Although divided by a separatist conflict and decades of tension, Abkhaz and Georgians have proven willing to set mutual grievances aside when humanitarian matters come into play. One such area is the treatment of those infected with HIV/AIDS.
The European Centre for Disease Prevention and Control (ECDC), a Stockholm-based European Union agency, reports that Georgia has one of Europe’s highest rates of full-blown AIDS cases – 6.5 per 100,000 people compared with 1 case per 100,000 people in the European Union.
As do most international organizations, the ECDC includes Abkhazia in its evaluation of Georgia. EurasiaNet.org could not obtain comprehensive, separate statistics for HIV/AIDS in the breakaway territory.
Intravenous drug use is named as the largest risk factor for HIV transmission; in Georgian-controlled territory, it accounts for approximately 55.9 percent of the 2,904 cases of HIV infection registered in 2011, according to Tbilisi’s Center for Infectious Diseases, AIDS and Clinical Immunology.
Data about the scope of drug use and abuse in Abkhazia was not available, but Abkhaz physicians describe the problem as “very serious.” Sukhumi AIDS Center Director Dr. Ljudmila Avidzba, a former de facto health minister, described drug abuse as the primary cause of Abkhazia’s HIV/AIDS problem. “Most cases are drug-related and the disease is passed on to the women,” said Dr. Avidzba. In an effort to control HIV infection, Abkhazia’s legislature in 2003 passed a law requiring mandatory blood tests for all registered pregnancies.
The Sukhumi AIDS Center, set up with support from USAID and Save the Children, has treated 600 patients since opening in 2001. Today, it treats 90 people for free with antiretroviral (ARV) therapy, and offers counseling. But staffers cannot address full-blown cases of AIDS, according to a source well informed about Abkhazia’s HIV/AIDS problem who requested anonymity.
Voluntary test centers also have been established outside of Sukhumi (in the seaside town of Gagra, to the north; and in the predominantly ethnic Georgian town of Gali, to the south).
The de facto Abkhaz government acknowledges the gravity of the problem and conducts two annual public information campaigns about the risks of HIV/AIDS. But those campaigns do not include a frank public discussion about safe sexual practices or drug abuse.
"People don't talk about condoms and safe sex publicly," said Liana Kvarchelia, deputy director of the Centre for Humanitarian Programmes, a non-governmental organization in the Abkhaz capital. “They [intravenous drug users] might know sharing needles is dangerous, yet they don’t realize that dipping individual needles into a communal cup of drug mixture is just as dangerous.”
No non-governmental organizations or professionals in Abkhazia work specifically on drug-abuse issues related to HIV. The Sukhumi Narcology Dispensary has a 25-bed detox facility, but chief physician Dr. Irma Anua says that a limited budget prevents the facility from developing a rehabilitation program.
Abkhazia’s de facto health minister, Zurab Marshania, could not be reached for comment.
Aside from limited local treatment options, the social stigma of HIV/AIDS often prompts Abkhaz to look beyond Sukhumi for help. Dr. Avidzba says that many people “go abroad to hide” when they discover they are HIV-positive. “They’re afraid to show their faces,” she said.
In search of treatment, some Abkhaz head to the Russian city of Krasnodar, roughly 300 kilometers from Sukhumi; some patients report, however, that they find the level of HIV/AIDS care sub-optimal and expensive.
Still others head to Tbilisi, an eight-to-10-hour car ride away. The Tbilisi-based Center for Infectious Diseases, AIDS and Clinical Immunology reports that since 2006, it has diagnosed and treated 198 residents of Abkhazia with HIV/AIDS.
“They receive all the same treatment anyone in Georgia would receive,” said Fati Gabunia, head of the Center’s Department No. 2, which oversees HIV/AIDS treatment. “At first, many do not feel comfortable about coming to Tbilisi and turning to our clinic, but after they see that we are doing a good job and it is safe to be here, they come again with more confidence.”
Most Abkhaz pay for treatment, Gabunia said. Roughly a quarter, she estimated, use Georgian passports to receive treatment and resources available for free to Georgian citizens via the Global Fund to Fight AIDS, Tuberculosis and Malaria. Others show Russian passports or other forms of identification. In critical cases, the clinic often bends the rules to help, regardless of whether patients have proper documentation, she added.
Such trips, however, are not readily acknowledged within Abkhazia, where most residents view Tbilisi as the hostile capital of an enemy state. With a shrug, Sukhumi AIDS Center’s Dr. Avidzba commented that an HIV-positive patient may choose to travel to Tbilisi, but added that she had no knowledge of such trips.
Similarly, representatives of Abkhazia’s de facto government would not confirm reports that Georgian doctors and public health program managers make occasional trips to Sukhumi to train local staff and deliver antiretroviral medicine and other HIV/AIDS-prevention supplies.
Tbilisi’s Center for Infectious Diseases, AIDS and Clinical Immunology is not the only medical facility working with patients from the breakaway region. Reports routinely circulate about hospital treatment of Abkhaz in the nearby city of Zugdidi, as well as in other clinics in the Georgian capital.
In Tbilisi, one dental clinic recently offered a 50-percent discount to Internally Displaced Persons (IDPs) from Abkhazia, a group overwhelmingly comprising ethnic Georgians. But, rather than IDPs, an Abkhaz family that had traveled from Sukhumi to Tbilisi was among the first to make use of the discount, relates clinic co-owner Nana Kintsurashvili, a Sukhumi-born dentist. Dr. Kintsurashvili, no supporter of Abkhaz independence, recounted that she and her Abkhaz patients – both natives of a region where feuds and friendships are often just a word away – struck up an awkward, yet intense conversation about mutual acquaintances, family connections and Abkhazia itself.
In the end, the dentist decided to extend the IDP discount to her visitors from Abkhazia. After all, she said; “[w]e are from the same land.”
Paul Rimple and Giorgi Lomsadze are both freelance reporters based in Tbilisi.