A United Nations report issued yesterday, just ahead of World AIDS Day on 1 December, says AIDS is spreading throughout the world at an alarming rate, with Africa continuing to be the critical hotspot for HIV, the virus that causes AIDS. But the report warns that former Soviet bloc countries in Eastern Europe and Central Asia are facing the world's fastest-growing infection rates, with more than 1 million cases expected by the end of the year.
Prague, 29 November 2001 (RFE/RL) -- In its annual report on AIDS published yesterday, the United Nations warns that the disease is continuing to expand around the globe at a fast pace, with the number of cases in Eastern Europe rising faster than anywhere else in the world.
The document -- titled "AIDS Epidemic Update 2001" -- says that in the two decades since it was first discovered, AIDS, or acquired immune deficiency syndrome, has become the most devastating disease humankind has ever faced, with an estimated 20 million victims, and is currently the world's fourth-biggest killer.
The report -- compiled by the Joint United Nations Program on HIV/AIDS, or UNAIDS, and the World Health Organization (WHO) -- says some 40 million people are currently carrying the HIV virus, with 5 million people becoming infected this year alone.
The document says that while Africa remains the AIDS hotspot, with three-quarters of the world's total number of HIV infections, it is the former Soviet bloc countries in Eastern Europe that are experiencing the fastest rates of infection. Throughout the region, an estimated 250,000 new infections were reported this year, bringing the total number of recorded cases to 1 million.
Among the causes that determined the epidemic's fast pace in Russia, Eastern Europe, and Central Asia, the report cites mass unemployment and economic insecurity, as well as an increased liberalization of social and cultural norms amid disintegrating public health services.
AIDS is caused by the human immuno-deficiency virus (HIV), which is found in body fluids and is transmitted through sexual contact, blood transfusions, and needle sharing, from pregnant women to the fetus, and through an infected mother nursing her baby.
AIDS is a syndrome, a combination of illnesses. The HIV virus attacks the immune system and leaves the body vulnerable to a variety of life-threatening diseases. The highest incidences of HIV infection are found among drugs users who share syringes, as well as prostitutes and male homosexuals. But improper medical care -- especially in orphanages -- can also result in an increased risk for HIV contamination.
The report says that in the former Soviet bloc, Ukraine has the highest adult HIV prevalence rate in the region -- 1 percent -- caused mainly by intravenous drug use. According to data published by Ukraine's Center on AIDS, almost a quarter of a million people were HIV-positive in 1999. The report also highlights the case of Estonia, where reported HIV infections have soared from 12 in 1999 to more than 1,100 in the first nine months of 2001.
But the report says Russia is the main cause of concern in the region, due to a startling increase in HIV infections, with new reported cases almost doubling annually since 1998. The total number of registered cases reached almost 130,000 in June, compared to some 11,000 in 1998. But the document warns that the actual number of people infected in Russia may be many times higher than reported figures.
Doctor Peter Piot, executive director of UNAIDS, said in a telephone news conference yesterday that, across the region, the real figures may be three to five times higher than reported figures: "In terms of Eastern Europe and particularly of Russia, we estimate that the under-reporting is about three to five times. In other words, in Russia, instead of the 75,000 new [HIV] infections this year, which are the ones that have been reported, there are about four to five times as many."
In Russia, as well as in other parts of the former Eastern bloc, the vast majority of reported HIV infections are related to intravenous drug use and needle-sharing. Across the region, the report says, some 1 percent of the population is injecting drugs.
The report says that while laws penalizing homosexuality have been abandoned in Russia and in most countries of the former Eastern bloc, homosexuals remain highly stigmatized and are exposed to greater HIV contamination risks because of lack of education and social awareness campaigns.
In southeastern Europe, sexually transmitted HIV infections and intravenous drug use are also on the rise, although still at considerably lower levels than elsewhere in the region. However, the report says, drug trafficking and the economic and psychological consequences of recent conflicts are increasing the likelihood that HIV epidemics will emerge in this region.
The document mentions Central Europe as being cause for "tempered optimism," since countries like Poland, the Czech Republic, Hungary, and Slovenia have well-designed prevention programs in operation, and there is little indication of a potential rise in HIV infections.
It also points to the worsening situation in Central Asia, where outbreaks of HIV-related intravenous drug use have been reported in countries such as Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan.
Doctor Piot said the current war in Afghanistan and the increased availability of cheap drugs could also lead to an increase in the number of cases in the region: "With the war in Afghanistan, the would-be population movements, perhaps with the appearing on the market of cheap heroin, the surrounding countries may also see an increase in the number of new infections. I am thinking of the Central Asian republics, which have starting epidemics, but perhaps also Pakistan. This is something we are watching very carefully."
The UNAIDS report warns that, based on current evidence, a much larger and more generalized epidemic is a "real threat" for the region. However, the good news is that the epidemic is still at an early stage throughout the region and its scale and extent could be reduced by what the report calls "massive prevention efforts." Such efforts would require action to reduce risky sexual behavior and intravenous drug use among the young and to tackle the social, economic, and other factors that boost the spread of the virus.
The report says some 150 HIV/AIDS prevention projects for intravenous drug users have been set up across the region in the last five years, along with programs centered on other exposed groups, such as prison inmates, sex workers and homosexual men.
However, further efforts are necessary, especially among young people, who are most vulnerable to HIV infection, to equip them with the education and services they need to protect themselves against the virus.
Doctor Piot says ignorance about AIDS among young people in the most exposed regions is one of the greatest dangers for the future: "According to a UNICEF study, in many countries and 20 years into the epidemic, there are still millions of young people who know little or nothing about AIDS. In countries from Ukraine to Botswana, I was shown that over half of all young people never heard of AIDS or don't know how HIV is transmitted and how to protect themselves."
But UNAIDS is welcoming what it calls the growing political commitment to fight AIDS in the region. It stresses that countries such as Bulgaria, Romania, Russia, and Ukraine have substantially increased the budgets of their national AIDS programs, while CIS countries are preparing a regional work plan to guide a coordinated response to the epidemic.
Piot told RFE/RL that, while focusing mainly on Russia and Ukraine, UNAIDS is also involved in AIDS prevention and cure programs in smaller Eastern European countries, such as Belarus, Romania, and Moldova, which rank among the poorest on the continent.
"Belarus is a matter of great concern [for UNAIDS], [as well as] the Baltic states [and] small but very vulnerable countries [such as] Moldova and Romania. There are programs that we are having not only in prevention, but in Romania, for example, there is a major effort of treatment because of older children who became infected through blood transfusions many years ago, and these children are ill. So there is an effort to go beyond bigger countries, no doubt about that."
Funding for such programs remains a problem, regardless of the level of political cooperation. A global AIDS and health fund established in June of this year by more than 50 countries, non-governmental organizations, private foundations, and other stakeholders, meant to fight AIDS, tuberculosis, and malaria, has yet to take off.
Piot says donors have pledged some $1.6 billion to the fund, which is expected to become operational by the end of this year or in early January 2002. But he says donors want solid assurance that the money will be used effectively.