Tuberculosis and HIV/AIDS are becoming serious public health problems in Belarus. And the government in Minsk has recently approved a World Bank plan that would fund treatment and prevention measures. But it's not clear if the plan will find favor with President Alyaksandr Lukashenka. Russia -- where TB and AIDS are even more serious problems -- rejected a similar proposal last year. Will Belarus follow suit?
Prague, 30 April 2002 (RFE/RL) -- The Belarusian government has approved a World Bank plan to battle tuberculosis, or TB, and HIV/AIDS infections. The plan was approved last week and is awaiting the signature of President Alyaksandr Lukashenka. It envisions the World Bank financing of up to $16.8 million.
Belarus suffers from near-epidemic levels of tuberculosis and one of the highest rates of HIV/AIDS infection in the former Soviet Union. The World Bank plan is viewed as crucial in treating existing cases and educating the population on disease prevention.
But Lukashenka is apparently skeptical about it. Last week, in his annual address to parliament, Lukashenka said the West "wants to spend millions of dollars in loans to flood Belarus with condoms."
Belarusian health officials say the situation is serious. Alyaksandr Cibin, head of the Department of Medical Help in the Ministry of Health, puts the rate of TB infection in Belarus at 47 cases per 100,000 people. This is just below the World Health Organization's (WHO) standard for an epidemic of 50 cases per 100,000 people.
Cibin says because of a lack of money, it is hard for Belarusian doctors to fight particularly difficult forms of TB that are resistant to treatment: "For us, it is very expensive because to cure the illness we need four or five drugs, and the drugs are very expensive. The drugs are not produced in the country, so we need to buy them abroad. There is no need to lecture us on how to cure, but please give us the means to cure."
The fight against AIDS poses similar problems. According to the WHO, Belarus has one of the highest rates of HIV/AIDS infection in the former Soviet Union. There were 3,000 people infected with HIV in Belarus in 2000.
Vladimir Kabanov lives and works in the city of Svetlogorsk, known as the country's AIDS capital because of its relatively high number of intravenous drug users.
For years, Kabanov has worked in a nongovernmental organization helping people infected with HIV/AIDS. He says the attitude of people toward those infected with HIV has changed, but the lack of money and medicine still hampers efforts: "The situation in our health system is bad. [Blood tests] are too expensive for our health system, and only in some regions are the tests conducted more actively."
Kabanov says he is afraid that in two or three years those who are infected with HIV will start developing full-blown AIDS.
Belarus officials are mindful of the fact that they must act quickly if they wish to avoid what has happened in neighboring Russia, where both TB and HIV have recently become enormous public health problems.
Murray Feshbach is a senior scholar at the Woodrow Wilson International Center for Scholars in Washington and an acknowledged expert on Russian demography. He says the TB infection rate in Russia is around 90 cases per 100,000 people -- nearly double the rate in Belarus.
In Russian prisons the rate is much higher -- around one in 30 inmates has TB (an infection rate of about 3,000 per 100,000 people). A third of these cases involve those TB strains that are resistant to drug treatments and are much more difficult and expensive to treat.
In terms of HIV/AIDS, Feshbach says the official figure in Russia is much higher than the 200,000 or so cases that officials admit to: "The total cumulative number of cases of HIV/AIDS in Russia is about 190,000. That's the official figure. Roughly 150,000 of that occurred during the last two years -- that is, in 2000 and 2001."
Feshbach says the real number of HIV cases in Russia is probably closer to 1 million, with most of those coming to light in the past couple of years.
Despite the dangers, the Russian government last summer blocked a $150 million World Bank loan for the treatment of tuberculosis and AIDS, a course of action that Belarus may also follow.
Feshbach says Russian authorities rejected the money because they wanted to deal with the problem themselves using domestic resources. The authorities also didn't want to increase their foreign debt by taking on more loans.
Cibin of Belarus's Ministry of Health says he, too, has doubts about the usefulness of the World Bank loan and fears the money will be wasted. "Belarus cannot afford World Bank officials using the money allocated to fight TB and AIDS for their inspecting tours."
World Bank officials tell RFE/RL the bank's loans and project grants are never used to finance World Bank missions.