Twenty years after the beginning of the HIV/AIDS epidemic, the virus is now seriously threatening the remote states of Central Asia. Fueled by an increase in intravenous drug use, the epidemic is unfolding in the region against a complicated backdrop of economic crisis and rapid social change. In the first of a two-part series, RFE/RL looks at the evolution of prevention and treatment measures for HIV/AIDS in the region, one year after an international AIDS conference was held in Kazakhstan.
Prague, 30 April 2002 (RFE/RL) -- In May 2001, representatives of local nongovernmental organizations (NGOs), Central Asian officials, and experts from the international community came together at a conference in Almaty, Kazakhstan, to discuss the explosive growth of HIV/AIDS in the region.
Central Asian governments signed a declaration at the conference that called for the development of a regional strategy to combat the epidemic.
Harriett Destler is the chief of the strategic planning and evaluation division in the office of HIV/AIDS at the United States Agency for International Development, or USAID. She told RFE/RL that Central Asian governments are moving toward a broad effort that will focus on segments of the population most likely to become infected: sexually active young people ages 15 to 25, and people engaged in high-risk behavior, such as intravenous drug users (IDUs) and sex workers.
"That conference was a good wake-up call both for governments and community groups and the larger donor community that is working on this issue [of HIV/AIDS]. I think that the positive consequences are a sort of shared commitment to a more comprehensive and larger regional approach focused primarily on prevention and based on the scientific principles of infectious-disease control and targeted at the underlying causes and effects of HIV/AIDS infection," Destler said.
Destler said current efforts are still relatively modest. She said pilot programs are focusing on three areas where the HIV/AIDS epidemic has already broken out: Temirtau in Kazakhstan, Osh in Kyrgyzstan, and Uzbekistan's portion of the Ferghana Valley. But she said that organizations and agencies are now cooperating on a new, expanded regional program.
"We [USAID] are very fortunate in Central Asia to have a good relationship not only with our host-country partners and other U.S. agencies but also international donors such as Doctors Without Borders, UNAIDS and WHO. We are also working with private groups and foundations," Destler said.
Destler said the new regional program is focused on five objectives:
1. Improvement of the public's knowledge of the epidemic through education programs;
2. An increase in safe-sex practices, such as condom use;
3. The promotion of healthy behavior, such as usage of clean needles, within high-risk populations, such as IDUs;
4. Better access to treatments against sexually transmitted infections (STIs); and
5. The support of national blood-safety programs.
Henning Mikkelsen is a senior adviser at the Mission for Europe and the Americas at the Geneva-based UNAIDS Secretariat. He told RFE/RL that the gathering in Almaty last year was an important step toward better recognition by local governments of HIV/AIDS as a global emergency.
"Some of the governments have left the idea that HIV/AIDS is a health problem only which can be dealt through a medical response. For example, in Kazakhstan, they have now a high-level national AIDS committee with representatives of all the different ministers who can do something on HIV/AIDS. So we now start to see a really broad-based effort starting to take place in the countries," Mikkelsen said.
To avoid a large-scale epidemic in Central Asia, Mikkelsen said, UN agencies, bilateral donors, and NGOs are all working in a coordinated fashion to import the lessons learned from other parts of the world. According to Mikkelsen, a lot of "new and innovative" projects are being created in the region to deal with the HIV/AIDS epidemic.
For example, an HIV prevention project among young people has just started in Uzbekistan. According to the Uzbek weekly "Novosti Nedeli," centers supported by the Uzbek youth movement, Kamolot, as well as UNICEF and UNAIDS, are planned to deal with drug, HIV/AIDS, and STI issues in Uzbekistan. In addition, a website containing information about HIV/AIDS has been set up, and a video clip has been recorded with the participation of popular Uzbek singer Sevara Nazarkhan.
In Kyrgyzstan, where an estimated 90 percent of those recently infected are intravenous drug users, the epidemic is concentrated in the southern region of Osh. The authorities are promoting needle-exchange programs for IDUs, while a methadone program against drug addiction has started in Osh.
Damira Imanalieva heads the health clinic run by the Bishkek-based Republican AIDS Association. She told RFE/RL that local ministries are cooperating in the prevention of HIV/AIDS through a committee headed by Deputy Prime Minister Nikolai Tanaev.
"We have begun a special program [in schools] called Healthy Way of Life that covers the causes of HIV and other infections transmitted through sexual activity, drug use, and other issues connected with a healthy way of life," Imanalieva said.
Imanalieva stressed that important work is also being done that focuses on psychological support for people infected with HIV/AIDS. According to Imanalieva, however, the main problem in the fight against the HIV virus is the cost of the treatments, combined with a lack of financial resources in Kyrgyzstan.
Larisa Bashmakova is the UN Development Program's HIV/AIDS coordinator for Kyrgyzstan. Speaking through an interpreter, she told RFE/RL that the Kyrgyz government has become increasingly concerned about creating a multi-sectoral approach to HIV/AIDS prevention in the country, while also improving cooperation with NGOs.
"After the conference in Almaty, governmental and nongovernmental organizations started to establish some kind of linkage. And at present, several oblast administrations are inviting nongovernmental organizations for activities and meetings, trying to work together on HIV prevention," Bashmakova said.
According to Bashmakova, however, the government is not doing enough because of what she calls "misunderstandings" about the problem. First, she said, the Kyrgyz government still considers HIV/AIDS a medical, rather than a social, problem. She also said local law-enforcement bodies are still treating those in high-risk groups, such as IDUs, too harshly, discouraging proper treatment.
Furthermore, Bashmakova said, a lot of work still must be done in the Kyrgyz mass media, which treats the issue of HIV/AIDS in a scandalous, rather than in an educational, way. She said the dissemination of accurate information about HIV/AIDS prevention will improve tolerance and respect for human rights in the country.
(Baian Jumagulova of RFE/RL's Kyrgyz Service contributed to this report.)