HIV moves in on homeless youth.

170 C R E D IT : M A L C O L M L IN T O N ST. PETERSBURG, RUSSIA, AND ODESSA, UKRAINE—Russians frequently boast that St. Petersburg is the most beautiful city in the country, and Ukrainians say the same about Odessa. Both feature well-preserved architecture in Italian and French styles that date back to the 18th century, stunning monuments, and lots of water, be it the canals that wind through St. Petersburg pouring into the Neva River or the majestic Black Sea that laps Odessa’s shores. Yet both cities have a dark underbelly that has caught the attention of HIV/AIDS researchers: Large numbers of youths living on the street who, as a group, are at as high a risk of becoming infected by the virus as any vulnerable population ever studied. “They’re hard to reach and invisible for HIV statistics and often for HIV prevention programs,” says Dmitry Kissin, an obstetrician/gynecologist who works for the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta. “No one knows how many street youth there are because no one’s counting them. And when you don’t know about something, you don’t pay attention.” Kissin, who is originally from St. Petersburg, has worked for the past 4 years with colleagues in both countries to bring attention to this underappreciated high-risk group. Estimates suggest that up to 3 million youths are living on the streets in Russia and 150,000 in Ukraine. They live in city shadows, sleeping in basements of apartment buildings and abandoned buildings, taking odd jobs and panhandling, and constantly dodging police. “You don’t see them unless you look for them,” he says. Kissin has been trying to do just that. Along with CDC’s Susan Hillis and co-workers from HealthRight International—a nongovernmental organization (NGO) formerly known as Doctors of the World-USA and founded by pioneering AIDS researcher Jonathan Mann—he launched a study in St. Petersburg in 2006. The researchers identifi ed 41 different train stations, metro stops, street markets, and other sites where groups of teens gathered. They picked half of the sites at random and started enrolling youths in the study. In the end, they signed up 313 teenagers between the ages of 15 and 19, two-thirds of them male, who lived at least part-time on the street, were not cared for by their families, and did not regularly attend school. They questioned the participants in detail about their lifestyles and tested each one for HIV. When they fi rst saw the results, says Konstantin Zakharov, the project coordinator for HealthRight, “it was a shock.” A staggering 37.4% were infected.