UN Chronicle | HealthWatch: HIV in the CIS

HealthWatch: HIV in the CIS
By Sanjay Sethi, for the Chronicle

Article

The AIDS epidemic is spreading rapidly across Eastern Europe and Central Asia, with countries of the Commonwealth of Independent States (CIS) experiencing the world's fastest-growing infection rate. Approximately 1 million people in the region are living with HIV/AIDS—more than double the 420,000 infected at the end of 1999. An estimated 250,000 new HIV infections occurred in 2001. With both high levels of other sexually transmitted infections (STI) and high rates of intravenous drug users among young people, the epidemic seems set to continue its rapid growth.

Before 1994, no country in the region was reporting more than a few HIV infections. A year later, the first reported HIV outbreak occurred in Ukraine and Belarus. The epidemic then started to expand into other neighbouring countries. Moldova had its first outbreak in 1996 and the Russian Federation in 1998. Similar outbreaks were reported in Latvia and Kazakhstan shortly thereafter.

The major mode of HIV-transmission in Eastern Europe is through intravenous drug use. Up to 1 per cent of the population of the CIS countries may be injecting drugs, placing themselves and their sexual partners at high risk of infection. Outbreaks of HIV-related intravenous drug use are also being reported in several Central Asian republics, including Kyrgyzstan, Tajikistan and Uzbekistan.

The best available data suggests that drug use by injection is responsible for more than 60 per cent of all new HIV transmissions in Eastern Europe. Unsafe sexual practices have also contributed to the spread of AIDS there, and with the increasing number of sex workers, this will likely continue to be a problem in the near future.

Ukraine is the hardest-hit country in all of Europe. According to its Ministry of Health, an estimated quarter million of its citizens are currently infected with the virus—approximately 1 per cent of the adult population. Helen Petrozolla of the United Nations Development Programme (UNDP) Country Office, an expert on HIV infection in Ukraine, suggests that the figures of those infected are vastly underestimated due to a lack of effective surveillance mechanisms; instead, it is probably five to six times that number.

Historically, countries of the former Soviet Union were slow in responding to the advancing threat of AIDS. This was due largely to the stigma attached to the disease. In the past, HIV testing was imposed only on populations that were considered at risk of contracting the disease. Those tested as HIV-positive were often detained and isolated from the rest of society, perpetuating the fear and stigma associated with HIV/AIDS. Fear of discrimination may prevent people from seeking treatment for AIDS or from acknowledging their HIV status publicly. People with or suspected of having HIV may be turned away from healthcare services, denied housing and employment, or turned down for insurance coverage.

According to Geneve Mantri of the UNDP Country Office in Romania, the Central European countries did not suffer from the same level of discrimination as those in Eastern Europe: "Countries in Central Europe recognized the problem quickly because of political and social dynamics. Their attitudes were closer to that of Western Europe."

Several Central European countries have managed to control the spread of HIV and serve as model examples for others in the region. The HIV-surveillance systems in the Czech Republic are considered among the best in Europe, and prevalence there remains low. Hungary and Slovenia have similarly designed national AIDS programmes and have just been as successful. Poland has also made considerable strides in curbing the spread of HIV among injecting drug users through needle exchange programmes and other initiatives to reduce the sharing of syringes.

Although the AIDS epidemic continues to grow in this region, changes have been made to reverse this trend. Countries such as Bulgaria, Romania, the Russian Federation and Ukraine have altered their strategies and substantially increased the budgets of their national AIDS programmes. An increasing number of health centres within the region now offer voluntary testing and pre- and post-test counselling. Belarus and Kazakhstan are employing successful education and HIV-testing programmes that are helping to curb the epidemic.

A number of UN agencies are also taking an active effort in the region. The United Nations Country Team in Ukraine has implemented ACT NOW, an initiative that is using the collective strength of all local UN agencies in order to support the Ukrainian Government in developing a sustained and coordinated national AIDS prevention programme. Similarly, in the Russian Federation, UNDP launched the "comprehensive partnership strategies for HIV/STI prevention among young people" in the country. The efforts are unified in their belief that intervention has the best chance of success in slowing the spread of AIDS in Eastern Europe.

Tip of the Iceberg?

Eastern Europe and Central Asia is home to the world's fastest-growing HIV/AIDS epidemic. In 2002, HIV infections climbed to 1.2 million. But an even darker portrait of the breadth of the HIV epidemic appeared in 2001 in the Russian city of Togliatti. The first community survey of injecting drug users (IDU) in the Russian Federation suggested that relying on registered HIV cases likely underestimated the number of people actually living with HIV by a large margin. Fully 56 per cent of the users participating in the study turned out to be HIV-positive—a large share of those had acquired the virus only in the previous two years. Three quarters of IDUs living with the virus had not known they were infected.

Heterosexual intercourse has become a prominent mode of transmission in Ukraine and Belarus. Some 40 per cent of female sex workers there who also injected drugs do not use condoms consistently with their regular partners, and about a quarter do not use them with their commercial sex partners.

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