There are an estimated 32,000 Central Asians between the ages of 15 and 49 infected with HIV and AIDS. In Kazakhstan, Kyrgyzstan, and Uzbekistan, nearly one-third of them are women, many of them prostitutes. The spread of HIV through the sex trade has been especially acute in Uzbekistan, the most populous state in the region. In the second of a four-part series on AIDS in Central Asia, RFE/RL reports on the rapid spread of the deadly virus among Uzbek prostitutes.
Prague, 30 November 2004 (RFE/RL) -- The 30-year-old prostitute refuses to give her name. She says she discovered she was infected with HIV, the virus that causes AIDS, roughly two years ago.
She doesn't know when she contracted the disease, or from whom. But she says she has no one to blame but herself:
"There were some clients who didn't want to use condoms. They were drunk. Men usually buy [sexual services] when they're drunk."
As the most populous country in Central Asia -- and a transit point for truckdrivers from throughout the region, as well as Turkey and Iran -- Uzbekistan has more prostitutes, and more risk of an AIDS epidemic, than any of its neighbors.
The woman says it is difficult to convince drunk clients to wear condoms. She believes she contracted HIV by having unprotected sex with one of these men.
The 30-year-old divorcee turned to prostitution in order to make a living and raise her 10-year-old son. But once she found out she was infected with HIV, she stopped her work and lost her livelihood.
Her family now refuses to have contact with her. But the worst part, she says, is knowing that she is dying: "The immune system doesn't work, and a person dies gradually from this illness."
The woman says she takes vitamins and some medicine to keep herself healthy. But it is expensive and she can't continue it for long.
Some 11,000 people in Uzbekistan are believed to be infected with HIV or AIDS. According to official data, 20 percent of those are sex workers.
Prostitution has been on rise since Uzbekistan obtained independence just over a decade ago. Many blame high unemployment, especially among women, for the growth in prostitution. As the most populous country in Central Asia -- and a transit point for truckdrivers from throughout the region, as well as Turkey and Iran -- Uzbekistan has more prostitutes, and more risk of an AIDS epidemic, than any of its neighbors.
In the capital of Tashkent alone, an estimated 6,000 women offer sexual services.
One woman, Gulya, says she has been infected several times with curable sexually transmitted diseases (STDs) like trichomoniasis. But she has not contracted HIV, and describes what she and her co-workers do in order to avoid being infected: "Usually we use condoms. Some clients say they don't want to use them. That is also possible. If we don't use condoms, we ask a man to [ejaculate] outside of us. Then disease can't be transmitted. We are very experienced. It's enough for us to look at a man once and say whether he is sick or not."
Safe-sex advocates face a challenge in Uzbekistan, where the average monthly salary is $15. A pack of three condoms costs $1 -- a purchase few people can afford to make.
The Washington-based organization Population Service International (PSI) works with HIV/AIDS sufferers in all of the Central Asian states but Turkmenistan.
Artur Niyazov heads PSI's work in Uzbekistan, and says the group is working to promote safe sex and condom use among the country's young people. It distributes information and sells low-priced condoms in areas where prostitution and drug use among young people is known to be high. Niyazov says PSI volunteers also work with prostitutes directly at the sites where sex services are provided:
"They go directly to the field -- meaning to streets, to highways, to apartments, anywhere where [prostitutes] gather. We collaborate with 'Mama Rozas' (eds: women who find clients for prostitutes). The collaboration is also between peers, because we have Mama Rozas among our outreach workers. Sixty percent of our outreach workers are former commercial sex workers and Mama Rozas."
PSI sells condoms at a price of 220 Uzbek soms for a three-pack of condoms -- nearly three times cheaper than the regular price.
Niyazov says the group also offers additional incentives to prostitutes to convince them to buy condoms: "We started a campaign to motivate them to buy condoms. If they buy 10 packs, they get a medical test for free. As you may know, such tests are quite complicated for these types of women [in Uzbekistan]. If a woman is diagnosed with an STD, she is registered and sent to a venereal disease center for compulsory treatment. Therefore, they hide their diseases. We give them the chance to have an anonymous test in a friendly clinic. We choose the clinic and we pay the doctors."
Government officials in Uzbekistan say they are fighting the battle against HIV/AIDS as well.
Bakhtiyor Madaminov is deputy head of the Health Ministry's AIDS center. He says in 1999 the country passed a law on preventing HIV infection that aims to protect the rights of those diagnosed with HIV and AIDS and provide them with free medical services.
To that end, the Health Ministry has opened AIDS centers in different regions of the country, as well as what Madaminov calls anonymous "trust rooms."
"Their major task is to provide drug addicts with new syringes and [a] chemical substance to disinfect used needles as well as with condoms," Madaminov said. "It's all financed by the government, from a state budget."
A number of nongovernmental organizations are also involved in the battle against the disease. One, "Ishonch va hayot" -- or "Trust and Life" -- holds special classes for people living with HIV/AIDS. Sergei Pyatayev, the deputy head of the NGO, says many of the group's psychologists, lawyers, and health counselors are themselves HIV-positive. It is one way, he says, of fighting the stigma attached to those living with the deadly disease.