3 December 2003, Volume 4, Number 35
IN FOCUSAIDS CASES SURGE IN EASTERN EUROPE AND EURASIA. Today, nearly 1 million people in Eastern Europe and Eurasia are living with HIV/AIDS, more than double the number in 1999, the United Nations agency dealing with HIV/AIDS (UNAIDS) reported on 1 December, marked as "World AIDS Day" to draw awareness to the epidemic. High rates of intravenous drug use among young people is fueling the spread of the disease, along with the breakdown in health services, wars, and dislocation of populations throughout the region in the last decade, the UN agency says.
Experts who work with AIDS prevention and treatment programs in the region agree that the hallmark of the epidemic in this part of the world, unlike the profiles of other regions, is the prevalence of drug users among those infected. Yet they caution that other vulnerable groups in the population are also showing increasing rates of infection. For example, as a rise in premarital sex is reported among Romanian adolescent girls aged 15-19, as well as in Ukraine, the number of AIDS cases has increased. A marker for vulnerability to HIV is often sexually transmitted diseases; UNAIDS say these rates are already very high and increasing in the region.
Each country has its specific profile, and generalizations about the region should not prevent understanding the dynamic in certain situations, caution those working at the local level. In the Czech Republic for example, there were only a cumulative total of 611 cases out of a population of 10.3 million. While some were injecting drugs, 53.2 percent and 30 percent of cases were infected through bi/homosexual and heterosexual transmission, respectively, UNAIDS reported. Hungary, with a similar population of 10 million, already had 963 cases at the end of 2001, but 258 of these were foreigners, with most cases due to bi/homosexual relations and a far smaller figure due to drug use.
In Latvia, while the number of cases is apparently less among the population of 2.4 million, 40 percent of HIV cases are aged under 24. From 1987-1997, most cases occurred through sexual transmission, mostly men having sex with men, but since 2000, 72 percent of new cases were from intravenous drug use and now heterosexual cases have grown, along with an "alarming increase" in HIV passed from mother to child, UNAIDS says.
The Balkans have been singled out as a highly vulnerable area for AIDS due to wars, population shifts, and economic privation, and yet the number of cases is dwarfed by comparison to the former Soviet Union. In Croatia, for example, with 4.4 million people, there are approximately 350 people reported as infected with HIV/AIDS.
In Ukraine, with a population of 48.4 million, in 2001, an alarming 1 percent of the population is reported to be infected, mainly among those injecting drugs. Yet the proportion of cases through sexual transmission has also been growing, say doctors, as drug users infect non-drug-using partners. Today, nearly half a million people are said to be HIV-positive in Ukraine, the greatest number of patients with the highest rate of infection in the region.
Romania continues to experience the impact of the infection of about 10,000 children due to unsterile needles and unscreened blood transfusions while in the hospital. In 2001, Romania declared HIV/AIDS a top priority and began to provide reduced-price drug treatment for patents. Its spending of $25 million in 2003 for such therapy contrasted with many other countries.
In Uzbekistan, with a population of 25.6 million, there were few cases until 2000, when cases jumped from 12 to 154 during an outbreak of HIV among drug users; in 2003 the figure had soared to 1,850, mainly in Tashkent and environs. Drug use and commercial sex trafficking are responsible for the increases in cases, UNAIDS says, and recommends that rather than implementing mandatory mass screening and legislation characterized as "repressive," the government should take an approach that reduces vulnerability among young people likely to engage in risky behavior.
Writing in "Foreign Affairs" of December 2002, demographer Nicholas Eberstadt, who surveyed Russia, China, and India as a whole region, concluded that AIDS in Eurasia understood in this wider context could have a far greater impact on the rest of the world in economic and political terms than it did in Africa. Since the appearance of his piece a year ago, experts have said the situation could grow far worse. Unlike the West, where both governments and affected communities have struggled more successfully against the disease, economic considerations will limit the ability of Eurasia to respond. A "drug cocktail" of various drugs to prolong patients' lives -- but not cure the disease -- typically costs $15,000 for one patient per year, Eberstadt wrote. Even if a year's supply of generic versions of the drugs made with local licenses could be manufactured in the developing world for just $600 annually, that cost would still represent a figure too high to pay for many countries. That is, the cost of distributing the drug for free "would often be more than the economic value to governments of the lives thus saved," Eberstadt wrote, implying they may not make the political decisions to save the drug-infected populations marginalized by society. "The tragic truth is that until some kind of actual cure is discovered, most people with HIV/AIDS in the developing world are essentially doomed," Eberstadt said.
