Focus on the battle against HIV/AIDS

Most nights, Fatakhov Shamelvich trudges the streets of Almaty's red light district looking for sex workers. But what he has on his mind is far removed from sexual gratification. Along with his team of volunteers, he distributes condoms, sterile needles and pamphlets to the city's estimated 2,500 prostitutes. "We know AIDS is a killer, and we know when people inject [drugs] and have sex without condoms then this disease takes hold," he told IRIN, as a shivering female sex worker reluctantly accepted the condoms and literature he pressed on her. Shamelvich's organisation, Kazakhstan Without Narcotics (KWN), has few resources, but it is targeting the kind of high-risk groups that are serving as an incubator for the disease in these remote countries. KWN began life four years ago as a support group for drug addicts, but has mushroomed into a grass-roots AIDS-prevention and -awareness campaign. "Stopping injecting drugs and AIDS are becoming the same battle for us," an Almaty housewife with a drug addict son recently recruited to KWN told IRIN. By global standards, HIV prevalence in Kazakhstan remains relatively low, but its growth is explosive. By mid-2002, a total of about 3,000 cases was officially reported. "But we estimate the real figure to be 10 times that amount," Nina Wessel of the joint United Nations Programme for HIV/AIDS (UNAIDS) in the capital, Almaty, told IRIN. This makes Kazakhstan the Central Asian country with the highest number of people living with HIV/AIDS, based on both official and unofficial statistics. According to a study conducted by the US Centers for Disease Control and Prevention, the prevalence of HIV infection among intravenous drug users in Kazakhstan is 18 percent. Based on this percentage and the UNAIDS estimate of 200,000 intravenous drug users, the real number of people living with HIV/AIDS in the country currently exceeds 36,000. Shamelvich's commitment to his nightly ritual resulted from his brother's death from a heroin overdose three years ago. "I have seen how drugs destroy you and those around you. Now it's even worse, with AIDS taking hold of injecting drug users," he said. UNAIDS says 85 percent of new AIDS cases in Kazakhstan are currently from this group. Although the Kazakh government had established AIDS centres countrywide offering harm reduction and prevention programmes, most were limited in scope and failing to reach the high-risk groups quickly enough, observers told IRIN. Treatment for those infected is virtually nonexistent, and anti-retroviral treatment is only available for pregnant mothers. Reports from the central city of Temirtau - where infection rates are among the highest in the country - indicate that some people living with HIV/AIDS are being refused medical treatment of any kind, "because the assumption is they will die anyway", one observer told IRIN. As the numbers increase so to does the level of discrimination those living with the disease have to contend with. A team from the international NGO, Human Rights Watch (HRW), has just returned from an assessment mission to Kazakhstan, having found that injecting drug users and sex workers face widespread and systemic abuse by police, and lack of due process in the criminal justice system. Fear and stigma about the disease are rife. In a country where not one individual has publicly acknowledged his/her HIV-positive status, the team also found that people living with HIV/AIDS often experienced severe discrimination in accessing health care, employment and housing. "This abuse and discrimination contribute to the above groups’ marginalisation from information and preventative services, often discouraging access to these services, or even preventing it," Marie Struthers of the HRW assessment mission told IRIN from Moscow. "Government still sees people with AIDS as outside this society, as a deviant minority, [and] while this image remains, people will not embrace the problem here," an AIDS activist in Almaty, who wished to remain anonymous, told IRIN. What is most disturbing is the rate of increase in HIV/AIDS incidence, which, according to Kazakhstan's official 2001 statistics, represented a staggering 238 percent increase from the previous year. The Central Asian states lack the funds and technical expertise needed to establish sound programmes to control the epidemic. NGOs like KWN receive no government support and rely on donations to function. Unless properly funded and prevention measures are soon established, the mounting infection rates among intravenous drug users and sex workers will lead to widespread heterosexual transmission as HIV/AIDS finds its way into the general population. "This is already happening; injecting drug users are not a closed group, they are infecting their partners. Sex workers take drugs and then sell sex to finance the habit," Wessel said. The HIV/AIDS epidemic is rapidly expanding in other Central Asian countries in a similar way. And at a time when key social indicators in the region are falling rapidly, an epidemic would devastate Central Asia's health sector and social development, and have a wide-reaching economic impact.