As the globe marks World AIDS Day today, the United Nations is warning that the spread of the disease is particularly acute in Eastern Europe and Central Asia, where the UN says "HIV prevalence clearly remains on the rise."

According to a 2009 AIDS epidemic update report prepared by UNAIDS and the World Health Organization (WHO), an estimated 1.5 million people are living with the HIV virus in the regions, compared with 900,000 in 2001.

AIDS claimed an estimated 87,000 lives in the regions during 2008, more than three times the 2001 figure.

The epidemic is especially severe in Russia and Ukraine, where almost 90 percent of HIV-infected people in the region live.

For UN purposes, Eastern Europe and Central Asia includes the countries of the former Soviet Union, in addition to Bosnia, Bulgaria, Croatia, and Romania.

Highest Level In Europe

Galimjan Zaripov tells RFE/RL's Tatar-Bashkir Service that the disease is following a worrying pattern in Russia's republic of Tatarstan. Zaripov is the chief doctor at the AIDS prevention center in Chally, the republic's second-largest city.

"Today more than 11,000 people are registered with the HIV infection in Tatarstan," Zaripov says. "Unfortunately, the number of infected people in rural districts is approaching the level of big cities. In towns like Elmet, Leninogorsk, and Bugulma the numbers have already overrun those in big cities."

With an estimated 940,000 people infected, Russia is experiencing the highest rates of infection in the region. Ukraine, however, has the highest infection level reported in all of Europe with adult HIV prevalence over 1.6 percent of the population.

Annual numbers of newly reported HIV diagnoses are also rising in other countries, including Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, and Uzbekistan, which now has the largest number of cases in Central Asia.

Injecting drug use remains the primary route of transmission in Eastern Europe and Central Asia, where an estimated 3.7 million people currently inject drugs. Roughly one in four are believed to be HIV-infected.

In many countries, drug users frequently engage in sex work, magnifying the risk of transmission into the general population.

Infected Children

The UN report says "a notable number of new infections may be occurring" as a result of unsafe injections in health-care settings.

That's what happened in Kyrgyzstan's southern Osh region, where 75 children were infected in 2007 in the Nookat district hospital. Four local health workers have been jailed and five others given suspended sentence for negligence in the case.

Kyrgyz lawmaker Gulnara Derbisheva of the ruling Ak Jol (Best Path) Popular Party told RFE/RL's Kyrgyz Service that the children's conditions remains serious despite international help.

"We all are aware that the 75 babies in the Nookat district got this disease because of the doctors' fault. The condition of those babies is grave," Derbisheva says. "Of course, there are drugs from the AIDS Center. There is help thanks to the grants provided by foreign countries. There is no shortage in drugs."

Researchers say the HIV epidemic cannot be reversed without strong, sustained success in preventing new HIV infections.

But social stigma and discrimination often undermine HIV prevention efforts, making people reluctant to be tested and to seek out information about how to protect themselves.

It also makes people already living with HIV less likely to seek care and treatment and disclose their HIV status.

In addition, many governments' aggressive drug control policies often inhibit the use of harm-reduction programs, such as the distribution of clean needles to drug addicts, which has been shown to reduce infection rates.

Homosexuals Stigmatized

In Tajikistan, the government provides a pension to those infected with HIV. But one Dushanbe resident, who declined to give his name, told RFE/RL's Tajik Service that too much paperwork and a fear of social exclusion prevented him from applying for the payments.

"There is no change in this regard. [HIV-positive people] are as poor as they were before. Only aid organizations provide some food," he says. "Most infected people are unemployed. If the employer finds out that they are HIV positive, they lose their job or won't be employed."

There are concerns that official statistics may significantly understate the extent of infection among homosexual men, a population heavily stigmatized in the region. Meanwhile, the criminalization of drug use makes it difficult to gain an accurate picture of the proportion of drug users who are living with HIV.

Access to antiretroviral treatment coverage remains relatively low in the region. By December 2008, 22 percent of adults in need of antiretroviral therapy were receiving it -- a level less than half the global average for low- and middle-income countries.

Evidence suggests that injecting drug users are often the least likely to receive antiretroviral therapy when they are medically eligible, while sex workers are often ostracized and deterred from seeking appropriate services.

Globally, there are now some 33.4 million people living with HIV, the vast majority of whom live in lower- and middle-income countries.

Copyright (c) 2009. RFE/RL, Inc. Reprinted with the permission of Radio Free Europe/Radio Liberty, 1201 Connecticut Ave., N.W. Washington DC 20036.