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Central Asia: UNAIDS Chief Says Disease Spreading At Record Pace

Peter Piot, executive director of UNAIDS (file photo) (epa) A new report -->  by the independent Commission On AIDS In Asia, sponsored by the United Nations, contains the most comprehensive assessment of the disease’s spread and impact in Asia. However, the report does not cover Central Asia and Afghanistan, which instead will be dealt with during a major international AIDS conference in Moscow in May. RFE/RL correspondent Nikola Krastev spoke with Peter Piot, executive director of UNAIDS, who says HIV, the virus that causes AIDS, is spreading faster in Central Asia than anywhere else in the world.

RFE/RL: Why were Central Asian countries not included in the new report?

Peter Piot: Well, the reason is that they felt that from the prospective of the economy and so on, that the rest of Asia is a more homogenous entity. And traditionally, the Central Asian countries, from the time of the former Soviet Union, are more still oriented in terms of their policies and so on towards an entity with Eastern Europe, so that’s why. But that is changing also. It is changing in terms of the political and economic landscape.

Also, when we look at migration, at where the natural resources are going, it’s more and more going eastwards, east and southeastwards, than not only west and northwards.

RFE/RL: How has HIV/AIDS developed in Central Asia since 2005?

Piot: In recent years, several countries have really made progress in Central Asia in terms of the spread of HIV and the control of it, but the truth is that HIV is increasing more rapidly in Central Asia than in any other part of the world. The absolute numbers are still quite low, and it’s the same story as before. It is mostly injecting-drug use, very slowly also among sex workers.

And the key problem for me is that countries are still not embracing major effective programs, such as needle exchange and the use of substitution therapy -- methadone for the injecting-drug users -- so that keeps them really, how to say, under control for their addiction, and also makes sure that they can have access to prevention methods.

RFE/RL: When we speak about HIV/AIDS in Central Asia, should we also include Afghanistan?

Piot: I think that’s a very good point because where do the drugs come from? Where’s the heroin coming from in Central Asia? It’s from Afghanistan. It’s not more complicated than that. And so, it will be very, very important to work also with Afghanistan, the drug trade. Just as in China, for example, in the western province of Xianjiang, which is kind of more part of Central Asia, heroin is coming from Afghanistan, but in Yunnan Province, more in the east, it is coming from Burma.

So, we must really tackle the problem also at its roots. And heroin production is at an all-time high, and that means that also the AIDS epidemic is going to follow the drug addiction as its shadow.

RFE/RL: What’s on the agenda for the Moscow AIDS conference in May?

Piot: From May 2 to 4 in Moscow, there will be the second major regional conference on AIDS covering the problem issues in Eastern Europe and in Central Asia with representatives from all countries. And the issue of HIV prevention, particularly among injecting-drug users, is going to be very high on the agenda. It is also the most controversial issue -- politically the most sensitive -- but that’s why it is important to bring all the countries together around this.

RFE/RL: What is the attitude of the Russian authorities toward the spread of HIV/AIDS?

Piot: There has been actually good progress in terms of the response to AIDS in Russia. The budgets have gone up. There are now programs for drug users, sex workers, and all that. But it is extremely variable from one oblast [region] to the other, and from one city to the other. Some are doing well and have active programs, such as we see in St. Petersburg and so on, and there are others where hardly anything is done and where only a police approach is happening, which we know doesn’t work.

RFE/RL: What is the difference between Russia and Ukraine in terms of impact and response?

Piot: Last week, the president of Ukraine issued a decree and announced that he is going to take personal charge of the response to AIDS, for the first time. And [he] declared it as an issue of national importance. Ukraine is the country that is the most affected [in Eastern Europe]. Over 1 percent of the total adult population is HIV-positive. And programs have been put in place.

What strikes me the most in Ukraine is that there is a very active civil society -- groups of people living with HIV, quite young people -- who are really taking these things in hand. And I think that, plus, if there is now political stability, I think it will be necessary to make sure that there are programs that will move [forward].

RFE/RL: One of your colleagues said, “We have to act as if there will be no AIDS vaccine.” Does that mean pessimism prevails?

Piot: Well, I think it is an expression of realism that up to now, all efforts to produce a vaccine have failed. And that we have to go back to the drawing board, as Dr. [Anthony] Fauci, the director of the National Institute [of Allergy] and Infectious Diseases in America, has just said. What we have is a social vaccine, is an educational vaccine, but not a vaccine that we can give a shot and then people are not infected. That is going to take a long time.