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The East: World Bank Warns Of HIV Epidemic

Washington, 4 November 1997 (RFE/RL) - The World Bank says the rapid social change and economic dislocation that accompanied the collapse of communism in Eastern Europe and the former Soviet Union have created conditions for a potential epidemic of the virus that leads to the fatal disease known as AIDS.

The Bank, however, also says it is not too late for governments in the region to take preventive measures to reduce the chances for infection in the population groups most at risk.

The finding was part of the Bank's report "Confronting AIDS: Public Priorities in a Global Epidemic." It was released Monday at Bank headquarters in Washington.

The report documents the progress of the Human Immunodeficiency Virus (HIV) throughout the developing world. HIV destroys the human body's natural protections against diseases and leads to the condition known as Acquired Immune Deficiency Syndrome (AIDS). AIDS is always fatal and there is no cure.

While researchers in the United States and other affluent nations have reported success in suppressing HIV in infected people, the treatment is very expensive. It can cost up to $10,000 a year and requires constant monitoring by physicians. This treatment, which involves the use of several medications, is out of reach for HIV victims in the developing world and even in the former communist countries, which the Bank and the International Monetary Fund refer to as nations in transition.

This is why the new World Bank report emphasizes prevention as the most effective method of fighting AIDS.

Those most at risk of HIV infection are people who have unprotected sex with many partners and drug users who share needles used to inject narcotics.

The Bank says about 90 percent of all HIV infections occur in developing countries. However, the Bank also said that, "more intensive government prevention efforts, especially among people who have many sex partners or inject drugs, could save millions of lives and reduce the severe economic and social costs of the epidemic."

The Bank says 23 million people around the world are infected with HIV. Another 8,500 are infected each day. Six million people have died from AIDS since the virus first appeared two decades ago, the Bank says. The report adds that, "new evidence suggests that while sub-Saharan Africa has the most people infected -- 14 million -- the virus may be on the verge of exploding in other regions, such as Central and Eastern Europe."

In Moscow last week, Russia's first deputy public health minister Gennady Onischenko said more than 6,000 Russians are infected with the HIV and that more than half of them contracted the virus this year. He said that since the first patient was discovered in Russia 10 years ago, nearly 250 people have died of AIDS.

The World Bank report describes Russia's HIV epidemic as "nascent", meaning that less than five percent of people in the high risk groups are infected. In Eastern Europe, the Bank says the epidemic was also in the nascent stage in Bulgaria, the Czech Republic, Estonia, Lithuania, Poland, the Slovak Republic and Slovenia.

In the former Soviet Union, Azerbaijan was also characterized in the nascent stage. The Bank says there is what is called a "concentrated" HIV epidemic in Ukraine. That means that at least five percent of the individuals in a high risk group are infected.

The World Bank says it could not classify the stage of the HIV situation in Albania, Bosnia, Croatia, Macedonia and Serbia, nor in Hungary, Latvia and Romania in Eastern Europe. It could also not classify the HIV stage in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan or Uzbekistan.

Martha Ainsworth, a senior economist at the Bank and one of the authors of the report, told reporters Monday that the Bank was not able to classify more than 30 countries worldwide because no information on HIV and AIDS in those countries was available. She urged the governments of those countries to be more diligent in monitoring public health to keep track of HIV infections.

She said it is important to have that information so that governments will know how much time and money to devote to prevention campaigns. Early action, she said, is the key to prevention.

While specific information is not yet available for many of the former communist countries, Ainsworth said a key signal for the potential for an HIV epidemic in the region is the dramatic increase in the number of new cases of sexually transmitted diseases. She said the number of cases of gonorrhea nearly doubled between 1990 and 1994 in Estonia, Latvia and Lithuania and in Russia. In Ukraine, she said the number of syphilis cases increased more than ten times between 1991 and 1995.

According to the World Bank report, prevention programs do work. The report suggests that governments find the people who are most at risk and then target education and prevention programs directly at them.

The prevention programs, said the Bank, are intended to encourage people to adopt safer sex practices or use sterilized needles.

The Bank says evidence compiled from studies shows that advocating safe sex and use of sterile needles does not encourage children to become promiscuous or addicted to drugs.

Joseph Stiglitz, a senior vice president and chief economist at the Bank, told reporters that governments can be effective in promoting behavior change. However, he said money alone cannot solve the problem. Stiglitz said: "Confronting AIDS requires that political leaders and government officials take the necessary steps to confront the epidemic, even when these are politically controversial."