SCIENCE sciencemag.org at [Western] Europe or the United States, I don’t understand why it’s so different here.” For Katia, the differences between east and west would soon become far starker. Since 2015, the World Health Organization (WHO) in Geneva, Switzerland, has recommended treating everyone who tests positive for HIV, but doctors—despite what the literature suggested—assured Katia her immune system hadn’t suffered enough damage to warrant antiretrovirals (ARVs). Two years later, Katia was married to a new partner and wanted to have another child. She had read on social media that HIV was a scam by Big Pharma, but that made no sense to her because the government promises free treatment. Other sites said proper treatment would almost eliminate her risk of transmitting the virus to her husband, who was uninfected, or their baby. She went to the AIDS center and requested ARVs. “They told me, ‘Don’t worry, your level of virus is low, you won’t infect your husband, he’s in the military and he’s strong.’” Finally, in February 2017, after more than 2 months and a battery of tests, the doctors agreed to treat her, and in May, she became pregnant. In June, the pharmacy ran out of ARVs. Through social media, Katia contacted an HIV-infected woman, 2000 kilometers away in St. Petersburg, who was part of a “reserve pharmacy”—a network that gathers and redistributes ARVs from people who have either switched treatments or died (see sidebar, p. 1174). The woman told Katia whom to contact in Yekaterinburg. “I asked how much the pills would cost,” Katia says. “She was like, ‘Are you out of your mind? Just go and get your pills.’” Almost anywhere in the world, an HIVinfected woman who has an uninfected partner and wants to have a baby would be first in line to receive ARVs. The challenges Katia faced in getting treatment amid Russia’s epidemic highlight the country’s faltering response, which critics have blasted as misguided, lackadaisical, and downright dismissive. Some federal health officials even question the term epidemic. “This is a very large and very serious epidemic, and certainly one of the few epidemics in the world that continues to get worse rather than get better,” says Vinay Saldanha, the Moscowbased regional director for the Joint United Nations Programme on HIV/AIDS (UNAIDS) in Eastern Europe and Central Asia. “This is a public health crisis.” Yet the informal network of HIV-infected people that ultimately supplied Katia with ARVs highlights another, less recognized side of Russia’s response. The darker the night, as Fyodor Dostoevsky wrote in Crime and Punishment, the brighter the stars. Bold, committed HIV/AIDS advocates in Russia are pushing hard for change—and a few places in the country show signs, albeit modest, of mounting effective responses.

中文翻译：

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身份的象征

[西] 欧或美国的 SCIENCE sciencemag.org，我不明白为什么这里如此不同。” 对于卡蒂亚来说，东西方之间的差异很快就会变得更加明显。自 2015 年以来，位于瑞士日内瓦的世界卫生组织 (WHO) 一直建议对所有 HIV 检测呈阳性的人进行治疗，但医生——尽管有文献表明——向 Katia 保证她的免疫系统没有受到足够的损害，需要抗逆转录病毒 (ARV) ）。两年后，卡蒂亚与一位新伴侣结婚，并希望再要一个孩子。她在社交媒体上读到 HIV 是大型制药公司的骗局，但这对她来说毫无意义，因为政府承诺提供免费治疗。其他网站表示，适当的治疗几乎可以消除她将病毒传染给未受感染的丈夫或孩子的风险。她去了艾滋病中心并要求获得 ARV。“他们告诉我，'别担心，你的病毒水平很低，你不会感染你的丈夫，他在军队里，他很强壮。'”终于，在 2017 年 2 月，经过 2 个多月和一个电池测试，医生同意对待她，并且在五月，她怀孕了。6 月，药房的 ARV 用完了。通过社交媒体，Katia 联系了 2000 公里外圣彼得堡的一名感染 HIV 的妇女，她是“储备药房”的一部分——该网络收集并重新分配来自已转换治疗或死亡的人的 ARV（见侧边栏，第 1174 页）。女人告诉卡蒂亚在叶卡捷琳堡联系谁。“我问药丸要多少钱，”卡蒂亚说。“她就像，'你疯了吗？去拿药吧。'”几乎在世界任何地方，有一个未受感染的伴侣并希望生孩子的 HIV 感染妇女将首先接受 ARV。在俄罗斯疫情期间，卡蒂亚在接受治疗方面面临的挑战突显了该国的反应迟缓，批评人士称其为误导、懒惰和彻头彻尾的不屑一顾。一些联邦卫生官员甚至质疑流行病这个词。联合国艾滋病毒/艾滋病联合规划署驻莫斯科的区域主任维奈萨尔达尼亚说：“这是一场非常大和非常严重的流行病，当然是世界上为数不多的持续恶化而不是好转的流行病之一。” （联合国艾滋病规划署）在东欧和中亚。“这是一场公共卫生危机。” 然而，最终为 Katia 提供 ARV 的非正式 HIV 感染者网络突出了另一个，俄罗斯回应中不太为人所知的一面。正如陀思妥耶夫斯基在《罪与罚》中所写的那样，夜越黑，星星就越亮。俄罗斯大胆、坚定的艾滋病毒/艾滋病倡导者正在努力推动变革——该国的一些地方显示出采取有效应对措施的迹象，尽管幅度不大。