RESURRECTION

Like Russian intellectuals who came before and after him, the late nineteenth-century philosopher Nikolai Fyodorovich Fyodorov had one Big Idea. To the perennial question What is to be done? he offered a simple answer: Conquer death.

Fyodorov’s ideas intrigued generations of Russian intellectuals. Dostoyevsky wanted details: was the resurrection literal or allegorical? During his ascetic-pacifist phase, Tolstoy was impressed by Fyodorov, though mainly because Fyodorov was a vegetarian who gave away all his money and slept on a humpback trunk, covered with newspapers and using only a book as a pillow. (Tolstoy was still wearing silk underwear under his peasant smock; he envied Fyodorov’s consistency.) Fyodorov’s special appeal for writers made sense, because he loved books above all else. For him, the preservation and rediscovery of a book was a sacred task, a first step toward universal resurrection. It didn’t matter if the book was bad, because, as he put it, “behind a book, a man is hidden.”

Fyodorov was in the vanguard of the “immortality myth” that preoccupied twentieth-century Russian writers, philosophers, and scientists alike, in an era when the line between truth and fiction became exceptionally thin.

Some revolutionary-minded Russians believed that death was merely an artifact of bourgeois capitalism. Others believed that Communism would bring relief from toil, another punishment for man’s fall. In a 1921 essay called “Idleness as the Highest Truth of Mankind,” Malevich argued that if socialism was for the good of man, and man preferred to relax, then socialism ought to maximize leisure. What happened was just the opposite. Employment became obligatory, and anyone who wasn’t officially employed was a “parasite.” Soviet culture glorified workers and machines, and workers who made themselves into machines; the scale and pace of industry were inhuman.

The Soviet “industrial novels” of the 1920s and ’30s were open about the fact that utopia would be achieved only with great suffering. In Cement, for example, the hero and heroine leave their little daughter in the children’s home so that they can work full time building a cement factory. This is not a decision they regret, even when the child dies of starvation.

By the time the Soviet Union dissolved in 1991, dreams of immortality, permanent vacation, and industrial paradise were long forgotten. No one thought any longer of utopia or perfection. They hoped for freedom, and for the resurrection of a functioning society. But even these dreams were too ambitious. Hyperinflation devalued money overnight, and there were food shortages and endless lines. The educational, medical, and legal systems were in shambles. The rates of murder, suicide, and death related to drunkenness, stress, and poverty skyrocketed. While the Soviet Union had guaranteed a reasonably steady livelihood for those who followed the rules—not exciting, perhaps, not lucrative, but steady—now there was panic and uncertainty.

Many people—especially the young—looked for comfort or excitement in chemicals. The old friends, cigarettes and alcohol, had become harder to get: sometimes you couldn’t buy proper cigarettes, just long uncut cigarette rolls, and people ate squares of “marmalade,” wine so old that it had turned into jelly. But drugs had become easily available, carried across newly open borders, sold under the noses of the corrupt, dysfunctional police, or made at home from poppies or chemical precursors. Alcoholism had been the scourge of the Soviet Union and the Russian Empire before it, but easily accessible drugs were a novelty, the vice of a new world.

Since Soviet medicine preferred shots to pills, Soviet children got over their fear of needles early. The high is more intense when you inject a drug, and it’s more economical, since you don’t need as much. People shot up with old-style glass syringes, which could be used over and over, and shared them readily, as if in a parody of Bogdanov’s vision of a communal blood supply. In Russia, there were rumors that HIV was transmitted not through dirty needles but through heroin that scheming Central Asians had infected in order to wipe out the Russian people. (This didn’t stop Russians from using heroin.) Another popular conspiracy theory was that HIV was invented by American pharmaceutical companies; this stopped people from taking HIV medications when they finally became available. Some drug users knew about HIV but didn’t worry about it much. Drug addiction shortens your perspective; if you’re in withdrawal, it’s hard to think about anything but your next fix.

