Focus on AIDS

A blue-eyed 21-year-old Tajik beauty, Ramina has been addicted to heroin for the last two years. When her habit proved too expensive, she turned to prostitution on the streets of the Tajik capital, Dushanbe, enabling her to shoot up four times a day. "If I don't take it, I feel ill and can't function," she told IRIN. But having over-dosed once, she said she was more careful in how much she took. Ramina was also now more weary of exchanging needles after she visited a needle exchange centre and was warned of the threat of HIV/AIDS. As an intravenous drug user and prostitute she is in the two highest risk groups of catching the killer disease. Now a volunteer at the centre, Ramina says she's spreading the word about the exchange among drug addicts in the hope that her friends will also be safe. The official number of HIV/AIDS cases in Tajikistan for 2002 is 58. However, this is not a realistic picture and the actual incidences are much higher, according to the head of the UNAIDS programme for Tajikistan, Maria Boltaeva. "We expect that the disease is spreading fast in Tajikistan, but we just don't know about it," she told IRIN. In the year 2001 there were 45 cases of HIV and two deaths, with most of the cases concentrated in the northern district of Khujand. Efforts to highlight the escalation of the disease in Central Asia were made in the form of a report followed by a conference in Barcelona earlier this year. The report said the scale of the HIV/AIDS epidemic had outstripped even the worst-case scenarios of a decade ago. Dozens of countries are now gripped by the pandemic - with many more on the brink. Estimates on a number of indicators that help to understand the magnitude of the HIV/ AIDS epidemic were presented at the conference, as well as the response at local, national, and global levels. Unofficial estimates suggest that the number of people living with the deadly virus in the five Central Asian countries was about 35,000, with 20,000 of them in Kazakhstan alone. UNAIDS, however, is moving fast on the issue in Tajikistan. The agency is carrying out annual surveys targeting five categories of people who are in the high risk groups, including intravenous drug users, commercial sex workers and prisoners. "During the Soviet era surveys were carried out on HIV, but they did not target specific communities which we are doing now," Boltaeva explained. The strategy, she said had completely changed, speeding up the process of identifying those affected. Moreover, according to UNAIDS, Tajik authorities have been responsive to the problem. The government has demonstrated its concern by preparing a national strategic plan for 2002 and 2004 on HIV, but remains short of funding. Approximately US $2.5 million is needed to implement the project. Drawn up in consultation with the UN agency, the plan had three priorities. Firstly to work with youth and raise awareness, secondly with injection drug users, and thirdly with commercial sex workers. "This is a real shame. They need financial backing before they can do anything," Boltaeva stressed. Indeed, lack of awareness was a major factor contributing to the increasing cases of the virus. UNAIDS has started several projects in educating the high risk groups. One project has been established within prisons, where jail staff are trained to talk to inmates sentenced for drug related crimes. Prostitution was also a contributing factor, Boltaeva said, adding that there were an estimated 500 sex workers in Dushanbe alone. "Aid workers are penetrating this community and are raising awareness of sexually transmitted diseases as well as promoting condom usage," she explained. However, the main factor leading to the increase of HIV/AIDS cases remains drugs. Since 1996, Tajikistan has become the main transit route for drugs from Afghanistan. This has had huge impact on the prevalence of the disease, subsequently resulting in a sharp rise in usage. In the past less potent drugs were more widely consumed such as hashish. According to a survey by the United Nations Drug Control programme in Tajikistan, there were 6,243 drug addicts and 1,500 drug users in Dushanbe in 2001. These statistics are worrying particularly when some 30 percent of the population is made up of youth. Some indicators by UNAIDS staff show that there is extremely high lack of awareness about diseases among the younger generation - especially in rural areas. Acknowledging that drug abusers are the high risk group for the disease, UNAIDS has established "trust points" or needle exchange centres. The first trust point was set up in 1999. There are 15 nationwide now, eight of which are supported by the government. Run by volunteers, most of whom are drug addicts themselves, the centres are open late into the evening. "We find this approach good as they can trust one another," Boltaeva said. At present there is only one local NGO by the name of RAN working with drug users. Funded by the US-based SOROS foundation, RAN has also helped to establish trust points in the capital. At one particular needle exchange place in the heart of Dushanbe, some 12 addicts were visiting every day to exchange needles, volunteers told IRIN. But with the threat of increasing deaths from AIDS, health experts say the need for more trust points is becoming more urgent. "We need more trust points in this country. They have proved to be very successful," Boltaeva added. UNAIDS has warned that up to 68 million people globally could become victims of AIDS in the next two decades unless the developed countries dramatically increased their role in the global fight against the disease. More than 20 million people have died of AIDS around the world since the clinical discovery of the disease in 1981.