Twenty years after the beginning of the HIV/AIDS epidemic, the virus is now seriously threatening the remote states of Central Asia. Fueled by an increase in intravenous drug use, the epidemic is unfolding in the region against a complicated backdrop of economic crisis and rapid social change. In the first of a two-part series, a senior adviser with the Geneva-based UNAIDS organization tells RFE/RL more about how and why HIV/AIDS is spreading in Central Asia.
Prague, 30 April (RFE/RL) -- Until recently, Central Asia had been little affected by the HIV/AIDS epidemic. Experts say, however, that considering a rapid increase in the number of intravenous drug users (IDUs) in the region -- which has already reached 500,000 -- the number of people infected with HIV/AIDS could rise to 1 million in just a few years.
At the end of 2001, Kazakhstan had the largest number of officially reported cases in Central Asia, with 2,256, followed by Uzbekistan (779), Kyrgyzstan (208), Tajikistan (45), and Turkmenistan (4), where official information about AIDS infections remains secretive.
Local and international experts believe the number of infections is at least 10 times higher, however, due to the lack of proper monitoring, the long incubation period before those who are infected begin to show symptoms, and the harsh treatment by law-enforcement agencies of those considered to be in high-risk groups, such as intravenous drug users, which discourages sufferers' coming forward.
Henning Mikkelsen, a senior adviser at the Mission for Europe and the Americas at the UNAIDS Secretariat, based in Geneva, told RFE/RL that: "Until 1995, the whole region was a low-prevalence area, but then we had a big outbreak of HIV [infection] in Ukraine. And very quickly, it spread to other countries, including Kazakhstan. In 2001, we have now seen the epidemic spreading more or less everywhere in Central Asia."
Mikkelsen said two factors explain why Central Asia is facing such a rapid spread of HIV/AIDS infections: "In terms of the rise of new infections, we have never seen such a steep growth of the epidemic in the history of AIDS. And this is because we have this very dangerous cocktail of a very high prevalence of injecting drug use among young people. And also, we know that there are very high rates of sexually transmitted infections."
Mikkelsen said needle sharing among IDUs is the main factor driving the epidemic in the region, where young adults -- many of them out of work -- have become a lucrative market for the illegal drug trade.
"We know that where there's drug trafficking occurring, there is also an increase of injecting drug use. And it's shifting from the sort of traditional drug use where there's smoking [of opium] and so on, towards injecting. So that means that people who are injecting are of a very high and immediate risk for infection," Mikkelsen said.
The city of Temirtau in Kazakhstan is considered the center of the HIV/AIDS epidemic in Central Asia. Around 10 percent of Temirtau residents between the ages of 15 and 29 are believed to be intravenous drug users. In this so-called one-company town, virtually everyone lost their jobs when its giant steel smelter ran out of cash in the early 1990s.
"That was the kind of situation where people started to take injecting drugs. Now, it's more widespread, I would say. It's not just in those kinds of really poor citizens. We see it everywhere. And we also see it not just among poor people but affecting all layers of society," Mikkelsen said.
An increase in the number of sexually transmitted infections (STIs) in the region is also an indicator of the serious potential for a second wave of sexually transmitted HIV in all layers of society. A recent study conducted by the World Health Organization (WHO) in southern Tajikistan found that almost 76 percent of the women there had one or more STIs.
Despite such alarming rates of STIs, Mikkelsen said, public awareness about the threat of HIV/AIDS remains very low in Central Asia. "Except for Kazakhstan -- where it has been for several years -- this is a completely new epidemic. So, of course, for most people, this is something [that] they don't really believe exists in Central Asia. A second problem is maybe that it has been seen as very closely linked to the injecting-drug-use problem."
Mikkelsen said the previously low infection rates of HIV/AIDS in Central Asia, as well as more pressing economic problems in the region, help to explain the slow response of governments to the crisis.
"Until a few years ago, there was not a lot of attention [paid to] HIV and AIDS for quite obvious reasons. The countries were struggling with a lot of other problems. But in recent years, we have seen a really growing commitment," Mikkelsen said.
Mikkelsen suggested that only Kazakhstan currently has the ability to offer treatment to limited numbers of privileged HIV/AIDS patients. The average cost of treatment for one AIDS patient can reach $10,000 per year.
Other Central Asian states like Kyrgyzstan or Tajikistan, Mikkelsen said, are struggling with problems of economic hardship that are taking potential funds away from the fight against the HIV/AIDS epidemic.
Mikkelsen said that some help is on the way in the form of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, an independent, public-private partnership working to increase global resources to combat AIDS, tuberculosis, and malaria, which kill 6 million people each year.
The fund announced last week its first round of grants to programs to prevent and treat the three diseases in severely affected countries. The fund awarded a total of $378 million over two years to 40 programs in 31 countries. Eight percent of the total, or some $30 million, is earmarked for programs in Eastern Europe and Central Asia.