My HIV Education Mission to Russia
As the plane begins the final approach to Moscow, it begins to feel real.
This trip is such an important one for me. I am coming home to Russia after two years, and this visit will be very different than my last. I am here as an ambassador for the global health organization Population Services International, or PSI, representing their local program. It's my second trip with PSI—the first was to Haiti, where PSI provides the most basic health needs in a country devastated by poverty.
Russia is very different.
I will be meeting young people in technical schools, youth centers and on the streets. Those most at risk here are injecting drug users, sex workers and men who have sex with men. Young people may initiate drug use as early as age 12 to 14, and the first use of injected drugs can be between the ages of 14 to 17. I'll visit PSI programs that focus on targeted HIV prevention and drug use for the most at-risk.
Watch Anna discuss her life-changing journey
At the early stage of the HIV epidemic, 80 percent of HIV infections came from using contaminated needles and syringes. The figure is now 69 percent.
Our goal here is to reach young people before they begin using drugs, to educate them, to give them the tools they need to make healthy choices. For those at most risk, the programs are targeted. I'll talk to you more about that later.
I have been back to Russia many times over the years for either tennis or personal reasons, but on this trip it suddenly feels like a completely different country to me. I am armed with all of these new facts and statistics, and they are all hard to believe. I hope that I can make a difference in these kids' lives and that my voice will be heard. I am really nervous about what lies ahead and what I will find.
Once we arrive at the airport in Moscow, I connect with a small group of people who will be joining me on the trip—people who contribute to PSI's programs financially and who, like me, are here to find out what else we can do to support the work and make a difference. We are headed to Yekaterinburg—Russia's third-largest city and a place I have never visited.
When we arrive, I am really impressed with the airport in Yekaterinburg. It's clean and new and really easy to get around. We are greeted by the staff and taken to our hotel, and then it's right to bed for me—we have an early start tomorrow and I want to be well rested.
A program keeping Russian mothers off drugs
I had a hard time sleeping last night. I am anxious about what I will learn and see and what we will be able to do to change it.
In the morning, I get a brief in the car on the way to one of five PTUs (a PTU is like a technical school for kids just out of high school) where PSI is implementing prevention programs.
Yekaterinburg is a pretty city, but it's a city on the drug trafficking route from Asia and Afghanistan.
One thing I really love about PSI's work is the research behind the programs. Of the injecting drug users they reach through their programs, they have found that 65 percent had spent some time studying at a PTU, so that's why they focus on reaching kids in the PTUs. Smart, right?
We pull up to a dorm, and I go inside to meet with a small group of new mothers. This is the only place in the region that new mothers from low-income backgrounds (orphans, etc.) can come where they can study and where their babies can be with them.
All of this is very emotional for me. Many of these girls had no idea about their reproductive health, and most didn't even know they were pregnant. They are at risk of becoming statistics, so this program gives them a chance to learn a skill and support their children with help from the nurses and caretakers at the facility. The work here is all about empowering people to make healthier choices and take control of their lives. I really love that.
I ask one young mother what she hopes for her son—an athletic, happy 11-month old who smiles at everyone. She hopes he will be healthy and happy and knows it's her job to help him develop and give him the support he needs. Hearing that, I know they will be okay. I know that she gets it.
While the stories of the women are difficult, there really is hope. And, the programs to reach them are working. We just need more of them.
Meeting more inspiring kids
The place is a hopeful place, somewhere young people want to be—this is where they hang out. It's what Spartak Tennis Club was for me when I was growing up in Moscow. It's smart, because they are there by choice and the information they receive about HIV and drug use is done in a very natural, open and nonthreatening way. Something we need more of in Russia (and everywhere, for that matter).
My next stop is at another PTU, where we will officially launch the youth center program. We are greeted by kids who are rapping. It's so amazing. They are really good, and I don't want to leave. I ask them to sing another song and a crowd of students gathers. It's a highlight of my day, and it's really cool to see them using their talents and being so creative.
I take a quick tour and head upstairs for a panel discussion and press briefing. I am a little nervous, but the remarks are well received and my fellow panelists are smart, dedicated people. I am glad to see a lot of press here. Hopefully, we have sent a clear message about the importance of these programs.
In Russian tradition, we go outside and plant a tree. I love this tradition. It represents a new beginning and hope for the future.
We join the kids in the cafeteria for lunch and to talk more. As I spoke to some of the kids at lunch, they were truly inspirational. I could see the fire in their eyes and the desire to improve their lives.
As we get ready to leave, the DJ plays a song by Enrique, and the kids start to rap again. They know that his music draws my attention. Pretty smart of them, right?
We say goodbye and head for the van.
