Interview with Aziz Khudoberdiev, Joint UN Programme on HIV/AIDS

The total number of registered HIV/AIDS cases in Uzbekistan is the highest recorded in Central Asia, according to the UN’s Millennium Development Goals (MDGs) report for Uzbekistan published on 11 April. Nearly 2,200 cases were registered in 2005, bringing the official total to 7,800. Unofficial estimates put the number of infections much higher. A rise in the number of injecting drug users is driving the increase in infections – particularly in prisons where more than 34 percent of new infections were registered in 2004. Young people have become highly vulnerable to HIV infection in the wake of rapid social and economic change in the republic and are being targeted by education and advocacy campaigns. In an interview with IRIN, Dr Aziz Khudoberdiev, a programme officer with the Joint UN Programme on HIV/AIDS, spoke about how the virus is taking hold in Uzbekistan and about government and UN strategies to limit its spread. QUESTION: Can you give us an overview of how HIV/AIDS is expanding in Uzbekistan? ANSWER: It’s mostly spreading through the injection of drugs. This has been the case since around 1999, when there were just a few cases, to where we are today with about 8,000 officially registered with the virus. Of course these are only the official figures, but now nobody can tell exactly the prevalence rate because we do not have enough information to make estimates. But we can see the way the virus is spreading. One worrying tendency is the number of women infected, that is rapidly increasing in Uzbekistan. It now stands at 22 percent of new infections, this is a big increase over where the disease was four years ago. Secondly transmission through heterosexual means is increasing, it now stands at 18 percent, several years ago it was much less. Q: Why is HIV/AIDS spreading so rapidly at this time in Uzbekistan? A: It’s spreading because of an increase in drug abuse by young people, injecting drug users particularly. This is due to the geographic proximity to Afghanistan – where so much of the world’s heroin continues to be produced. We are right on one of the main trafficking routes from Afghanistan to Russia and on to Europe, therefore, cheap drugs are available in Uzbekistan, despite the battle of law enforcement agencies to stop trafficking. The increase in heterosexual transmission is a general tendency in many countries where the disease is growing. It spreads from high risk groups like intravenous drug users, sex workers and men who have sex with men to the general population through heterosexual means. Q: At least 30 percent of new infections are occurring in prisons, according to official figures. Why is this? A: The system here is that all newcomers to prison pass through mandatory testing for HIV. In prisons we have a big concentration of intravenous drug users, therefore the testing tends to throw up many more people infected with HIV/AIDS than in the civil population. But prisons are not isolated from society. Prisoners are returning to society after their sentences, so the Global Fund [to Fight AIDS, TB and Malaria] and the government of Uzbekistan are working hard on prevention programmes in the prisons. The projects are trying to educate prisoners and prison staff on how to reduce the spread of the disease. Q: Does the government recognise the seriousness of the HIV/AIDS situation in the country and are its programmes up to the challenge that the disease presents? A: The government does recognise the seriousness of the problem. A few years ago there were hundreds of cases, now there are thousands and that’s just the official figures. Donors and the United Nations are supporting advocacy on HIV/AIDS prevention, particularly in the provinces. For examples, special seminars for decision makers at a local level, organised through the women’s committees have been very successful. These kind of initiatives are helping to change attitudes to those with the disease, so this is also important. At the start of these seminars those attending say people living with HIV should be isolated, but at the end they begin to see they have prejudices that need to be challenged. The UN has helped with the establishment of a network of NGOs in Uzbekistan that can support those living with the disease. These groups now operate in eight regions of the country, thanks to support from the Global Fund. The fund has provided US $24.5 million to Uzbekistan over five years for treatment, prevention and advocacy. Q: What about other practical measures like needle exchanges and promoting the use of condoms? A: Harm reduction policies are already common in Uzbekistan. They take the form of “Trust Points” – these are places in clinics or other places where there is public access where injecting drug users can obtain advice and exchange needles and get condoms and information. There are also extensive outreach programmes designed to target intravenous drug users. Often the outreach workers are former drug users. They go out and distribute clean syringes, condoms and information. These programmes have the full backing of the relevant ministries. Importantly, law enforcement bodies do not obstruct this kind of work, recognising its centrality to reducing the spread of the disease. There is a lack of funds and specialists for these trust points in the provinces. But a lot of donors are working in this field, so there should be many more of these places throughout the country soon. Eight UN agencies in Uzbekistan have HIV/AIDS programmes in the country. Another initiative, last year the ministry of health opened a series of “Anonymous Cabinets” – these are places where anyone can go and get tested for the virus totally anonymously, free of charge. These services are widely advertised on radio, through newspapers and on billboards to get people to know they exist. On top of this there has been mandatory training of health workers on HIV/AIDS so they are aware of the rights of those with the virus and so they can also work with them better. Q: What does the future hold for Uzbekistan and the HIV/AIDS epidemic? A: The disease is set to continue spreading, that’s for sure. But the key here is that the right policies to reduce the disease are being followed and will significantly increase in the years ahead. But there’s still a low level of awareness about the disease so much work needs to be done here to reduce stigma, mostly in the provinces.