Central Asian governments have a "unique opportunity" to prevent an explosion of HIV infections from spreading from high-risk groups, especially intravenous drug users, to the general population, experts said at an Almaty conference. However, some added that a successful prevention effort requires a more efficient use of scarce resources and better coordination among regional governments and international donors.
The conference, "HIV/AIDS/STI Central Asian Initiative," held May 16-18, sought to improve and expand mechanisms to promote awareness and implement preventative action. The more than 90 participants included senior officials from every Central Asian state except Turkmenistan, leading representatives from international donor organizations and health experts. They sought to identify best practices and optimal information dissemination strategies. The conference was co-sponsored by UNAIDS, UNICEF and USAID.
"Even though the overall infection rates remain low in ECA [Eastern Europe and Central Asia], given the socio-economic conditions, increases in other sexually transmitted infections (STI), and other worrisome coinciding trends, the region is ripe for a devastating epidemic," said Laura Shrestha, a World Bank official. "On the positive side, the countries in the Eastern Europe and Central Asia Region have a unique opportunity that many other countries have lost - to intervene early and decisively to prevent the HIV/AIDS epidemic from taking off and spreading into the general population. But the window of opportunity for preventing a heightened epidemic is getting progressively smaller."
Several international organizations, including UNAIDS and WHO, estimate that the number of HIV infections in Eastern Europe and Central Asia has grown from less than 30,000 cases in 1995 to an estimated 700,000 at the end of 2000. The number of reported AIDS cases at the end of February 2001 remained relatively low, with Kazakhstan reporting 1,403 cases; Kyrgyzstan, 58; Tajikistan, 15; and Turkmenistan, four. However, some experts say that official counts of AIDS cases vastly underreport instances of the disease. [For background information see the Eurasia Insight archive].
An overwhelming number of HIV infections in Central Asia are related to intravenous drug use (IDU). In Kazakhstan, for example, health officials reported that 85 percent of new HIV cases were caused by IDU. In Uzbekistan, IDU was linked to 71 percent of new HIV cases. Awareness and prevention programs, if implemented quickly, could significantly reduce the chances of an AIDS epidemic in the region, experts say.
But the implementation of effective awareness and prevention programs is hampered by a severe lack of government resources. International organizations provide a large share of funding for existing programs. Kazakhstan has received the largest amount of support - over $610,000 from various international agencies since 1997. Given the constraints, participants at the conference recognized that greater efficiency in the allocation of resources needed to be achieved.
Central Asian states have increasingly recognized the public health danger posed by HIV/AIDS/STI. Between 1996 and 2000, all five countries in the region approved national programs on HIV/AIDS. Officials attending the Almaty conference asserted that their countries are working to improve national policy frameworks, placing increasing emphasis on promoting coordinated responses to the HIV/AIDS threat.
All five countries have also modified legislation concerning HIV/AIDS-related issues, including detection and confidentiality provisions. Some of the changes are aimed at removing taboos associated with at-risk groups, thereby encouraging those in at-risk groups to seek assistance, instead of remaining underground. As a result, homosexuality is no longer a criminal offense in Kazakhstan and Kyrgyzstan. Meanwhile, prohibitions on drug use have been eased, while trafficking and dealing drugs draw stiff penalties.
Despite the introduction of more liberal legislation, the practices of law enforcement and health authorities remain repressive and controlling. "I constantly am very afraid for my life because my community hates homosexuals, and police persecution is very brutal here," said Tolibjon, a homosexual who lives in Margelan, a small town in the Uzbek sector of the Ferghana Valley.