Foundations and nongovernmental groups have not accepted such grim predictions as a reason for inaction, and have begun various educational and treatment programs throughout the region. The Open Society Institute funded by George Soros has initiated what it calls the "Harm Reduction Development Program" as part of its public health initiative to work with local government and community groups to distribute clean needles to drug users as well as condoms, and to provide education about how to mitigate the affects of risky behaviors. Conservative officials and some religious groups have objected to the programs as contributing to the promotion of objectionable lifestyles, and rightly point out the lack of focus on creating more programs to end addiction and turn around lives. Proponents of the "harm-reduction" approach believe it is the only way to help stop the further spread of disease, as drug use has become very common.
A key to turning around the numbers of new AIDS victims is much better public education. UNAIDS says knowledge of the virus is very low in Central Asia, especially among vulnerable groups such as teenage girls. In Tajikistan, only 10 percent had ever heard of the disease; in Azerbaijan and Uzbekistan, fewer than 60 percent of the total population knew of and understood the disease, according to UNAIDS surveys. In Ukraine, only 9 percent of adolescent girls knew how to avoid being infected with AIDS.
The International Center for HIV/AIDS Communication (ICHAC), a U.S.-funded organization founded two years ago, is working to change these statistics. The first step is to get governments to become aware of the size of the problem, ICHAC representatives told "RFE/RL (Un)Civil Societies." Many of the figures reported by governments on which UNAIDS and other international agencies rely are only those people willing to come to state-controlled health systems and report that they are intravenous drug users or men having sex with men, the two populations where the rates have risen most in the region. "You have to ask if the people who need to get tested are being tested in these environments," ICHAC President Robert Arsenault said. Hospitals can be more careful about testing women having babies, he says, but they may not reach out to others who could be affected. The prison system, overcrowded and lacking in health services, is fueling the disease, experts say, along with the rise in the number of guest workers moving around the former Soviet Union.
"What is scary to people is that they don't yet understand the dynamic of how AIDS will jump from drug users to non-drug users, or from bi/homosexuals and the sex-worker population to the general population," ICHAC Executive Director Robert Hornsby said. Because this dynamic has developed differently in Eurasia than in other parts of the world, it is difficult to predict how the epidemic will grow. There is no question is will exacerbate the existing population decline, Hornsby says. Governments, spurred by a special UN focus on HIV/AIDS, have begun to respond and speak more openly about the epidemic and prevention. "There have been some surprisingly frank public-service messages on Russian TV," Arsenault said.
Getting an accurate count of cases is crucial to understanding how the trends of infection are turning and where to target prevention and treatment efforts. Experts say methods for collecting statistics on drug users are not effective, because they only include those who voluntarily enroll in programs. In addition to a general breakdown in health administration in Eurasia, there is a lack of compliance still with the standardized reporting methods encouraged by the Council of Europe. "The farther away you are from a voluntary drug-treatment center, the less likely you will be reflected" in statistics collected at the regional or national level, Arsenault said. Ill people do not seek treatment because they wish to avoid punishment; meanwhile, reporting is in disarray and not reflecting the true state of affairs.
While governments must understand the scope of the problem to tackle it, "if you admit to the size of the problem, you will have to come up with the money to tackle it," Hornsby said, in explanation for the reason why some public health systems have played down the threat. This will be hard to do, but countries are beginning to get the wake-up call. The U.S. Agency for International Development has also devoted considerable resources to AIDS, as have other Western governments, the UN, and the World Bank.
