Focus on HIV/AIDS in the south

While Kyrgyzstan has a low prevalence for HIV infection, a steady rise in the number of injecting drug users is increasingly making its threat felt. The largest and fastest growing high-risk group for HIV, injecting drug users are particularly prevalent in the south of the country. "We have more HIV/AIDS-positive people here than anywhere in Kyrgyzstan," Jusnev Jarkynbay, the deputy director of the HIV/AIDS centre in the southwestern city of Osh, told IRIN. "We are on a main drug road here. Even in Soviet times, Osh was a primary transit point for drugs that ultimately found their way to streets in the West. There are currently 162 people infected here." According to Kyrgyzstan's National AIDS Centre in the capital, Bishkek, of the 334 cases of HIV/AIDS officially reported since 1997, almost half occurred in and around Osh, a city of 400,000 and the provincial capital of Osh Oblast near Uzbekistan. According to official statistics, HIV/AIDS has spread rapidly in the area. The region saw its first case in 1998, though IRIN was told that in 2001 the government's figure of those infected jumped from only a few to more than 100. Commenting on the situation, one doctor, who preferred to remain anonymous, said the rise might be due to the fact that it was only a few years ago that international organisations and NGOs came to the region and started encouraging drug users and prostitutes to get themselves tested. Before 1999, he said, very few people gave blood samples to see if they were HIV positive. One local social worker told IRIN that many drug users knew at the time that they were HIV positive, but saw little to be gained by actually being tested and becoming part of the government's statistics. It was also shortly before this, that heroin was introduced into the country. This significantly increased the number of intravenous drug users in the region. "Heroin is easy to make, and very cheap for the country's cash-strapped addicts," Jarkynbay said. "One dose costs less than a beer." But despite this increase in numbers, there are likely to be many more HIV-positive people in the country than officially recognised. One leader in Osh's AIDS prevention and treatment community estimated there were now more than 9,000 drug users in the region. However, only 1,000 of these users were officially accounted for in government statistics, he added. Given that "most of the country's HIV/AIDS-positive people are drug users", according to Omosheva Orumgul Joroevna, deputy chief of Osh's Alliance of Reproductive Health, health experts believe that the number of AIDS sufferers could actually be several times higher than the figure currently being suggested. Sixty-three percent (or 102) of those infected in the region are in the city of Osh itself. A senior AIDS specialist explained that although many prostitutes - the second-largest risk group -come from villages, their blood samples were generally taken in Osh and not in the rural community. "In the urban areas, there are also more needle drug users," Jarkynbay explained. "In the villages, most of the addicts smoke their drugs." Equally troubling is the stigma attached to those infected. "There is still a huge stigma against people who have AIDS," Joroevna noted. "People hide it from their friends and family, and even doctors themselves don't know the precise number of HIV-positive people in the country. People with HIV are looked at with different eyes," she asserted. This stigma also served to discourage people from seeking information about the disease. People viewed AIDS with great fear, she said, pointing out that no one could go to the AIDS centre to get tested without attracting unwanted negative attention. "It is the mentality in Kyrgyzstan that prevents people from finding out more about HIV/AIDS," she maintained. Another major area of concern is the prison system - one of the main breeding grounds for the disease. It is said that a single needle might do the rounds for as long as two months. And although Jarkynbay said that HIV/AIDS-positive prisoners got methadone treatment and were counselled against engaging in sexual activity for fear they would spread the disease, it was suspected that many had sex with unwitting partners shortly after getting released. But despite the many sensitivities in discussing the issue openly, many organisations in Osh have made HIV/AIDS education and prevention their top priorities. One means of this is through workshops and seminars held at regional high schools and universities. Jarkynbay explained that while there was an overall strategy to promote AIDS awareness in these institutions, the AIDS centre cooperated with each school to implement that strategy in a way best suited to that institution. Moreover, many doctors from the region give lectures as part of this campaign, which often focus on the use of condoms. The AIDS centre also utilises the mass media in these efforts, even sponsoring a one-hour question-and-answer show about HIV/AIDS three times a week on a local radio station. Staff at the centre told IRIN that broadcasting companies often asked it to shoot brief slots highlighting AIDS prevention and awareness. Four years ago, the Kyrgyz government launched its own state-sponsored AIDS-prevention campaign in the context of an overall class on health-education called "A Healthy Way of Life". The goal, said Jarkynbay, was to teach every student in the country this material. They would study the first few chapters in eighth grade, and by 11th grade would be learning about reproductive health. But one social worker who trains educators for a local AIDS prevention NGO called Rainbow, told IRIN that the course was prevented from reaching its full potential due to an unfortunate lack of teachers, especially in the rural villages. "Many of these teachers are too shy or embarrassed to teach this class," she said. "Sometimes, groups like ours organise classes for these specialist teachers in addition to students. Often, young people seem to know more about HIV/AIDS than even the teachers do," she added. Distributing clean needles to risk groups is another way by which Kyrgyz and international organisations are combating the spread of the virus. Joroevna said that there were many programmes doing this, and that drug users could either come to the clinics to get needles, or often nurses would go to where the addicts were. Despite such positive initiatives, there remain many challenges to prevention in this tiny nation of 4.8 million. Many aid workers told IRIN that a lack of awareness, transparency and fear associated with AIDS often hampered their work. "Most people don't understand why we focus so much of our efforts on drug addicts and prostitutes," Natalya Shumskaya, director and founder of the NGO Podruga, told IRIN. "Sometimes people say that we are increasing the country's AIDS rate by being kind to prostitutes and giving away free needles. They say that this will lead to more prostitutes and addicts." One involved social worker told IRIN: "Militia often stop and harass us, and ask us for our documents. Some people try to actively prevent us from distributing clean needles." Yet another major challenge to their work, is a genuine lack of financing. So far, Shumskaya said, groups like Podruga were just getting their financial support from NGOs. "There is a real lack of financial resources here. It is very important for us to organise and reach those who are at risk of contracting and spreading the disease, for prevention purposes. One of the main things that we need is to find this support and assistance to provide people with medical treatment," she explained. A doctor from Osh's AIDS centre told IRIN that his organisation received only 30 to 40 percent of the funding it needed from the Kyrgyz government. "UNDP [UN Development Programme] gives us another 40 percent of what we need, and that adds up to only 70 to 80 percent of our financial requirements," he said. The centre said the condoms, needles, and leaflets it distributed all came from international organisations. Nonetheless, there is a way forward. Many of the doctors and social workers involved feel that what is really needed is to bring in foreign specialists to help combat the problem and to move the awareness programmes into the regions outside Osh. Shumskaya said Podruga had plans to do just that by organising AIDS-prevention seminars in the rural areas outside Osh, adding, however, the organisation was also now at a point where means of treating AIDS patients were needed. "People now need AIDS drugs, and not just psychological treatment," she said.