The exhaustive report covers 28 countries in Eastern and Southeastern Europe, as well as the Commonwealth of Independent States (CIS).
The document singles out the Western CIS countries -- Russia, Ukraine, Belarus, and Moldova -- as well as Estonia for having the highest growth in infection rates over the past several years. The report estimates that up to 1.8 million people in the region could be infected -- almost 1 percent of the adult population. Infection rates of HIV/AIDS above 1 percent have proven very difficult to reverse.
Kalman Mizsei is the UNDP's director for Europe and the CIS. He tells RFE/RL that unless urgent measures are taken, countries like Ukraine and Russia could face a full-blown crisis in three to six years.
"In the countries where the epidemic has penetrated about 1 percent of the population, if the action doesn't come very immediately -- and if the action is not comprehensive -- then we will have that full-blown situation in three, five, six years' time. And there will be two symptoms of this full-blown crisis. One, we will see a lot of deaths, unfortunately, in countries like Ukraine and Russia starting in three years' time. And past experience tells us this is going to be a very rude awakening [for] societies to the problem. The other is that the prevalence rate is going to grow, but how fast it is going to grow -- it can be higher or lower, depending on the societies and the government agencies' reaction," Mizsei said.
The UNDP report finds a high correlation between a country's successful transition to democracy and the capacity of authorities and civil societies to stop the spread of the disease. It says transparency and human rights guarantees for the groups most at risk have proven crucial in the fight against HIV/AIDS.
"[HIV/AIDS] punishes bad governance because if the different sectors of government don't cooperate, the fight against it will be very ineffective,” Mizsei says. “It's not enough to give a task to the health ministries. They alone will not be able to do it. Secondly, it punishes discriminative behavior from the society and/or authorities, because those people who are the main carriers of HIV/AIDS happen to be people who are carrying a social stigma, be it homosexuals, be it sex workers, be it intravenous drug users. If they cannot live in a society without shame, they will not cooperate with the authorities. Therefore, the risk of them spreading their diseases is higher."
The report points to the success story of Poland, where the emergence of an open, democratic society led to the ability of nongovernmental organizations to work directly with those at risk. Poland has managed to contain HIV/AIDS infections to about one-tenth of 1 percent of the adult population.
Mizsei says the former Soviet command-and-control system is counterproductive. He says mandatory testing, punitive policies, and attempts to control information are recipes for a generalized epidemic. In Central and Eastern Europe, the report finds the main means of spreading HIV/AIDS is through syringes used by drug users -- unlike in Africa, where the disease is largely transmitted sexually.
But Mizsei says there are signs that a combination of both is now at work in Russia and Ukraine.
"Unfortunately, the Afghan opium [and heroin] route really determines a lot of what the early risks are, and there are very high concentrations in Ukraine and Russia of more or less about 1 percent of infection rate in the adult and sort of older adolescent population. That is very high, and then, of course, the sexual habits in these countries are also very open, so that, of course, puts us at the risk at a certain point -- and the signs are already there now -- [that] the transmission route shifts from drug to sexual transmission," Mizsei said.
The report says that because people between the ages of 15 and 40 are most often infected, the fast spread of HIV/AIDS threatens economic and social development in the region. It also says an HIV/AIDS epidemic could have devastating effects on the already aging societies and shrinking populations.
Mizsei explains, "These countries cannot afford even lower [HIV/AIDS] prevalence rates, given the demographic trends already in the western part of the CIS -- Ukraine, Russia, Belarus, [or] Moldova, also at high risk. So, a 1 percent prevalence rate in these countries in just pure economic terms means, when it grows to 2 or 3 percent, it will mean quite a different thing than in much younger societies [such as those in Africa]."
The report says premature deaths in Russia could reduce the annual gross domestic product (GDP) by 1 percent. And growing health costs associated with treating larger numbers of people suffering from HIV/AIDS could devour up to several GDP percentage points annually.
The report warns that Russia's positive economic trends of recent years could be wiped out by the spread of the epidemic. It suggests that between 5.4 million and 14.5 million people out of Russia's 145 million could suffer from the virus by the year 2020.
It also touches on the national security implications of an HIV/AIDS epidemic, which could weaken military capacity and threaten the reform and modernization of the armed forces.
Mizsei says the best way for governments to fight the spread of the virus is to provide firm but transparent leadership.
He says countries do better when governments, “starting with the prime minister and president -- go out and, officially, not only acknowledge the problem but publicly pledge to fight it, and fight it with highly democratic and highly humane [methods]. Also, what has to follow this leadership is a very energetic public campaign -- television and other ways of public campaigning -- for safer lives, which is condoms, which is, for drug users, through NGOs and through other campaign methods, needle exchange, syringe exchange."
Mizsei also says governments have a duty to do as much as possible to provide those already infected with affordable treatment, which remains prohibitively expensive in most of the region.