The AIDS epidemic has illustrated again and again that making assumptions about how and why infection spreads, without collecting accurate data, can hobble effective prevention and treatment. With populations in Eastern Europe and Eurasia, "there's a vision that because they have much higher literacy, they will have better behavior," Arsenault said, describing a belief that drug use will be isolated only among the poor and uneducated. Surveys performed by nongovernmental groups are finding this stereotype to be inaccurate, as relatively well-off educated people in urban centers also use drugs, become infected, and help spread the disease.
AZERBAIJANJAILED OPPOSITION LEADERS STAGE HUNGER STRIKE. Overshadowed by the tumultuous events in Georgia in recent weeks, where demonstrators in a nonviolent "Revolution of Roses" were able to compel President Eduard Shevardnadze to resign, a group of detained opposition leaders in neighboring Azerbaijan have been on a hunger strike, demanding the release of about 100 protesters, RFE/RL reported on 1 December.
The opposition leaders were imprisoned following Azerbaijan's October presidential elections and still remain in pretrial detention on charges of instigating riots. They in turn are demanding an investigation into alleged vote rigging, said to be similar to the pattern of fabrication of results and imperviousness to scrutiny practiced by authorities in the Georgian elections. Western governments and the Organization for Security and Cooperation in Europe, while maintaining that the election was flawed, have recognized the new leader, Ilham Aliyev, son of previous President Heidar Aliyev, who, like Shevardnadze, was a regional strongman who got his start in the Soviet era.
The head of the committee defending the rights of the detainees in Baku, Vagif Hajibejli, told RFE/RL that 24 people went on an indefinite hunger strike in a prison in the capital Baku and more than five joined them in Musavat and Umid party headquarters. At least 107 opposition activists were arrested and kept in detention in Azerbaijan after thousands of people protested 15 October elections officially won by Ilham Aliyev. At least one death and numerous injuries were reported during the unrest. Musavat Party leader Isa Qambar finished second in the poll and accused the authorities of falsifying the results.
The Journalists' Trade Union in Baku reported on 2 December that Rauf Arifoglu, editor in chief of "Yeni Musavat," a popular opposition daily in Azerbaijan associated with the Musavat Party, joined the hunger strike on 1 December to protest what he said was mistreatment by authorities. On 27 October, Arifoglu was summoned to the Prosecutor-General's Office where he was interrogated about street clashes immediately after the elections. Arifoglu, a leader of the Musavat Party, has accused authorities of instigating the clashes. Since his detention, Arifoglu has not been questioned by officials and they do not appear to be investigating the case, his lawyers say. Other journalists, including from the "Milli Yol" weekly intend to join the strike, as they say that many of those arrested after the demonstrators were journalists covering the events.
The consolidation of power after the October elections has occasioned a general crackdown against all opposition groups and individuals, even those not directly involved in organizing street protests. A leading Muslim activist, who in October found it necessary to seek temporary refuge in the Norwegian Embassy, was detained on 1 December, Forum 18, a European group monitoring religious freedom, reported the same day. Imam Ilgar Ibrahimoglu, of the Djuma mosque in Baku, was originally summoned by the authorities as a witness in a criminal case. "There is no indication what that case was about and who was allegedly involved," a spokesman for a local religious-freedom group known as Devamm (the Azeri acronym for Center for the Protection of Freedom of Conscience and Religion) told Forum 18. After eight hours of questioning, Ibrahimoglu was detained and as of 2 December was still being held in a police isolation cell before a court hearing within 48 hours to decide whether he is to be charged with a criminal offense or released, Forum 18 reported. Ibrahimoglu is also secretary-general of the Azerbaijani chapter of the International Religious Liberty Association.
After the disputed 15 October presidential election, police raided the Djuma mosque during Friday prayers on 17 October in what appears to have been an attempt to arrest Ibrahimoglu and his colleague Azer Ramizoglu. Ibrahimoglu escaped arrest by seeking refuge in the nearby Norwegian Embassy, which he left only on 20 October, Forum 18 reported.