By the late 1990s, there was a marked increase in HIV rates among army conscripts and pregnant women, two groups that were tested routinely. Post-Soviet governments continued to do little to prevent or treat HIV and AIDS; instead, they threw large numbers of drug users into prison, where HIV spread even faster. (I once heard about forty Russian inmates injecting heroin with a single syringe fashioned out of a ballpoint pen.) Police loitered outside pharmacies, waiting to fill their arrest quotas with drug users who’d come to buy syringes.

AFTER RETURNING to New York from Siberia, I got a job at the Open Society Institute, a grant-making organization based in New York. OSI was founded by George Soros, a Hungarian who escaped the Nazis, made a fortune, and decided to use some of his wealth and influence to try to ease the transition from Communism after the fall of the Soviet Union. My job was in the international public health program, which had started needle exchange programs throughout Eastern Europe and had funded the Red Cross in Irkutsk.

At first, most of my responsibilities were with the palliative care program, which sought to relieve pain, especially for terminally ill patients. Palliative care was a strange field for a twenty-three-year-old: hot with indignation, optimism, and the desire to rescue everyone in need, I was in no mood to accept the reality of death. Still, the job promised to take me back to Russia someday; as depressing as Irkutsk had been, I was hooked. In the meantime, I enjoyed pressing a button and sending thousands of dollars to Georgia, Romania, or Ukraine, learning to recognize the family names (Gomiashvili, Dumitrescu, Savchenko) peculiar to each country. I bought a map of Eurasia and hung it on my cubicle wall, memorizing all the Eastern European capitals and hoping to visit every one.

A few months after I started, I accompanied my bosses to a palliative care conference in Budapest. Most of the attendees were in late middle age or older; they kept asking me if I was somebody’s child.

At the cocktail reception after the conference, I waited for a drink beside an almost freakishly tall man, young but not very, thin to the point of emaciation, with a shaved head. His eyelids drooped over bored, off-kilter black eyes. With his beaklike nose, he resembled a dissolute vulture. Inexperienced though I was, it was obvious to me that he was not a palliateur or an oncologist: he looked more like a lost member of the Ramones, or Iggy Pop’s Eastern European cousin. I introduced myself, just as he plucked the last orange from the bartender’s bowl and started eating it, peel and all.

With a heavy Russian accent but an easy drawl, he told me that his name was Alik. He offered me his hand; the skin was soft and loose.

Alik was a doctor and activist who worked to help Eastern European drug users get HIV treatment. He had come to the conference because he was trying to learn more about palliative care for drug users, who were almost always denied pain medication. His interest in palliation was not purely professional: he soon mentioned that he was not only a doctor, but an on-again, off-again drug user.

I told him about Irkutsk; he had been there. I told him about the tulips; he said that his friends, activists from St. Petersburg and Moscow, had trampled them in protest against the Russian government’s refusal to take meaningful action against AIDS. I was ashamed to have been associated with the tulips, and eager to enter the ranks of the tulip stompers.

When the reception was over, we adjourned to my hotel room. I wasn’t sure if it was a good idea to let this strange man come upstairs, but Alik was more interested in stories than sex. He dazzled me with a long series of unbelievable anecdotes. It turned out that he was from Kiev, though he had spent some years working at a factory in Liverpool, and in Africa working for an international AIDS NGO. While there, he’d gotten a child’s HIV-infected blood sprayed in his eye. I wondered whether it was the eye that drifted off to one side, damaged, he told me, when another child at his school had beaten him on the head with a stone. He let me touch the soft spot on his skull, and let me in on a few secrets: Lou Reed had HIV, and one of his AIDS activist friends had slept with Tennessee Williams.

“When did Tennessee Williams die?” I asked, suddenly suspicious.

He changed the subject, turning to his native land.

“My father was in KGB, you know. He was anti-Semite. The most important thing my father taught me is that I am a Jew. My nanny killed man. But at that time in my country, everybody killed man. My granny killed man too...”

He waved his hand dismissively, and sniffed.

