By Catherine A. Fitzpatrick
It is "already too late" to avoid an AIDS crisis in Eastern Europe and the Commonwealth of Independent States (CIS), say the authors of a new report by the United Nations Development Program (UNDP), "Reversing the Epidemic: Facts and Policy Options" (see http://www.undp.sk). Yet governments and nongovernmental organizations are already improving protection of human rights for HIV-infected patients and vulnerable groups. By ending the stigma of AIDS, creating more public awareness, and taking a humane rather than a punitive approach, countries could still mitigate the type of devastation already experienced by Africa, UN experts say. The former communist countries have the greatest rate of infection in the world, but a turn toward democracy and prosperity also creates the potential to reverse the trend.
Today, one out of every 100 adults in Eastern Europe or the CIS carries the HIV virus, primarily from injecting-drug use, say UNDP officials. Eighty-percent of them are under 30. Although as many as an estimated 1.8 million people in the region are infected, of the 80,000 who require treatment only 7,000 receive it. Ukraine, Estonia, Latvia, Belarus, and Moldova all show sharp spikes of HIV prevalence in the last two years. Overcrowded and unsanitary prisons have become "incubators" for the virus as drug users are jailed. Sex trafficking and mother-infant transmission have created new groups of people living with AIDS. The immunity-destroying virus is no longer just a health problem, but will likely cause significant economic losses and social disruption.
The UNDP advocates better data collection and public-information campaigns, sex education in schools, drug prevention programs, and affordable access to voluntary counseling, HIV testing, and medicines. Some measures are already under way through joint government and civic partnerships such as in Poland, where 80 percent of state-funded AIDS work is through NGOs. The report acknowledges the great role nongovernmental organizations have to play, and that "the communist institutions that dominated political life in most of this region until the 1990s prevented the development of these much-needed representatives of civil society." Pharmaceutical companies should also cooperate to increase production and affordability of retroviral drugs.
Ukraine has been particularly hard-hit, with rapidly increasing numbers of HIV cases, little access to treatment, and weak NGOs. Although the Baltic states are among the most developed countries in the region, their AIDS profiles are "extremely worrisome", the UNDP report says, due to the failure to contain outbreaks among injecting-drug users and prisoners. The Czech Republic, Hungary, Slovakia, and Slovenia differ from their post-Soviet counterparts in that most reported cases were transmitted through male-to-male sex. In Turkey, Bulgaria, Albania, and Macedonia, HIV was spread mainly through heterosexual contact. In the Caucasus and Central Asia, the infection rate is slower, but the proximity of cheap heroin from neighboring Afghanistan mean that in Uzbekistan, for example, prospects for a large outbreak "are uncomfortably high."
The UNDP recommends "de facto decriminalization of injecting-drug use and sex work" rather than penalizing the afflicted, and urges instead the promotion of social intolerance and provision of health services. While recognizing the controversial policy implications, experts say without more tolerant work with infected populations, the epidemic will continue to spiral. The poverty, dislocation, and wars of the region have all set the stage for the epidemic, but where government transparency, media freedom, public education campaigns, and active NGOs are present, there is hope of turning the tide.
For more on HIV/AIDS in Eastern Europe and the former Soviet Union, please see: AIDS Cases Surge In Eastern Europe And Eurasia http://www.rferl.org/reports/ucs/2003/12/35-031203.asp and 'Harm-Reduction' Programs In Russia Threatened http://www.rferl.org/reports/ucs/2004/01/1-080104.asp.
Today, one out of every 100 adults in Eastern Europe or the CIS carries the HIV virus, primarily from injecting-drug use, say UNDP officials. Eighty-percent of them are under 30. Although as many as an estimated 1.8 million people in the region are infected, of the 80,000 who require treatment only 7,000 receive it. Ukraine, Estonia, Latvia, Belarus, and Moldova all show sharp spikes of HIV prevalence in the last two years. Overcrowded and unsanitary prisons have become "incubators" for the virus as drug users are jailed. Sex trafficking and mother-infant transmission have created new groups of people living with AIDS. The immunity-destroying virus is no longer just a health problem, but will likely cause significant economic losses and social disruption.
The UNDP advocates better data collection and public-information campaigns, sex education in schools, drug prevention programs, and affordable access to voluntary counseling, HIV testing, and medicines. Some measures are already under way through joint government and civic partnerships such as in Poland, where 80 percent of state-funded AIDS work is through NGOs. The report acknowledges the great role nongovernmental organizations have to play, and that "the communist institutions that dominated political life in most of this region until the 1990s prevented the development of these much-needed representatives of civil society." Pharmaceutical companies should also cooperate to increase production and affordability of retroviral drugs.
Ukraine has been particularly hard-hit, with rapidly increasing numbers of HIV cases, little access to treatment, and weak NGOs. Although the Baltic states are among the most developed countries in the region, their AIDS profiles are "extremely worrisome", the UNDP report says, due to the failure to contain outbreaks among injecting-drug users and prisoners. The Czech Republic, Hungary, Slovakia, and Slovenia differ from their post-Soviet counterparts in that most reported cases were transmitted through male-to-male sex. In Turkey, Bulgaria, Albania, and Macedonia, HIV was spread mainly through heterosexual contact. In the Caucasus and Central Asia, the infection rate is slower, but the proximity of cheap heroin from neighboring Afghanistan mean that in Uzbekistan, for example, prospects for a large outbreak "are uncomfortably high."
The UNDP recommends "de facto decriminalization of injecting-drug use and sex work" rather than penalizing the afflicted, and urges instead the promotion of social intolerance and provision of health services. While recognizing the controversial policy implications, experts say without more tolerant work with infected populations, the epidemic will continue to spiral. The poverty, dislocation, and wars of the region have all set the stage for the epidemic, but where government transparency, media freedom, public education campaigns, and active NGOs are present, there is hope of turning the tide.
For more on HIV/AIDS in Eastern Europe and the former Soviet Union, please see: AIDS Cases Surge In Eastern Europe And Eurasia http://www.rferl.org/reports/ucs/2003/12/35-031203.asp and 'Harm-Reduction' Programs In Russia Threatened http://www.rferl.org/reports/ucs/2004/01/1-080104.asp.