In addition to a crackdown on opposition figures, the government has stepped up activities of state-controlled groups to present a facade of stability and unity to the public and the world. On 1 December, Sheikh ul-Islam Haji Allahshukur Pashazadeh hosted a much-publicized press conference to discuss his meeting with religious leaders of the Caucasus and Russia's leaders, Azertag and other local media reported on 1 December. Congratulating his audience on the feast of Ramadan, he noted that his meeting with Russian Orthodox Church leaders in Moscow was the first meeting at this level since the 1,000th anniversary of Russia's conversion to Christianity. The religious leaders representing the two major faiths of Eurasia discussed events in Georgia and signed a statement exhorting religious believers "not to allow terrorists and extremists to use ethnic and religious differences for their purposes," while urging politicians to "maintain a firm peace in the Caucasus," Azertag reported.
Pashazadeh met with President Vladimir Putin and the Patriarch of Moscow and All-Russia Aleksii II and as well as with representatives of the Azeri diaspora in Moscow. An "inter-religious peace-making forum of CIS countries" was established to affiliate CIS religious leaders, Azertag reported, initiated by Aleksii and Pashazadeh. The group plans to address conflicts in the region, evidently including the dispute between Armenia and Azerbaijan over Nagorno-Karabakh, the subject of some of Pashazadeh's more pointed remarks.
The human rights ombudsman of Azerbaijan, Elmira Suleymanova, appeared on 29 November in Baku and claimed that "everyone enjoys the right of freedom of expression, conscience, and religion" and that the government of Azerbaijan "attaches great importance" to human rights issues, Azertag reported on 1 December. The roundtable where the ombudsman made her remarks seemed designed to deflect criticism from Western embassies about the handling of protesters of the elections.
Rafig Aliyev, head of the state committee on work with religious organizations, said at the roundtable that Islam is based on humanist and universal values, and that every condition was available for other religions in Azerbaijan as well. Speaking of foreign connections of some religious groups, he stressed that no group should commit terrorist acts under the pretext of religion, Azertag reported. Razia Sultan Ismail, coordinator for the Global Religion Net for Children in the Caucasus and Central Asia, said Azerbaijan, as a country linking Europe and Asia, is a convenient place to organize dialogues between various religions. Those at the meeting did not comment on the arrest of Ibrahimoglu.
RUSSIADORMITORY FIRE EXPOSES SHODDY BUILDING, RACISM. A fire in a Moscow dormitory on 24 November that killed at least 36 foreign students and left 171 hospitalized has laid bare Russia's deteriorating infrastructure, drawn attention to fierce racist attitudes particularly among extremist youth groups, and also revealed that despite these conditions, students from developing countries in Africa and Asia still come to Russia in search of a low-price, quality education. Residents at Block No. 6 at the Russian University of the Friendship of Peoples named for Patrice Lumumba, a Congolese revolutionary, fled the early-morning fire, some losing their lives as they were forced to jump from five-story windows after they discovered exits were blocked, AP and Russian wire services reported. Students among the dead and injured were from China, Vietnam, Laos, Cambodia, Mongolia, Afghanistan, Angola, Ivory Coast, Nigeria, Guinea-Bissau, Ecuador, Peru, the Dominican Republic, Morocco, and Lebanon. They had been kept housed in the dilapidated quarters for at least three weeks as part of a quarantine procedure.
Russian and foreign press have speculated whether arsonists were involved, either by skinheads, youths in neo-Nazi movements antagonistic to non-Russians, or disgruntled foreign students themselves. Police have opened up a case not on arson charges, however, but on criminal negligence for failure to provide fire-safety precautions. Deputy Interior Minister Rashid NurgAliyev reported to President Vladimir Putin during a cabinet session that the preliminary investigation revealed an electrical problem, AP reported on 24 November.
Dormitory residents say a common custom of using portable electric space heaters in the poorly heated rooms during Moscow's chilly winters may have caused the conflagration. Students also showed reporters frayed, sparking wires in the dormitory, and unventilated, crowded rooms. They said fire precautions were nonexistent.