BEFORE I MET ALIK, I was just another girl in a cubicle, doing the usual two years before leaving for graduate school, the standard trajectory for administrative assistants at OSI. I had the feeling that I was a mass-produced good. My row of cubicles was almost entirely female, dark-haired and petite. We all wore colorful pashmina shawls to protect us against the air conditioning, and we got our periods at the same time. I had replaced Danielle, another small, dark-haired, Ivy League–educated woman in her mid-twenties, who was moving to Africa to do something more interesting than filing grant reports. It was true that I went home at night and read books about Russia—but how could anyone guess that as I sat at a staff meeting, taking notes?

With Alik’s help, I was promoted to a job working on programs that reduced drug-related harm through needle exchange, drug treatment, and other services. Alik and I spoke often on the phone and exchanged frequent emails. Over the next year I learned more about his life, finding the facts in his rushing river of auto-fictionalization.

Exceptional though he was, Alik was in many ways representative of his generation. Born in the mid-1970s to a bohemian mother and an alcoholic sailor-turned-KGB officer, he reached adolescence just as the world collapsed around him. As a teenager, he lived with his grandparents. They had been relatively well off, but inflation made their savings worthless, and they had to sell their belongings to survive.

Alik went to medical school, where he specialized in dermatovenerology, the treatment of diseases of the skin and sexual organs. But he couldn’t resist the call of newly open borders. He had always been fascinated by American culture and had learned good English. Now he took a break from medical school and went to Liverpool, where he learned to do a passable imitation of a Liverpool accent. (Another Ukrainian friend rode his bicycle all the way to Berlin, where he spent a few months squatting with musicians and artists.) Alik traveled through Europe; one highlight was the Amsterdam airport, where, he said, you could root through the garbage cans and find drugs jettisoned by departing tourists. He wasn’t sure whether he ought to go back to Ukraine, but he did, and finished medical school.

Kiev was exciting, full of change and opportunity, but there were also many people about Alik’s age who were dying of overdoses, or jumping off buildings, or crashing their cars, or falling into rivers, or losing their minds. Then people started to die of AIDS. Alik got a job working for an international NGO that was bringing HIV treatment to Ukraine.

THE LIFE STORY OF OSTAP, a Ukrainian man I met through Alik, is a case study of the drug-addicted children of perestroika. Ostap was from Chernigiv, in northern Ukraine. As a teenager in the mid-1990s, he tried drinking but didn’t like it. He smoked pot, but it was hard to find. Then someone offered him some opiates. At that time, an opiate brew made from poppies was available more or less everywhere, and it was extremely cheap.

As Ostap explained it to me, injecting drugs was fashionable in the 1990s. It made you seem like a criminal, and criminals had credibility: they were the only ones who were thriving. Ostap started shooting up.

After he’d been using opiates regularly for some time, he went to the seaside in Bulgaria. He didn’t understand why he wasn’t sleeping, why he was sweaty and nauseous and throwing up, why his nose was running. When he talked to his friends in Ukraine and complained about his health, they told him not to worry—he wasn’t sick, just in withdrawal.

Back in Chernigiv, Ostap often tried to quit drugs. Once, he was “coded.” This process, still popular in the post-Soviet world, is a form of “autosuggestion” that involves persuading someone that if he takes drugs or drinks again, he’ll die. Sometimes a capsule is implanted in the patient’s body; he’s told that as long as the capsule is in place, drugs will kill him.

Ostap’s parents took him for an implant, but he knew it was just gelatin.

“Where’s the guarantee?” he asked. “Let’s make a deal—you code me, and if I go and shoot up and nothing happens, give me my money back.”

The doctor refused to code him, saying he only treated alcoholics.

