BACKGROUND: In June 2001 Central Asian Conference on the Prevention of HIV/AIDS held in Almaty, Kazakhstan brought together government officials, UN specialized agencies and NGOs to discuss the explosive growth of HIV/AIDS prevalence in the region. It was the first time that Central Asian governments openly acknowledged the problem and signed a declaration that calls for the establishment of a consensus and the development of a regional strategy to combat HIV/AIDS. The declaration is considered a major breakthrough in recognizing the problem and hopefully marks the end of the "denial era". The lack of awareness, and the relatively low prevalence rates of HIV/AIDS in Central Asia in the last decade have been the main reasons for the slow response from the governments to the increasingly worrying problem. Recent HIV/AIDS outbreaks all over the region, however, sent an alarming message that immediate preventive measures were necessary, if a large-scale epidemic was to be avoided. According to the United Nations, Eastern Europe and Central Asia have shown the highest incidence rate of HIV/AIDS in world last year, with 250 000 newly registered cases. At the end of 2001, Kazakhstan had the largest number of officially reported cases in Central Asia (2,256), followed by Uzbekistan (779), Kyrgistan (208), Tajikistan (45) and Turkmenistan (4). Even government officials, however, recognize that these statistics grossly underestimate the real prevalence which according to local and international experts is at least ten times higher. Accurate estimates are problematic because of the lack of proper epidemiological surveillance and the repressive practices of law enforcement bodies used against high-risk groups. Police continue the old soviet practice to use medical professionals to track drug users and commercial sex workers. Public condemnation of the victims and the costs of treatment further marginalize them, effectively isolating high-risk groups from medical and preventive services. 

IMPLICATIONS: Needle sharing and other unsafe practices among drug users is the main factor that drives the epidemic. It is also evident that the epidemic is spreading along the drug trafficking route that stretches from Afghanistan across Central Asia to Russia and then to Europe. During 2001 alone, 8.8 tons of drugs, including 4.2 tons of heroin, were seized in Tajikistan, a 26% increase over 2000.  High rates of extreme poverty and unemployment throughout the region, furthermore, foster the illegal drug trade. Initially serving only as transit countries for drug smugglers, Central Asia and its young population has become a lucrative market in itself for illegal drugs.  The high incidence of other sexually transmitted infections (STI) in the region further facilitate the emergence of a HIV/AIDS epidemic. Kazakhstan had 640 cases of syphilis per 100,000 in 2000, which is the second highest prevalence rate in the European region, reflecting a more than 500-fold increase from the early 1990s. In one study conducted by the World Health Organization (WHO) in the south of Tajikistan, it was found that a number as high as 75.7 % of the surveyed women had one or more STI. Despite such alarming incidence rates of sexually transmitted infections, the public perception of the HIV/AIDS threat is very low, and it is commonly viewed that HIV/AIDS is a problem of foreigners and drug addicts only. Even health professionals don't always feel comfortable, or have skills, to discuss HIV/AIDS prevention with the population that they serve.  So-called one-company towns have become the first centers of the HIV/AIDS epidemic in Central Asia. Virtually everyone in the Kazakh town of Temirtau has become unemployed when its giant steel smelter ran out of cash in the early 1990s. Since then, Termirtau has become almost a "ghost" city and a main hub of illegal drug trade in Central Asia. Now Termirtau is also home to 70% of all HIV/AIDS cases registered in Kazakhstan.  The HIV/AIDS epidemic in Central Asia appears to follow the same pattern as in Russia and Ukraine: at its early stage, the epidemic hits mainly intravenous drug users, but later as sexual transmission begins to prevail, the virus penetrates all layers of society. Relatively free population movements within CIS countries and the existence of several millions of seasonal workers from the Central Asian states (mainly Tajikistan and Uzbekistan) in the European regions of CIS link the epidemics in Russia and in the Central Asian states. There were 182,000 reported cases of HIV/AIDS in Russia as of February 1, 2002, and it is commonly believed that this represents only a small fraction of the real number – and there may well be more than one million Russian adults already infected with HIV. 

CONCLUSIONS: If the epidemic continue to grow at the same rate, one can expect hundreds of thousands of HIV-infected people in Central Asia in a very short period of 5-6 years. With its scarce resources available for health care, the region simply cannot afford the epidemic. Among Central Asian states, only Kazakhstan has the capacity to some extent to offer antiretroviral treatment to a limited number of privileged patients. The average cost of life-sustaining treatment for one AIDS patient is around $10,000 annually. For the majority of Central Asians, a diagnosis of AIDS would therefore mean a death sentence. The treatment of opportunistic diseases associated with AIDS would be an unbearable burden for the health care budgets of the regional states, and in combination with ongoing epidemics of tuberculosis and STI, they may well wipe away the results of any modest economic growth. However, there is still opportunity to avoid a large-scale epidemic in Central Asia. However, time is short, and collective regional efforts with an emphasis on prevention and reduction of prevalence of drug addiction is urgently needed.  

AUTHOR BIO: Ali Buzurukov received his M.D. degree from the Tajik State Medical Univerity and worked with international aid NGOs in the CIS. He studied public health management and economics at the St. Petersburg Academy of Posgraduate Medical Education, and then as a Muskie Fellow, he received a Master degree in Public Health from Boston University in 2001. Until recently he served as Country Director for Russia and CIS of Doctors of the World (USA).  Last may he joined the United Nations Population Fund in Geneva, Switzerland as a Program Officer. 

Copyright 2001 The Analyst. All rights reserved