Foreign residents of Moscow, debating the cause of the fire on the authoritative Johnson's Russia List (JRL), an Internet discussion group, were quick to cite racist attitudes among Russians in general, as well as a surge in skinhead attacks in the last year, as either directly behind the blaze, or a contributing factor in the failure to establish and communicate safety precautions and respond quickly to the crisis. They also cited a general negligent attitude to fire hazards, especially on campuses. It is common practice, they say, to throw lit cigarettes into wastepaper baskets, to leave burners lighted on stoves because they are difficult to ignite, to use primitive space heaters, and to block fire escapes and exits.
The magnitude of the tragedy -- it appears to be the highest number of victims in a fire in Moscow in a quarter of a century -- has prompted observers to ask questions that go beyond such carelessness. "The area is the closest thing that Moscow has to a black ghetto. Racist incidents happen there with some frequency with skinheads and (allegedly) with the police," wrote one JRL reader about the Lumumba University, while acknowledging that poorly constructed buildings were the immediate cause of the fire. Another reader said the dormitory was overcrowded and the habit of discarding lit cigarette butts widespread, yet racist attitudes prevalent. University staff warned foreign students to stay indoors during times of probable skinhead attacks, like Hitler's birthday in April, but "Russian politicians seem to be indifferent to the problem of racist attacks," he said, recounting the experience of a Liberian student leader whose efforts to get attention to problems of racism were unheeded. Authorities said they "could not rule out" an arsonist's attack, perhaps motivated by xenophobia.
Nikolai Butkevich of the Union of Councils of Jews from the Former Soviet Union, which monitors racist attacks in the region, told "RFE/RL (Un)Civil Societies" that he did not believe the fire was necessarily a deliberate, racially motivated attack, precisely because security had been stepped up in recent months due to a spate of hate crimes against foreign students. On the other hand, he noted, according to "Nezavisimaya gazeta" reports this week, one student removed obscene graffiti from his door three times, and believed either some inside the university were targeting black students, or were managing to pass through security desks.
Concern that the fire could have been set by a hate-filled arsonist was fueled by a fresh attack across the street from Patrice Lumumba University on 29 November. Approximately 20 skinheads in leather boots got off a bus and beat severely two males and three Lumumba students from Jamaica and Colombia, then disappeared on the next bus. Subsequently, a second group of attackers got off a bus and attacked another dark-skinned student, and then fled , "Moskovskii komsomolets" and other Russian papers reported on 2 December. Police arrested three youths aged 15-17, but charged only two, and other attackers eluded authorities.
As news of the attack spread through the campus, a hundred classmates of the victims of the skinhead attack gathered on the street to demand action from school officials. Police were called to the scene to dispel the crowd. Education Minister Vladimir Filippov personally intervened, promising the enraged students that 50 additional police would be brought to the campus, although a police station is already located at the university and there are 240 guards, "Moskovskii komsomolets" noted -- evidently insufficient to prevent attacks. Filippov also proposed that the students themselves organize "druzhiny," groups of volunteer patrols, to watch the campus at night.
"Nezavisimaya gazeta" shone a harsh spotlight on the higher educational system with reports this week of official malfeasance leading to the questioning of Filippov and other officials. Two more stories of fires in dormitories in provincial cities were also reported. While arson was not ruled out in either case, carelessness with either electrical appliances or cigarettes were said to be a likely cause.
Russian attitudes to safety have been discussed extensively since the "Kursk" submarine disaster. Recently, Russians and Americans cooperating in a space program revealed a dispute between what they saw as more safety-conscious Americans and a more flexible Russian approach, AP reported on 9 November. The former head of NASA's safety advisory board said: "In the U.S. program you must prove it is safe. The Russian approach is 'prove it's not safe.'" Each year, 18,000 people die from fires in Russia, five times the number of deaths in the U.S., which has almost twice the population, and contrasting even more with the United Kingdom, which has one fire death per 100,000 compared to 12.5 per 100,000 in Russia, AP reported.
