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HIV 'Wave' Feared in Central Asia
Asia Times
November 4, 2013

by Pavol Stracansky

MOSCOW - Healthcare systems in Eastern Europe and Central Asia remain woefully unable to cope with HIV/AIDS as the region's raging epidemic - the fastest growing in the world - takes on a new dimension, a senior UN official has told IPS.

Until now the Eastern Europe and Central Asia epidemic had been driven by injection drug use. But data and anecdotal evidence has shown a strong rise in the spread of the disease through heterosexual transmission as well as via men who have sex with men - potentially throwing up a new set of challenges for governments and healthcare ministers.

But, says the UN Secretary General's Special Envoy on HIV/AIDS in Eastern Europe and Central Asia, Michel Kazatchkine, until a new approach to treating the disease is taken in countries worst affected by it, the response to the epidemic will continue to be poor and largely ineffective.

He told IPS: "HIV/AIDS in Eastern Europe and Central Asia needs to be taken out of the medical ghetto which it is in at the moment.

"Regardless of whether it is driven by heterosexual transmission or drug-injection, I am afraid that until the disease gets visibility and health systems get geared up to take it on, it will not be dealt with properly. In some countries it will probably take a wave of deaths, or the death of someone famous or a prominent member of the church for anything to change."

For many years Eastern Europe and Central Asia has had the world's fastest growing HIV/AIDS epidemic. The estimated number of people with HIV has grown by 140% in the past 10 years, according to UN figures. Russia has 70% of all people living with HIV in the region and together with the Ukraine accounts for 90% of the region's HIV infection cases.

The epidemic remains primarily linked with injection drug use with over 35% of case reports in the region associated with drug use.

But in the last five years, there has been a marked increase in heterosexual transmission which now accounts for 30% of reported cases, according to Kazatchkine. Much of this is believed to be between male drug users and women.

However, the exposure route of 40% of infections in the region is classified as "unknown". It is thought that most of these are among men who have sex with men.

Discrimination, persecution and stigmatization of homosexuals, drug users and people with HIV/AIDS means that it is impossible to collect accurate data on the spread of the disease.

Gay men are often fearful of admitting to doctors how they became infected and instead say that they contracted it through heterosexual sex. Drug users, who can face long prison sentences in some countries in the region, do the same.

Recent legislation banning the promotion of same sex partnerships and long-standing travel restrictions in some parts of the region for people with HIV have only further marginalized groups in which the disease is spreading rapidly. This presents a major problem in effectively dealing with the epidemic, say doctors, as it adds to existing barriers to the prevention and treatment of the disease.

Professor Jens Lundgren of the European Aids Clinical Society (EACS) told IPS: "What we know is that any policies, anywhere in the world, which are introduced and which marginalize or stigmatize people with HIV are counter-productive to treating the disease. A good, rational health policy is one that involves a clear view of a disease's epidemiology - where, in what communities and how it is being spread."

This comes on top of what has been repeatedly criticized by international bodies as a continuingly poor healthcare response to the disease in many countries.

Access to anti-retroviral treatment is very low - with as little as 8% of all those in need of it being able to obtain it in Russia, for example. Systematic care of those diagnosed with the disease is also inadequate.

"One of the problems in Russia is that there is no integration of a patient with HIV into the primary health care system," said Kazatchkine. "When someone is diagnosed they are simply referred to a special center and passed on. It is as if they are something to be got rid of. No one follows up on them and they are essentially forgotten."

There are fears that news of the changing nature of the epidemic's spread could be used by some authorities to push their own political agendas on how to deal with the epidemic.

International bodies have urged countries in the region to adopt harm reduction program, including needle exchanges and drug substitution therapy, which are recommended best practice in the West as a front-line measure to help prevent the spread of the disease.

While some countries, notably the Ukraine, have had some success in rolling out these program and helping bring down new infection rates, others, such as Russia, are apathetic or even hostile to harm reduction.

Drug substitution therapy is illegal in Russia as political and medical authorities refuse to sanction it and there are no state needle exchange program. The vast majority of funding for prevention programs has come from foreign organizations, but some of these have left the country as its regime has become more authoritarian.

Some of the few organizations in Russia offering harm reduction services, such as the Humanitarian Action NGO in St Petersburg, have told IPS of the problems drug users face in accessing harm reduction programs and of the difficulties they have in providing them, from almost absent funding to hostile police and societal attitudes.

That the disease is being spread more and more by sexual behavior could provide ammunition to those who argue harm reduction programs are a waste of resources.

"There are some authorities in the region which take every opportunity to use something that takes attention away from the need for continued harm reduction strategies and programs, and I fear the fact there is a rising heterosexual spread of the disease could be instrumentalized to attack harm reduction programs among drug users," Kazatchkine told IPS.

This would further hamper efforts to combat the epidemic as injection drug use is expected to remain the main route of transmission of HIV in the region for some time to come.

"There will continue to be an increase in sexual transmission while the epidemic among drug users will not slow down," said Kazatchkine.

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