I get a couple hours of rest before I head out for the mobile outreach program for injecting drug users. It's a van that has built-in shelves for clean needles, testing equipment, condoms and a small table for counseling. The van shows up at the same place every day so people know where to come.
Trying to end the stigma of HIV testing
We first meet with a 23-year-old woman who has come for clean needles—the needle exchange part is not funded by the United States, but by the Global Fund, and funding for this component is running out. The woman tells us she used to attend a PTU (I think about the kids I met today, some of the young mothers, and how any one of them could be this woman), but had to quit because she had to get a job to support herself. It's then she started using drugs. She has a boyfriend—he is in prison and she tells us she is waiting for him to get out. She has a hard edge to her and she seems visibly uncomfortable with our presence and our questions.
She tells us she's HIV positive and that she actually got her results in this van from the counselor some time back. She comes here regularly for support and for clean needles. She uses 2 grams a day, which costs about $66. The average monthly income in the region is $300 to $500 a month. When asked how she supports her habit, she doesn't answer. Many turn to sex work or petty crime or whatever they have to do to support their habit. It's really heartbreaking.
Next, Ivan comes in, a very thin, quiet, but confident man. He knows everyone who is gathered around the van and moves in and out of the van regularly. He is a peer educator. Ivan used intravenous drugs before prison. After being released, he started using intravenous drugs again. He knew of the program because he came to the van for clean needles and to get tested. He's also HIV positive.
He's clean now, and he helps other users get the help they need. He's really an inspiration. He's got a girlfriend—she is also HIV positive. They hope to marry and dream of a family someday.
The situation for those addicted to drugs is difficult here. There's no rehab mentality in Russia, and people have a hard time getting ARVs (AIDS drugs) until they are clean, so most people who are infected move quickly from HIV to AIDS because support services don't really exist for injecting drug users and it's nearly impossible for them to quit on their own. Methadone is not legal here.
I decide to get tested in the van. It's important and something everyone should do regularly. Here it's a pinprick to the finger and the counselor draws blood and the results come back in 20 minutes. She can test for HIV and hepatitis. The clients know they can be confidentially tested. If the results are positive, she works with them to provide case management. She also works at the clinic, and for those newly infected, she walks them through the process herself.
The last man who comes in is tall, very matter of fact and he smells of cigarettes. He says he will answer whatever we ask. Heroin has clearly had its affect on him, and there is a layer of pain and hopelessness between us. He tells us he uses with his wife. He is 29; she is 23 and has been using since she was 19. He doesn't see a reason for him or his wife to stop using unless she gets pregnant.
I ask if he is tested regularly, and he says they know their status. In Russia, it's still very difficult to talk about your HIV status due to fear of discrimination; I understand it.
We ask him if he has ever overdosed. He has not, but he tells us of two friends who recently did. One died, but the other was saved thanks to Naloxon. It's an overdose medication PSI provides at the mobile outreach. It costs less than $1 per shot and saves lives. The clients receive the drug for free.
After we leave the mobile outreach, I go back to my room and have to be by myself for a while and let this all sink in. The reality of it all is very intense and emotional.
Tomorrow I have another day ahead of me...
It's an early day today. I leave the hotel at 4:30 a.m. for the 7 a.m. flight from Yekaterinburg to St. Petersburg and hour-and-a-half drive to Gatchina.
Gatchina is a quaint town on the outskirts of St. Petersburg with a beautiful palace that was a summer house for Tsar Pavel I. But as nice as the town is, I am not here to tour the palace or see the sights. I am here to see PSI's work with partner organizations.
During my morning brief, I am impressed to find out that PSI is working so closely with USAID, other organizations and the local government to provide the best services and information to young people. This information gives me hope.
My first stop in Gatchina is a panel discussion with several officials from St. Petersburg and Gatchina. I feel more prepared at this panel discussion. Yesterday, I met adults who are using injecting drugs and are HIV positive. I have heard their heartbreaking stories. I have also met kids full of life, benefiting from programs that teach them important life skills. I'm ready to tell their stories.
Gatchina is actually the site of the first "Youth Center," which was housed in the youth medical center and local schools in the fall of 2007 and targets kids ages 11 to 18. What makes this so special is that healthcare and medical providers also work with families. Parents can receive one-on-one support or join a group of other parents who want to support each other in better communication and parenting.
After the panel discussion, I join a group of very special and talented kids in a very small room, packed with people. In front of me is a group of deaf and hearing-impaired youths. And they are quickly preparing an improvisational skit for their eager audience about HIV. The activity helps educate deaf children about making healthy choices. Through acting, they learn about important topics like safe sex, getting tested for HIV, being faithful and honest with your partner—all in an interactive, fun and positive way.
