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Central Asia: Expert Fears HIV Epidemic

As the HIV epidemic spreads into the former Soviet Union, international organizations fear the next major outbreak could erupt in Central Asia because, as one expert says, the infection follows the drug trade. RFE/RL correspondent K.P. Foley interviews a Soros Foundation activist who says the time for action in the region is now.

Washington, 15 March 2001 (RFE/RL) -- An international advocate for aggressive efforts to stem the spread of the infection that leads to the deadly disease called AIDS says Central Asia is at risk for "an explosive HIV crisis."

HIV is the acronym for Human Immune Deficiency Virus, an infection whose end result is Acquired Immune Deficiency Syndrome (AIDS), a condition for which there is no known cure.

Kasia Malinowska-Sempruch is the director of the International Harm Reduction Program of the Open Society Program, one of the institutions established by the non-profit Soros Foundation. She believes that HIV follows the same route as the drug trade and says "Central Asia is a critical drug trafficking route."

In an interview with RFE/RL she said her conclusions are based on the history of the HIV epidemic. HIV can be passed from person to person through sexual contact, but United Nations and other experts say that increasingly, HIV and AIDS are being spread by users of illegal drugs who share contaminated needles. Malinowska-Sempruch says this is the path HIV followed in Asia, where an estimated 7.2 million HIV infections were reported by the end of last year.

"If one looks at Asia today and looks, for example at Thailand and just generally trafficking routes outside of Burma, it's quite clear that HIV follows drug-trafficking routes and I think this is why Central Asia is going to experience exactly the same phenomenon if something doesn't get done and if something doesn't get done immediately."

Reports from the U.S. State Department and the United Nations say that Afghanistan has emerged as one of the leading suppliers of illegal drugs, chiefly heroin. Malinowska-Sempruch says these drugs flow through Kazakhstan and Kyrgyzstan into other Central Asian nations and into Russia and Ukraine. She says it is "only natural and logical that HIV will follow."

She says that while the estimates of injecting-drug users in Central Asia are not very high right now, the same was true for Russia and Ukraine a decade or so ago.

"My concern is not that there is an HIV epidemic that is occurring in Central Asia now. My concern is that HIV epidemic is fast approaching and if something doesn't get done we're going to experience the same disaster."

Russian Prime Minister Mikhail Kasyanov said on 13 March that drug addiction in Russia has increased 20 times over the past 10 years. The United Nations AIDS Program (UNAIDS) reports that the number of HIV infections in Eastern Europe and the former Soviet Union rose from 420,000 at the end of 1999 to more than 700,000 at the end of last year.

At an Open Society forum earlier this month on HIV/AIDS in Central Asia, Malinowska-Sempruch called on Central Asian governments to re-examine drug policies and practices. She urged nations to reform policies that, she said, "dogmatically marginalize people who are at risk for HIV."

She told RFE/RL that there is a great fear and shame associated with drug use in the Central Asian countries.

"People are dying of overdose in their own homes because there is such incredible shame and stigma in admitting that you have a husband or a son who is drug user."

She said this shame, and a fear of the authorities, hinders access to drug treatment.

"If we send out a message and even if they believe us that HIV epidemic and Hepatitis C are diseases that are going to affect them, if there is such an intense amount of fear against establishment, whatever they are, then they simply will not come and access services."

However, she also said there are positive signs that governments in the region recognize that there is a problem. She said the fact that needle exchange programs, where addicts can turn in dirty drug paraphernalia for sterile materials, "is a great sign." She also said there are national AIDS programs in the countries and a visible presence by UNAIDS.

She added though, that these are just "pilot programs," and that a massive effort is what's needed.

"My only concern is that whatever small steps are taken to move forward they're just not large enough to in fact stop the HIV epidemic."

In a related story, a new report by UNAIDS suggests that migrants and refugees may be more vulnerable to HIV/AIDS than stable populations.

In its February update, "Population Mobility and AIDS," researchers for UNAIDS estimate that some 150 million migrants live and often work outside their country of citizenship. The agency describes migrants as people who take up residence or who remain for an extended stay in a foreign country.

In addition, UNAIDS says there are about 15 million refugees and people seeking asylum. The report also notes that some 20 million to 30 million people around the world are displaced within their own countries because of wars, ethnic tensions, and human rights abuses.

UNAIDS says studies shows that travel or migration are factors in the spread of an infection. The UN says that in many countries, regions reporting higher seasonal and long-term mobility also have higher rates of HIV infection. UNAIDS says higher infection rates can also be found along transport routes and in border regions.

The agency makes a number of recommendations for protecting mobile populations. These include a call for including migrants and refugees in national and local AIDS plans; targeting education programs specifically to mobile populations; implementing cross-border international programs, and improving the legal status, working conditions, and health care for migrants.