Ostap also spent a lot of time in the Chernigiv “nuthouse,” as he called it. He committed himself on a regular basis, usually for about two weeks. There you were put in a medically induced stupor that kept you from noticing the agonies of drug withdrawal; by the time you got out, your drug tolerance was far lower, which made it cheaper to get high. The nuthouse charged almost nothing, they’d accept you under any name, and they’d feed you three meals a day for a solid month. If a parent needed a vacation from an addicted child, sending him to the nuthouse for a few weeks was a cost-effective choice.

About 10 percent of the nuthouse beds were paid places, for addicts. According to Ostap, the addicts were always doing something stupid. They’d knock out a psychiatric patient’s tooth, take the gold crown, and trade it for moonshine, or steal all the sleeping pills in the dispensary. Once they stole the soldiers’ uniforms and boots and traded them for moonshine. In order to elicit confessions, a doctor had all the patients tied to their beds and injected with haloperidol, a powerful antipsychotic.

“How to describe haloperidol?” Ostap said. “You can’t drink—you’ll miss your mouth. Your head gets stuck when you try to turn it.” Haloperidol was used to sedate Soviet dissidents in the 1970s, when they were sent to psychiatric hospitals instead of the Gulag.

During the interrogations, the haloperidol was accompanied by a mysterious oily substance that was heated and injected into the patients’ buttocks and shoulder blades, causing a high temperature, shakes, and chills. Then the staff turned over the beds, so that the patients were hanging from their straps, facing the floor. But Ostap wasn’t resentful. He said the addicts left the doctors no choice.

The nuthouse figures prominently in artistic depictions of the post-Soviet 1990s. The Russian word nevmenyaemost comes up, too: it indicates the state of derangement in which a person can no longer be held responsible for his crimes. Such was the zeitgeist.

It took a life-threatening illness to make Ostap kick heroin. In 2002 he noticed that when he shot up in his legs, he couldn’t even feel the needle. He saw a neurologist, who prescribed ointment; he saw five more neurologists before someone did an X-ray and found that his spine was fractured. He had tuberculosis of the bone and a malignant tumor under his jaw—lymphoma. This, it was discovered, was probably because he had HIV, as well as hepatitis C, another blood-borne virus widespread among injecting drug users. The doctors knew how to treat his cancer, and he even found a surgeon willing to operate on his back, but no one knew anything about treating HIV. He got chemotherapy for six months, lost his hair, and swelled up like a balloon. He was bedridden for four months; it took him another month to stand. But he did. Like that of Pavel, the hero of How the Steel Was Tempered, Ostap’s body was almost destroyed by the hard times in which he lived; like Pavel, Ostap returned from the brink of death.

He hadn’t talked to anyone but his parents and his doctors during his treatment; all his friends were users, and he was afraid he’d relapse if he saw them. Then he got a phone call from some ex-user AIDS activists he’d met during a stint in rehab in Odessa. They asked Ostap to help open a branch of their organization in Chernigiv. He wanted to, but his parents were afraid of what would happen if their neighbors found out about his illness. So he packed his belongings into a single black plastic bag and moved to Kiev, to work with the activists.

Ostap told me that of his group of thirty or forty friends from high school, only three or four survived into their thirties. The rest died from overdoses, from injection-related diseases like sepsis, or from HIV-related illnesses like tuberculosis. Those who were still alive were in prison.

IN THE SUMMER of 2006, I attended the International AIDS Conference, the biggest health and development conference in the world. It was held in Toronto, in a conference building the size of a town, with glass walls and endless escalators. It reminded me of the interplanetary market in Star Wars: groups from every part of the galaxy moving in pods, a din of competing languages and cultures. There were sex worker activists in high ponytails and tight T-shirts with clever, obscene slogans. There were the Eastern Europeans, with their bad teeth and mullets. There were Indian hijras in bright saris, including the famous Laxmi, who’d won the admiration of Salman Rushdie, and Thai and Indonesian activists dressed warmly against the air conditioning. Most of all there were Africans, many of them in colorful outfits made of waxed cotton printed with AIDS ribbons or anti-AIDS slogans. In the “Global Village,” you could buy handicrafts like African-print handbags made by HIV-positive rape survivors in Rwanda, embroidered blouses made by HIV-positive Mexican women, colorful jewelry made by South African AIDS orphans, or, my personal favorite, a piece of African beadwork imploring DON’T SHARE NEEDLE INJECTION.

