While some progress has been made in Central Asia's battle against AIDS in recent years, there have been numerous challenges along the way. In the last of a four-part series about AIDS in Central Asia, RFE/RL looks at what regional governments, charities, NGOs, health-care workers, and religious groups are doing to combat the problem.
Prague, 30 November 2004 -- Sasha is a 33-year-old drug user who lives in the Kazakh city of Almaty. Two years ago, he was diagnosed with AIDS.
At that time, he says, the situation seemed hopeless. There was no care in Kazakhstan for people suffering from HIV/AIDS. But now Sasha says circumstances have improved: "Now I've started a course of treatment. We have begun searching for a solution [to the problem]. People in Kazakhstan are very nice, thank God. They understand all these [issues] very well, and accept someone else's pain as their own."
The situation, in fact, is not as dire as it was five years ago. Advocacy efforts are on the rise, with education and information programs growing. Agencies have been founded to help people with HIV/AIDS, and Central Asia has seen increased funding for fighting the problem as well.
All the Central Asian states have national AIDS centers that perform HIV testing and blood screening for hospital donations. With the exception of Turkmenistan, all have also developed national AIDS programs.
Kazakhstan has also developed a number of special programs aimed at HIV prevention in schools and the armed forces. The World Bank and other international organizations have made available some funds for these AIDS prevention programs.
Arun Nanda of the Tashkent office of the World Health Organization (WHO) explains what progress has been made in Uzbekistan: "The chair of the UN team group gave the Jonathan Mann Award [for Global Health and Human Rights] to the [Uzbek] Ministry of Defense because [it] has started doing a major project under the umbrella of the UN team group to do HIV training and awareness raising among the military cadets. I know that two to three years ago we had difficulty in discussing with the Ministry of Defense whether there were any HIV cases in the army."
But in spite of such improvements, HIV infection is on the rise across Central Asia, with drug users and prostitutes forming the largest risk groups. The WHO says 70 percent of all new HIV/AIDS cases in Uzbekistan are injecting drug users.
Ironically, drug abuse is one factor that can exclude a person from receiving necessary medical treatment. Antiretroviral treatment is slowly becoming available in Central Asia. But it is not available for injecting drug users -- except in Kyrgyzstan, which has started offering simultaneous substance-replacement therapy with methadone.
Alexander Kossukhin is Central Asian coordinator for the United Nations' AIDS agency: "The issue of implementation of antiretroviral therapy in Central Asian countries has not been resolved, maybe except in Kyrgyzstan. Because, unfortunately, most of the eligible people living with HIV who need antiretroviral treatment are injecting drug users and indeed injecting drug users will never be eligible to receive antiretroviral treatment if they do not implement substance-replacement therapy simultaneously."
Local cultural attitudes also present a roadblock to treating many AIDS patients.
In Uzbekistan, which is notorious for its poor human rights record, homosexual relations are a criminal offense. In Kyrgyzstan, the Education Ministry issued a decree demanding the removal from school libraries of a booklet explaining how to avoid HIV infection.
In such situations, it is often NGOs that fill the gap, bringing information and support to people living with AIDS.
Some NGOs are formed by AIDS patients themselves to lobby for basic rights. Others provide essential medical services and harm-reduction programs for drug users, prostitutes, and other high-risk groups.
A major problem for many Central Asians is the difficulty of being tested for HIV anonymously. Many people fear that once they are examined and tested, the information will be officially registered.
For this reason, many people turn to NGOs for help. But such organizations are limited in the care they can provide. Most are prohibited from delivering antiretroviral treatment or even providing standardized training for staff.
Alexander Kossukhin of UNAIDS says regional governments are suspicious of nongovernmental organizations and inhibit much of their work:
"The [nongovernmental] organizations are not considered to be professional ones. That's why such organizations are not allowed to deliver antiretroviral treatment. Specialists who help reduce HIV risk among vulnerable groups of the population are not recognized by professionals. We have no institutions in Central Asia which train NGOs on a regular basis."
The number of official AIDS cases is low in Central Asia. In Uzbekistan, for example, the number of officially registered cases of HIV/AIDS is just 3,647. The WHO says the actual number is far higher, and growing steadily.
Roman Gaylevich works at the Europe and Central Asia section of UNAIDS. He explains what needs to be done: "There must be greater political will to prevent HIV/AIDS in these countries. That in particular might be an issue in Uzbekistan, where over the past three years the number of infections has increased steeply. But attention [to the problem] at top government levels is missing, and probably is not existing, beyond the words of the Health Ministry."
But there is still hope for the future. A number of projects are under way to battle HIV/AIDS in Central Asia. One of them, financed by the Global Fund to fight AIDS, tuberculosis and malaria, devotes resources to training health care professionals and showing school teachers how to raise AIDS awareness. In some countries, groups have even reached out to Muslim religious leaders to include anti-AIDS messages in their Friday prayers.