who had contracted the disease in Africa and then spread it to some 15 Soviet soldiers with whom he had had homosexual relations - was presented at the time as a freak incident and the result of a corrupt lifestyle.

Through the 1990s, rates of AIDS and HIV infection crept gradually up in Russia and the rest of the former Soviet Union, a combination of increasingly porous borders, loosened sexual mores and lack of knowledge about the disease. Then, in the later half of the decade, infection rates began to skyrocket. In 2000, Russia had about 70,000 registered cases of HIV - twice the level of the previous year. And that is only registered instances of infection; that year, the World Health Organization estimated that, all in all, some 200,000 people in Russia were infected. The vast majority of these people were IV-drug users infected by using shared, unhygienic needles.

Many specialists say that now, 16 years after the disease first reared its head in this country, Russia and the rest of the former Soviet Union are poised on the edge of an epidemic. Russia now has the highest rates of increase in HIV infection in the world, Arkadiusz Majszyk, UNAIDS­ representative in Russia, went on record as saying in 2000. More than 100,000 new cases were reported in Russia last year alone, bringing the estimated official total to approximately 182,000, according to the BBC. Doctor Vadim Pokrovsky, head of Russia­s anti-AIDS program, recently proffered an even more disturbing statistic; he estimated the true number of HIV-positive people may be as high as 1 million - about one in every 150 people. The situation in Ukraine is estimated to be even worse, with an infection rate of one in 50.

Pokrovsky did not mince words when it came to describing the scale of the problem. He recently made the claim that Russia risks "catching up with certain parts of Africa, where about 30 percent of the population are AIDS patients."

This is an alarming thing to hear. Sub-Saharan Africa is the AIDS center of the world, where the disease has been much more destructive than in the relatively lucky West, where its ravages have by and large been limited to specific sections of the population: IV drug users, male homosexuals, hemophiliacs. Moreover, especially with recent advances in medical technology, Western countries have been better able to afford the tremendous costs involved in caring for HIV-positive patients or those with full-blown AIDS. In Africa, on the other hand, whole countries are being devastated by the disease, and the long-term effects of the ravaging of the population - decreased economic viability and the burden of millions of orphaned children - are expected to be felt for decades.

Naming Russia as a potential second Africa may have elements of scare tactics - as HIV in Africa is largely spread by heterosexual sex (and the problem is exacerbated by such cultural factors as the widespread myth in South Africa that HIV can be cured by having sex with a virgin) not by sharing of needles by IV drug users, as is the case in Russia. But the statistics are still frightening, especially considering rates of heroin addiction and the easy availability and low price of that drug.

The comparison with Africa does, in addition, bring to mind one rather disturbing factor: The effect that AIDS might play in the demographic situation. In Africa a high death rate brought about through AIDS-related diseases and other factors mostly related to poverty and lack of infrastructure - disease, malnutrition and lack of access to clean water prominent among them - also has a very high birth rate. This is not the case in Russia, in which only about half the number of births necessary to keep the population stable are taking place as is. The slight increase in number of births and dip in mortality rates reported last year are not nearly enough. This occurs at a time when many analysts are saying that the population decline in the Far East may some day seriously affect the balance of power in the region to Russia­s detriment, especially vis-a-vis China. Accordingly, even just speaking on a macro-level and disregarding the individual human pain and loss associated with the disease, the problem is one to be deeply concerned about.

In addition, the soaring infection rates will probably, even leaving to one side their tragic personal cost, pose a staggering burden to society. One million people infected with HIV would be a great load to bear for any country. And Russia­s system of health care is by and large functioning at a level far below that of any Western country. Any belief that the nation can possibly cope with a sick population that large, especially considering already rife epidemics of such diseases as tuberculosis and hepatitis and the exorbitant prices of effective anti-HIV medication charged by pharmaceutical companies, is positively delusional. Even given the greatest of good will on the part of the government, it would be a virtual impossibility to come up with the finances necessary to adequately treat every person in need - which come to tens of thousands of dollars per patient.

What is needed is some real attention and meaningful aid cast in the direction of alleviating the roots of Russia­s soaring drug problem. Russia­s drug of choice is not the relatively innocuous marijuana or even cocaine; it is heroin, of the injected variety. While Soviet estimates of drug abuse were more than likely vastly tilted toward underreporting, everyone - from a clinic specialist to someone seeing the obvious junkies in the metro - knows that the country­s problems in this area have grown vastly and may, in fact, be intractable in the short term.

One problem is that the Russian government has largely employed exclusively repressive means to curb the problem; strict sentences for drug users and/or traffickers unlucky enough to get caught and are unable to bribe their way out of the situation - who then wind up, of course, in a prison in which drug use is more than likely just as rife as on the outside.

Such measures, or relying largely on the law-enforcement agencies and judicial system to curb the problem, will likely as not go nowhere. Not only are these agencies notoriously inefficient, if not outright corrupt, the full scale of the problem mitigates against it. No one is going to be able to render Russia­s enormous border with the heroin-producing Central Asian countries impermeable, and no one is going to be able to enforce complete abstinence at the point of a gun. This has never worked; not in Western Europe, not in the United States and certainly not here.

In short, what is needed is more than just education programs and posters extolling the virtiues of safe sex and decrying the evils of narcotics abuse. What Russia requires more than anything else with respect to this problem at this point of history is an approach that addresses the underlying cause - drug addiction - and in a meaningful way. This means hospitals, rehabilitation clinics and the identification of drug addiction as at least in part a disease and not a personal vice.

AIDS is currently the fourth-biggest killer worldwide. According to UNAIDS, about 18.8 million people have died from opportunistic infections related to the disease between 1983 and 2000 - with 2.8 million dead in just that last year.