Deaf children in Russia are often stigmatized, and those who have HIV bear the burden of a double stigma. Even more concerning is they often lack access to reading materials that educate them on living a healthy life. The program I'm visiting provides these educational materials (they are developing comic books that will address HIV, drug use and healthy choices) along with a support network and a nurturing, healthy environment.
The skit is a highlight for me, and the PSI peer educator is one of the best, most animated and positive kids I have ever met. I am super impressed. Again, I have hope.
Next, I go right next door to a medical center, where I meet with another group of kids who benefit from counseling services. They are well adjusted, they have dreams and goals, and they are not at all nervous to talk in front of their friends (or the dozen or so adults in the room).
Natasha, 11, told me she wants to be a doctor. Andrei, 16, says his dream is to be a politician. And Sergei, 12, talked about his love for music. Hopefully this will be a constructive part of life like tennis was for me. They see their future ahead of them and they don't plan to let drugs or alcohol get in the way of their success. This program is a perfect example of success.
I'm back in St. Petersburg now and have an hour or so to rest.
I knew my next activity would be tough—but not this tough
We all pile in the van and travel to the center, which serves as a clinic, a dining hall, a youth center, you name it—all in three very small rooms. We all sit down in a tiny room and meet about 10 kids between the ages of 13 through 19. Most live on the streets or in abandoned buildings or hide away in attics and basements. Nearly all of them struggle with injecting drug use, but some are now clean.
One of the boys I met, Maris, gave me hope. He had this tenderness about him and a genuine smile. He was also a natural salesman. He even asked for my phone number. It was hard to imagine that he started doing drugs when he was 14. At his lowest point, he was living in a condemned flat with a few of his friends doing 5 grams of heroin every day. He got involved in the street youth program gradually. At first, he just went there to eat and shower. Then, he started a rehab program. He relapsed but got clean again. And he became a student at the "mobile school."
Maris now volunteers at Humanitarian Action's center. He just recently got the documents necessary to rent an apartment, which he shares with a few other people. Meanwhile, Maris has one of the most important jobs at the street youth program: He recruits new kids to join the program.
The next person to share her story with us was far less hopeful—a young girl, who did not tell us her name. She was there with her two children. Two baby girls, one about 18 months and one who is just 2 months old. They live on the streets. Her story is incredibly painful. An orphan, she wandered the streets, using drugs, doing whatever she had to in order to survive. She got pregnant and had a baby, and the baby became very, very sick. The baby was taken from her and brought to a hospital, then another and finally was placed in an orphanage. She followed her child from hospital to hospital but was not allowed in. She told us that when her baby was finally taken away from her, she didn't want to live anymore. She would later give birth to the two girls we met at the center.
She doesn't know who any of the fathers are and didn't speak of the circumstances of her pregnancies. I know that sexual violence is a painful part of life on the streets for young girls. We don't press her for information, partly because we don't want her to have to relive it and partly because maybe we are afraid to hear what happened.
I see Wendy, my friend and a new mother herself tearing up. I fight back tears. I don't want to cry in front of the girl—I won't—so I excuse myself for a few minutes. Standing outside in the cold, the floodgates open. I imagine their lives. Her, a single mother living on the streets, no family, no home, no food, nothing...and those two beautiful girls being raised in such a difficult situation. It's hard for me to walk back in, but I do.
Back at the hotel, I can't stop thinking of the girl and her children and the many girls I have met on this trip. I won't sleep at all tonight.
Going to St. Petersburg
I am still thinking about the young mother I met last night and her two baby girls as we head to the ribbon-cutting ceremony. I wonder where they slept last night and if they have had anything to eat.
Today we are officially launching the District's Youth Social Center project. I'm honored to be participating in the ceremony with the District's Vice Governor Ludmila Andreevna Kostkina and U.S. Consul General Sheila Gwaltney. Both very impressive women dedicated to helping young people in Russia.
Just to give you a little background, there are five Youth Social Center locations in Admiralteisky District in St. Petersburg. They all work to provide healthy, positive alternatives for young people. These centers prevent kids from getting into alcohol and drugs, which can lead to addiction problems, HIV and other life-threatening illnesses.
The center I get to visit is a truly welcoming place for kids of all ages. It's equipped with rooms for studying and one-on-one counseling. It has separate, comfortable activity spaces for the youth and families and younger kids. I was also really inspired by the women who run the facility. They take such pride in the safe environment they have created for their kids. You can tell they really love what they do.
After the official ribbon cutting, I tour the center. I walk into a room, more a safe haven, someplace fun and special for orphans. I jump on the floor and start playing with four children. One of the younger girls I meet hops into my lap while we're talking, and suddenly I find myself at the bottom of a mound of cute, laughing kids with giant bows in their hair! The atmosphere of the room is magical and playful, right down to the disco ball that hangs from the ceiling above us.
