The World Bank is urging leaders in Central Asia and Eastern Europe to take urgent measures to avert a potentially catastrophic epidemic of HIV/AIDS. In a report released yesterday, the World Bank says the postcommunist region has the fastest growing number of HIV/AIDS victims in the world. But many governments, according to the World Bank, remain in "denial" over the crisis.
The World Bank, in its latest report, says Eastern Europe and the republics of the former Soviet Union are experiencing the globe's fastest rise in HIV and AIDS cases.
The World Bank says an estimated 1.2 million people are living with HIV or AIDS in the region at present, with 250,000 new infections diagnosed in 2002 alone.
Olusoji Adeyi, the organization's leading health expert, is warning that unless governments of the region devote far greater time and financial resources to tackling the problem, HIV/AIDS could soon turn into a crisis that will have dramatic demographic and economic consequences, as seen in other parts of the world.
In almost every country across the region, the pattern has been the same. At the end of the 1990s, a handful of HIV cases -- the virus that causes AIDS -- were diagnosed, mostly among intravenous drug users. Within a couple of years, cases of HIV infections began to grow at exponential rates and continue to do so.
Since 1998, for example, the number of HIV cases in Russia has grown twentyfold -- from 11,000 to more than 240,000 in 2003. According to official government statistics, the trend in neighboring Ukraine is similar, with the number of HIV cases last year jumping to more than 50,000. The director of the Odesa-based Institute for Social Studies, Oleksandr Yaramenko, says that by 2010, the number of patients is expected to rise to 1.4 million, with an estimated 100,000 people dying per year from AIDS.
Although the numbers appear lower at first glance in Central Asia and the three Baltic states, the trend there is equally worrying. In Lithuania, for example, the number of people registered with HIV doubled in a single year following an outbreak of the disease in one of the country's prisons.
Researcher Chris Beyrer, in a recent study for the Johns Hopkins Bloomberg School of Public Health in the United States, found a direct correlation between the jump in HIV infection rates in Central Asia and the location of heroin trafficking routes. In Central Asia, the cities of Timertau, Kazakhstan; Yangi Yul, Uzbekistan; and Osh, Kyrgyzstan, have some of the highest documented rates of HIV in the region and all lie directly on drug-trafficking routes.
Irina Savtchenko of the World Health Organization (WHO) in Geneva tells RFE/RL that, demographically, young people are disproportionately affected by the growth in HIV/AIDS in the region.
"Youth is the most vulnerable section of the population now, and about 85 to 90 percent of infected persons are between 18 and 25 years old," she said.
Unlike in Western Europe and the United States, the majority of HIV infections in the former Soviet Union and Eastern Europe occur among intravenous drug users. This, says Savtchenko, is one of the main reasons why infection rates are growing at such a rapid pace.
"In Western countries, it's mainly a sexual way of transmission, which is slower, and in Eastern Europe it's injecting drug use," she said. "For example, the risk of obtaining HIV via sexual intercourse with an HIV-infected person is 0.1 percent, whereas via sharing injecting [needles], it's about 30 percent, so you see the difference."
The fear among health officials, which is starting to be confirmed by statistics, is that the dramatic rise in HIV infections among young drugs users will begin to spread to the rest of the population through sex and blood transfusions.
Ainagul Osmonova, deputy director of Kyrgyzstan's AIDS Center in Bishkek, acknowledges the potential for an epidemic, especially because of the rapid rate of transmission in the region through intravenous drug use.
"At the present time, there are some 400 HIV/AIDS patients in Kyrgyzstan, although this is only the official count," Osmonova said, "and it could in fact be up to 10 times greater. Most of them are intravenous-drug users. For Central Asia, this new disease presents a grave potential danger. If the disease were primarily spread through sex, the rate of infection would not be so rapid."
Yet the World Bank report says many countries that could be the worst affected by this potential crisis continue to live "in denial."
For the past several years, in Western Europe and North America, state-sponsored anti-AIDS campaigns have focused on education and treatment of AIDS patients with expensive antiretroviral drug therapies. The drugs do not cure AIDS but keep the disease under control. Some countries, such as the Netherlands and Switzerland, have adopted what they call a "harm-reduction" strategy, which includes giving drug users clean needles in exchange for used ones, so they can cut their chances of catching AIDS.
Savtchenko explains: "A harm-reduction strategy includes a lot of different interventions: counseling, information, needle-exchange, referring persons to the appropriate medical settings and, yes, there are some projects in the countries of the region. For example, in Russia, there are about 50 harm-reduction projects, but the coverage is still very small."
The problem is that most countries in the former Soviet Union say they cannot afford the cost of providing expensive drugs and their budgets for AIDS education remain very small. Russia last year allocated the equivalent of only $5 million for federal anti-AIDS programs.
But experts say this will have to change. Governments will have to make more money available, at least for prevention, if they want to avoid a major public health crisis that will have a far greater economic impact five to 10 years down the road.
By Jeremy Bransten,
RFE/RL Weekday Magazine, September 17, 2003