The AIDS Conference wasn’t always so inclusive; it started as a strictly scientific event. In 1989 activists from the American group AIDS Coalition to Unleash Power, or ACT UP, pushed their way into the conference, carrying their SILENCE = DEATH posters. ACT UP was famous for its direct actions in the United States, where members were often arrested during acts of civil disobedience. Over the years ACT UP members infiltrated the New York Stock Exchange, chaining themselves to the VIP balcony to protest the price of the only AIDS drug approved for use; marched to the White House carrying the casket of a dead ACT UP leader; and put an enormous condom over Senator Jesse Helms’s house in Arlington, Virginia. At the 1989 AIDS Conference, ACT UP members seized the microphone and presented scientists with a report on the failures of AIDS research. From then on the conference included people with HIV, and scientists and pharmaceutical companies made a show, at least, of consulting with them about research and drug trials.

The research and activism bore fruit, and the world’s first effective HIV treatment was introduced in 1996. People who had been about to die recovered suddenly. For a long time things had moved in only one direction, flesh melting off bodies, skin disfigured by Kaposi’s sarcoma, legs growing too weak to hold the weight of a body, eyes losing the power of sight. And then, suddenly, people started making the journey backward. People who had been in wheelchairs could walk again. The lesions healed, the weight was gained back, and the sick were well again, more or less. (The drugs have many unpleasant side effects.) It’s been called the Lazarus effect.

Perhaps because they have witnessed this triumph over death, achieved through the hard work of humankind, AIDS activist slogans have a Fyodorovian optimism: END AIDS NOW! END AIDS BY 2016! Demands often revolve, like Fyodorov’s theories, around the word universal, one of many indicators that such activists are the heirs to the utopian ideas of the nineteenth and twentieth centuries. Providing universal access to medications that have already been invented is a lot easier than collecting ancestral dust from outer space. And yet it’s unlikely that any of these demands will be met in the next century, let alone in the next decades. AIDS drugs exist, and energetic activism has succeeded in driving down their prices and getting rich governments to contribute to AIDS treatment efforts, but still no one will pay for them to be delivered to every single person with HIV, for the remainder of these people’s lives.

By the time I arrived at my first AIDS Conference, the international AIDS bureaucracy—what Eastern Europeans, with their usual cynicism, call the “AIDS business”—was bloated and pious. Bureaucrats agreed on everything that was vague and euphonious—human rights, equality, universal access, a fight against all kinds of “stigma and discrimination”—and yet national governments continued not to pay for medicine or prevention programs, and to punish drug users and sex workers and gays. Angry activists, some of them veterans and some of them younger people inspired by the example of the first generation of AIDS activists, seemed almost quaint in their anger. During one session I attended, in a cold, sepulchral room, representatives of pharmaceutical companies were speaking when, in their matching T-shirts, ACT UP members filed onto the stage, chanting about price reductions for an AIDS drug. They were right, of course, that the drug ought to be cheaper, and ACT UP did win important victories from time to time. But storming the stage was no longer a shocking disruption, as it had been in the 1980s. Now it was a scheduled event, part of the agenda. As the protesters shouted, the speakers sat patiently, looking irritated. They were used to this process. The audience, too, looked unimpressed, though the protest was more interesting than the session had been. It ended soon enough, just as everyone had known it would. In the 1980s ACT UP had turned anger into action, harnessing it to accelerate research and change policies. But by the time I arrived on the scene, anger had been assigned its place in the bureaucracy.

My most important task at the AIDS Conference was to help Sasha, an HIV-positive Russian AIDS activist in her late twenties, to write a keynote speech. Sasha was attractive without being beautiful, with a straight nose, crooked teeth stained by tobacco, golden-brown hair cut into an awkward mullet, and large, expressive green eyes. Just out of rehab, she had the edginess of a person unaccustomed to sobriety.

