Shift in mode of HIV transmission indicated

Recent figures provided by the official Kazakh Republican AIDS Centre reveal an increase in the number of HIV infections through sexual transmission, an important development in Kazakhstan's efforts to mitigate the disease's spread. "There are indications of a shift in the mode of transmission from intravenous drug usage to sexual contact," Nina Wessel of the joint United Nations Programme for HIV/AIDS (UNAIDS) told IRIN on Wednesday from the Kazakh commercial capital of Almaty. Since the disease first appeared in 1987, the vast majority of infections in Central Asia's largest nation had been, and continues to be, amongst intravenous drug users (IDUs). However, government statistics now indicate a gradual decline in the number of new cases among IDUs. Of the 3,788 officially registered cases thus far, only 388 or 10.2 percent were through sexual contact, while over the past eight months (January - August 2003) 18.3 percent or some 97 cases were through sexual transmission. "In August alone, the number of cases through sexual contact stood at 15.5 percent," Wessel said, noting that UNAIDS works on an estimate of 25,000 actual cases as the vast majority of cases were unreported. Despite these numbers it is clear more research is needed. In September 2002, the government abolished mandatory testing of inmates in the country's penitentiary system, thereby lessoning its surveillance basis. This may have had an impact on the numbers as the vast majority of cases within the prison system were among IDUs. Wessel noted that recent serological surveillance in Karaganda province, one of the most badly affected areas of the country, concluded that the number of new HIV infections amongst commercial sex workers exceeded the number among IDUs. Since there can be a lot of intravenous drug usage among CSW, they are planning to also conduct behavioural surveillance in Karaganda in October. "There needs to be a greater emphasis on sexual awareness," she said. According to government statistics, there are 47,241 registered intravenous drug users (IDUs) in the resource-rich nation, while independent estimates place the real number closer to 250,000. [For more information on HIV and addiction in Kazakhstan see the comprehensive IRIN report]