The once-glorious infrastructure of the Soviet Union, built more than 50 years ago as the country emerged from World War II and providing education and jobs for many of its people and for its allies abroad, has now begun to deteriorate, revealing shoddy workmanship. The Soviet-era "speed ups" at construction sites especially at the end of the month, as well as padded accounts to fool superiors, have also taken their toll. Emergency-response systems do not work well, either. Some half-naked victims of the dorm fire suffered frostbite as they waited for ambulances to arrive -- no one thought to bring them blankets. Lumumba University students complained firemen took some 30-40 minutes to respond, a delay some believed was caused by reluctance to help foreign students.
As the days went by and more victims succumbed to their injuries in Moscow, a persistent list of missing or unidentified caused some authorities to claim that itinerant traders were living in the dorm illegally. But a campus official denied the charges, saying that the building had a strictly enforced security system because it was used for a lengthy quarantine procedure to ensure that foreigners did not spread diseases -- a procedure that itself seemed to be applied selectively to those from poor countries and which drew no comment even from a critical media.
Discussion at the "Nezavisimaya gazeta" open forum at ng.ru ranged from the rabidly racist to the remorseful. Some readers posted brutal comments about supposed overpopulation of Africans who "deserved" the fire; others called the tragedy a stigma for a great nation. One reader cited an infamous remark made by President Putin in 2000 about plans to rub out Chechen fighters: "Unfortunately, fascistic youths who are ethnically Russian...have been raised on the Putin ideology of 'soaking' the blacks 'in the outhouse' and they do everything that is expected of them from the powers that be...."
Foreign students believe that Russian authorities are unable to cope with the global educational responsibilities they assumed for ideological reasons in the Soviet era. "Nobody cares about us" students told "Nezavisimaya gazeta." "It's dangerous to live here: the wiring is faulty, the faucets don't work, the sewage system often backs up, and it is filthy We try to put things in order ourselves, and to keep a watch going. But capital repairs are needed, and that costs a lot of money. One bureaucrat told us, 'We don't have a place to live ourselves, and now you come along,'" the students said.
Foreigners have grown more fearful with a disturbing pattern of racist attacks in the last year, according to the Union of Councils of Jews from the Former Soviet Union, which monitors press reports and maintains a network of monitors throughout the region. In October and November, in Moscow, St. Petersburg, and other cities, a half-dozen skinhead attacks left victims in the hospital and only some arrests were made. Prosecutors refused to bring charges of hate crimes against them although witnesses said the assailants had cried, "Beat the blacks!" Authorities often claim such attacks are youthful "hooliganism" rather than hate crimes, and that has given extremist groups a sense of impunity.
RECOMMEND NEWS LINKSINTERNATIONAL. The website of the United Nations agency dealing with the HIV/AIDS epidemic contains individual country reports, public surveys, research, and description of national action plans to combat the epidemic. http://www.unaids.org
A portal page at the Soros-funded Open Society Institute contains links showing Soros-funded and other programs devoted to combating HIV/AIDS and providing education and care for AIDS patients. http://www.soros.org/initiatives/health/links/hivaidssti
RUSSIA. Aids Foundation East West (in Russian and English) provides regularly updated information on issues related to HIV/AIDS with relevance to Russia and other CIS countries. http://www.afew.org/
The Hera International Center of Health Protection (Gera), a network of Russian health NGOs founded in 1995 and the first Russian NGO to join the region-wide European Public Health Alliance, has established sex-education programs in four regions in Russia. Financed by the European Commission, Hera's pilot project plans to present a program to the Health Ministry to disseminate across Russia. The program, named for the Greek goddess known for protection of the family, provides a variety of activities ranging from seminars for health professionals to hotlines for breast-feeding mothers and has made a special focus on AIDS prevention. (In English and Russian). http://www.gera.ru
UKRAINE. The UN's website in Ukraine has devoted extensive attention to UNAIDS and the work of the Ukrainian government and local NGOs in addressing AIDS prevention and treatment. http://www.un.kiev.ua/