In the youth and family activity room, it is equally energetic as we have asked press to come. But I get a chance to talk with the teenagers here first. They are at the age when Russian youth start doing drugs. I mostly just listen to them. One boy, dressed kind of punk with orange hair, asks me what I think of his hair. I tell him to be himself. He smiles and so do I. My message to all the kids is to be an individual; to surround yourself with healthy, active friends and family; and to never feel scared to ask for support from the counselors at the center and never be afraid to ask questions. The kids pile in behind me and together we address the press.
There are many things about this center that remind me of the tennis club where I spent much of my childhood and teenage years. The club was a family and a community, and it helped me to have confidence in myself, stay focused and be the person I am today.
In the van again and off to another panel discussion. These are great. I learn from my fellow panelists, and I bring the stories of the young people I meet. Together, it's a great message we deliver. Facts, stats, stories and hope.
An inspiring performance
For those of you who don't know about Parkour, it looks like a mix of gymnastics and dance, where the performers use skills like jumping, climbing and flipping. It is mostly practiced in urban areas, so you use buildings, rails and benches as apparatus. It is very cool.
I even get to participate in part of the warm-up and training. Well, the kids are doing most of the training. I just help with the warm-up.
Parkour is really an excellent exercise for your body and spirit. Like most sports, it helps developing coordination, strength, endurance, self-awareness and self-esteem. PSI will pair this activity with HIV education and helping kids learn skills to make healthy choices that will last a lifetime.
All in all, more than 20 kids from the Youth Social Center participate and then get passes to another Parkour show and to participate in training classes—such a great and creative alternative to time spent on the streets.
It's time to speak up for the people I've met
Today is the last official day of my trip, and probably the most important. Today I will participate in a press conference at the famed ITAR-TASS. It's a global news agency like Associated Press or Reuters—the fourth largest in the world and Russia's official news agency. So you can imagine the pressure I feel to convey all of the incredible stories I have heard and seen this past week.
I have been, in a sense, practicing for this press conference since the first time I spoke on a panel discussion in Yekaterinburg, which today seems like months ago. I don't yet consider myself an expert. But I have learned so much in the past week that I'm confident I can represent the people I have met and speak with my heart. My job will be to bring to life the issues facing youth in Russia. To speak for Irina and Natasha and Maris and the young mother who wouldn't share her name.
Sitting on the panel with me today are Jonathan Kamin, acting mission director for the Russia Mission of USAID in Moscow; Michael Grishnakov, State Duma deputy; Michael Gorbachev, country director for PSI Russia; and Elena Arutyunova, a director at PSI Russia. Our focus is on collaboration of government, business and nonprofit organizations in addressing the health challenges facing youth and vulnerable groups in Russia, and here in my home country, it's very important to have government support.
Nearly 20 new outlets are at the press conference—the most I have interacted with yet. They ask me a variety of questions, from whether I intend to rally other tennis professionals (my friends) to join this cause to whether I would accept a position as health minister of Russia if I were offered it.
I stay focused on the task at hand, letting the public know that HIV is a growing issue in Russia, that most infected are infected through injecting drugs and the population at greatest risk are Russia's youth. And, that there are proven programs that work, that partnership is the key—working with other nonprofits, international donors like USAID and in collaboration with the Russian government—each learning from the other, each teaching the other. I am pleased with how the press conference goes and with the response we have received. I am so honored to have been able to represent PSI and the many people it helps.
Time to say goodbye
Meeting with Ambassador Beryle is an honor. I was struck by his sincerity and interest in everything I had to say. As a token of my appreciation for meeting with me, I brought him one of my favorite childhood toys, Cheburashka—a Russian animation character and also a mascot of the Olympics in Russia.
From the Embassy, I went to the U.N. House to take part in a peer education session and reception. Joining me was Alexey Vorobyov, a Russian actor. I met with about eight kids—some of the most confident, intelligent young people I have ever seen. I was proud to see two of the PSI peer educators among this select group of kids. They were fantastic. I watched as they put together an improvised skit on HIV and then perform it for leaders of different U.N. agencies and the media.
These kids are future leaders of their country. It was the perfect way to end my trip, filled with hope and promise. Saying goodbye...
That evening, I shared a meal with my new friends from PSI Russia, the team from PSI in Washington, D.C., and the individual supporters who joined me on the trip. It was filled with a lot of tears, laughter and hope. Most of all, I am grateful for the chance to be part of an organization that is finding effective ways to reach young people and empower them and for being able to speak for all the young people I met along the way.
I feel like I am leaving Russia a stronger person than when I arrived a few short days ago, and more dedicated than ever.
I hope you will learn more about PSI at PSI.org. For as little as $10, PSI can help protect and educate a young person from HIV for an entire year.