Focus on HIV/AIDS awareness

While Turkmenistan enjoys one of the lowest HIV/AIDS prevalence in the world today, a growing increase in sexually transmitted infections (SDI) and injecting drug usage makes the potential risk of its spread real. Enhanced awareness, particularly among vulnerable groups and the general public, must remain a key component of the government's already existing prevention strategy, say local and international experts. "People need more information as public awareness is limited," Leyla Rejepova, a 23-year-old instructor for the Turkmen Red Crescent Society, told IRIN in the Turkmen capital, Ashgabat. One of a growing number of AIDS awareness trainers in the country, she said there was insufficient information on and discussion of HIV/AIDS. "Many feel this is an outside problem in which Turkmenistan does not play a part," she said. Working with young people and a team of volunteers in the western city of Balkanabat, she called for enhanced awareness of the dangers of drugs - describing drugs as the last step before HIV. "Young people need to have more information. They don't think the risk really applies to them," she added. With drug addiction hardly new in Turkmenistan, such an attitude is disconcerting. According to official figures for 1989, 124 people of every 100,000 were addicted to drugs - more than four times the average across the former Soviet Union. That figure has grown steadily since the country gained independence in 1991. Official data from the ministry of public health put the number of registered drug addicts in the country at 4,087 in 1996. Today, international experts put the figure at 13,000. But in a country that officially has no problems, such subjects remain largely taboo. Whatever efforts are being made are made in the background, often not receiving the acknowledgement they are due because of minimal transparency. In a report on opium usage by Dr Nina Kerimi of the department of psychiatry at the Turkmen State Medical Institute, the Turkmen population generally assessed the risk of HIV infection as low. This finding was reflected by an independent survey commissioned by the Turkmen Ministry of Health - the Turkmenistan Demographic and Health Survey (TDHS) - released in September. With a population of five million, and only one known case of AIDS and one HIV-positive case, compared with other parts of the world, Turkmenistan has remained relatively untouched by the epidemic. Almost no respondents reported that they knew an HIV-infected person or anyone who had died of AIDS. However, it was the attitude of respondents that revealed that awareness and knowledge of HIV/AIDS was limited. While 73 percent of respondents reported having heard of HIV/AIDS, only 50 percent believed that they could adopt behaviour patterns that would reduce their risk of contracting the disease. Further evidence of limited knowledge was that only 31 percent of respondents recognised that condom use was a risk-reducing practice. Equally disturbing was that the survey found unsympathetic attitudes towards HIV-infected individuals. Only a small proportion of respondents - 24 percent - stated that an infected person should be allowed to keep that information private, with a large proportion - 73 percent - believing that an infected person should not be allowed to work alongside other people in a shop or office. "These findings suggest that respondents have the mistaken idea that they can become HIV-infected through ordinary human conduct," the survey added. However, it would be unfair to say the Turkmen government is ignoring the problem. Speaking at last year's Special Session of the UN General Assembly to review and address the problem of HIV/AIDS, Aksoltan Ataeva, head of the Turkmen delegation, told participants in New York that irrespective of how many cases were found in a particular country, the danger of its spread presented the same threat to everyone since there was no absolute barrier against penetration of the disease into the country. "Taking account of the current situation, we support the call about the necessity to without delay join efforts of all countries in implementing a comprehensive prophylaxis of the disease, and this work should be headed at the highest level," she said. The national programme officer for UNAIDS, a joint United Nations Programme on HIV/AIDS, Galina Karmanova, defended the government, saying it understood the seriousness of the problem of HIV. "HIV/AIDS is one of the most critical threats of the world today, and Turkmenistan is not an exception," she told IRIN. "In July 2001, Turkmenistan adopted a new law on AIDS, and the government initiated an HIV/AIDS strategic planning process jointly with the UN," she said. According to Karmanova, in addition to a comprehensive AIDS awareness campaign initiated in collaboration with the health ministry, the UN was also working with officials in the area of prisoners, truck drivers, military forces and "young vulnerable women", as well as medical personnel working with blood. "The approach has worked, and last year alone over 500,000 people were covered by the public awareness campaign," she asserted. Efforts have been particularly strong among youth groups, she added. Rudick Adamyan, UNAIDS inter-country adviser in the Central Asian republics, told IRIN from the southern Kazakh city of Almaty that in emulation of other Central Asian countries which had developed a national strategic programme, Turkmenistan had initiated its own approach to the problem. Its multi-sectoral team from government and nongovernmental sectors would soon conduct a situation and response analysis on HIV/AIDS in selected regions and Ashgabat. "There have been a lot of positive changes in Turkmenistan regarding this issue," Adamyan said. "This is definitely encouraging." Turkmenistan has had a national programme for the prevention of AIDS and STIs for the past five years, aimed at preventing HIV/AIDS and decreasing STIs. In terms of response, there are national prevention centres in each of the country's five provinces, with a strong information network between them. Also on offer are anonymous services and hotlines, as well as condom distribution by both reproductive health services and AIDS prevention services. There is, however, no official needle-exchange programme operating in the country at present. As the country is hesitant in acknowledging the issue of drug addiction, implementation of such efforts remains sensitive. But despite the limited numbers of AIDS/HIV cases, the number could rise. Given the growth of STIs, which have the same mode of transmission, the risk of a potential increase is real. Syphilis morbidity has increased 10 times in the last five years (50 cases in 100,000). Moreover, parenteral hepatitis (B,C,D) morbidity is also increasing, evidencing that there is an actual risk of spreading HIV infection in hospitals. And while Turkmenistan may claim to have the lowest prevalence of HIV/AIDS of all five Central Asian states, there has yet to be sentinel surveillance conducted among vulnerable groups, including intravenous drug users. "To ensure the real picture, this needs to be done," Adamyan said. Targeting vulnerable groups nationwide for prevention must be undertaken to prevent a further spread of the disease, he said. In short, experts maintain Turkmenistan must remain vigilant in its efforts for greater public awareness. AIDS knows no boundaries and full acknowledgement of all forms of risk behaviour are key. According to UNAIDS, millions of people throughout the world know nothing or too little about HIV to protect themselves against it. Twenty years after the first clinical evidence of the disease was reported, AIDS has become the most devastating disease humankind has ever faced. Since the epidemic began, more than 60 million people have become infected with it. HIV/AIDS is now the leading cause of death in sub-Saharan Africa; worldwide, it is the fourth-biggest killer.