Sasha had been diagnosed with HIV when she was only twenty-two, after sharing needles with her boyfriend. The staff at the clinic gathered around her, staring at her, as she later told a journalist, as if she were some mysterious beast. The doctor said, “That’s it, girl, you’re HIV positive, go where you like.” She didn’t find out about HIV treatment until three years later.

Hospitalized with HIV-related complications, Sasha found that no one was helping the young, dying AIDS patients around her. She and some other HIV-positive activists started an organization to provide palliative care in St. Petersburg’s infectious disease hospitals. Drawing on her training as a psychologist, she helped teach Russian doctors and nurses how to talk to their patients about death—although there was no reason they had to die, from a medical perspective. HIV drugs were easily in reach for the oil-rich Russian government. And yet Russia didn’t care to exercise its power to conquer death. Committees of doctors decided who was eligible for state-sponsored treatment and who wasn’t—who would be resurrected, and who would be left to die. HIV treatment cost twelve thousand dollars a year, more than almost anyone in Russia could afford. In 2004 there were five hundred people receiving government-funded HIV treatment, and a million on the waiting list.

Sasha was always dressed in the same uniform: jeans, Converse sneakers, and the T-shirt of her organization, FrontAIDS. The logo had a man waving a red banner that formed an AIDS ribbon. Under FrontAIDS was written a slogan, in Russian: WE WILL LIVE—THAT IS OUR POLICY!

FrontAIDS was a radical protest group formed by Sasha and her fellow activists, some of them anarchists or eco-activists (the sorts of people who would later form Pussy Riot). Like their American counterparts, FrontAIDS held disruptive actions with a high risk of punishment. For them, too, silence equaled death. No one would rescue them; they would survive only if they were ready to fight. Once, demanding treatment for HIV-positive prisoners, they handcuffed themselves to the Ministry of Justice in Moscow, chanting “A prison sentence is not a death sentence.” In St. Petersburg, activists carried empty red coffins to City Hall. Just behind a large statue of Lenin pointing the way to the future, the activists draped the facade of the building in a banner that said OUR DEATHS, YOUR SHAME. FrontAIDS activists were conscious inheritors of the ACT UP legacy, but they were also the heirs to the 1917 revolution.

Many of the FrontAIDS activists protested with masks on; public exposure as HIV-positive people and as drug users could lead to firing, ostracism, and police harassment. But Sasha decided that masks only made it easier for the public to treat HIV-positive people as frightening and alien. In 2005 she agreed to have her face and her story used for an anti-AIDS campaign, making her one of the first Russians to publicly admit to having the virus.

IN TORONTO, the conference sponsors had paid for a nice hotel room for Sasha. She was letting two other AIDS activists stay with her: a Russian man, Aleksandr, and an American who had been living in Russia for many years and was the kind of earnest, hard-working expat woman who, I found, often propped up NGOs in countries without much history of civic engagement. They all slept in Sasha’s king-size bed. Aleksandr, a tall, obese, bearded man in his late twenties, had traded his FrontAIDS shirt for an African dashiki that squeezed his pasty flesh.

Sasha had trouble concentrating on her speech and kept asking me to buy her what she called, charmingly, “energetic drinks,” picking them based on whether they matched her outfit. She told me everything she wanted to say, and I wrote a speech; but it was full of big words and complicated clauses, and when she tried to read it out loud, she stumbled.

“I’m sure it sounds very nice, Sophie,” she said. “But it’s not my language. I need it to be simpler.” I took out all the big words and shortened every sentence. Her speech was a success.

One afternoon we went swimming together on the roof of her hotel. My bathing suit was a little too big and kept slipping down, making it hard to swim. I watched her do fast laps across the pool, her long, powerful blond limbs hardly splashing as they moved through the water. She laughed with happiness and told me she had once been an athlete, a sportsmenka. But that was in another life.