The response to Central Asia's HIV/AIDS crisis is hampered by a lack of information. International experts suspect that statistics produced by regional governments may significantly underestimate infection rates. The dearth of hard data is in part related to Central Asia's continuing reliance on the propiska system - a vestige of the Soviet-era designed to limit freedom of movement.
The propiska, or residency permit system effectively discourages many groups particularly vulnerable to HIV infection from officially registering with authorities. It also hinders those already infected from seeking counseling and treatment. In spite of these self-evident drawbacks, Central Asian leaders are reluctant to tinker with the system out of concern that changes could foster political challenges to their authority.
Though statistics paint an incomplete picture of the HIV/AIDS crisis in Central Asia, international observers are frightened by what they see. For example, a Kazakhstani newspaper reported December 8 that there were 480 HIV-positive cases in the northern Pavlodar region. In December 2000, the region had only 13 registered cases. The newspaper also reported that Pavlodar's infection density was 4.4 times higher than the global average.
Overall, experts estimate that roughly 14,000 people with HIV live in Kazakhstan, ten times the number the government released in February. To prevent the epidemic from settling in the general population, the government would have to commit itself to comprehensive surveillance programs to monitor and prevent the transmission of the virus. Given the context of the propiska system, where those who are most vulnerable are likely to avoid all contact with state authorities, achieving the requisite level of surveillance is practically impossible.
During the Soviet era, authorities required all citizens to have a propiska, or residency permit. Without one, a citizen could not work legally, or obtain access to health care and other social services. The residency rules were designed to assist the development of the centrally planned economy, but they also helped the Communist regime maintain political control by regulating population movements.
Following the Soviet collapse in 1991, the newly independent states of Central Asia officially renounced the propiska framework. Nevertheless, many elements of the system remain in force throughout the region. Central Asian leaders evidently fear that lifting all controls over population movement at a time when their countries' economies continue to struggle could create a socially explosive situation.
Mostly, the rules are employed to discourage migration from rural areas to cities. In Kazakhstan, for instance, the government can still refuse registration in places like the capital where more economic opportunities may exist. Residency rules may reduce internal migration, but they do not prevent it. Observers say significant numbers still are moving to cities, but, since those on the move must lead an underground existence, the trend is difficult to gauge.
That the propiska system is now being linked to the HIV/AIDS crisis does not come as a surprise to Kasia Malinowska-Sempruch, who runs the International Harm Reduction Development Program at the New York-based Open Society Institute. When Soviet-style rules are utilized to govern movements in a quasi free-market environment, social problems are bound to arise, she says. "The fact that we are beginning to see HIV infections in pretty much all the large cities of Kazakhstan and in parts of Kyrgyzstan is an indication that people are moving around," Malinowska-Sempruch said.
Economic necessity is driving migration. A recent Almaty telephone poll found that at least 10 percent of people leave their homes for different Kazakhstani oblasts or foreign countries in search of work. The failure of regional governments to change residency rules to recognize the new economic reality may constitute a threat to public health. Many economic migrants, especially prostitutes, are at high risk of HIV infection.
Sexually transmitted infections (STIs) have spread faster in communities located along transport routes or surrounding major developing projects, such as oil and gas-related ventures. In the last decade, says Malinowska-Sempruch, known precursors to HIV epidemics such as syphilis, gonorrhea, and other STIs, have increased exponentially, especially in Kazakhstan.
While governments have tried to deal with the problem through strict immigration restrictions, such a policy approach is inadequate, given current migration patterns. Increasing economic inequalities between regions and the permeability of surrounding borders have led people to move without legally immigrating. By making citizenship so hard to gain, the process may actually discourage vulnerable people like migrant laborers, drug users and prostitutes from seeking HIV prevention information, testing, counseling, and support.
The propiska system also keeps migrants on the fringe of their host communities, even if they live with legal citizens. Without official registration, migrants and their children do not have easy access to health care and education. They also suffer from police harassment and shakedowns more often than registered citizens. In addition, economic migrants elude outreach efforts by aid workers, and thus, once infected, they can continue to pose a health risk to those they come in contact with.
The near-term prospects for changes in the propiska framework appear low. Eurasia Group senior associate Leslie Powell said the increasing reliance of Central Asian governments on authoritarian methods precludes the adoption of measures that ease restrictions on movement. Regional leaders cite the threat of Islamic radicalism as justification for keeping tight controls over migration.
"While the overhaul of the system in the more distant future is not altogether inconceivable, to do so in the near future is certainly not a likely possibility," Powell says.