Trust points work to bolster HIV prevention

Olga, a volunteer at a newly established trust point in the Yunusabad district of the Uzbek capital Tashkent, one of the city's larger red-light districts, doesn't want to reveal her real name for fear of losing the confidence of her clients - injecting drug users and prostitutes. "Clients are afraid of coming to our trust point. They suspect that we have hidden cameras in our office or we will inform the police. They say 'you only find free cheese in a mousetrap'," she told IRIN, noting the efforts that she and other volunteers were making to change that perception. "I visit them and distribute leaflets about the threat of HIV/AIDS and try to encourage them to use the services our trust point offers - free consultation, examination by specialists, needle exchange and condom distribution," the volunteer said. Since the beginning of 2004 there have been some 1,500 permanent clients among the 10 trust points now functioning in this city of two million. Operating under the HIV/AIDS prevention control project for high risk groups and youth in Tashkent entitled SOS project - a partner project of the Japanese International Cooperation Agency (JICA) and the World Vision office in Uzbekistan - the trust points have succeeded in distributing nearly half a million needles and more than 28,000 condoms to their target groups. Such results have not come easy. The first challenge the trust points faced was establishing relations with high risk groups such as injecting drug users, commercial sex-workers and homosexuals - driven deep underground by traditional Uzbek social attitudes and an increasingly hardline approach to prostitution and drug addiction by the police, experts believe. "I grew up in this neighbourhood, so I won their confidence very early," Olga said. She initially worked with local pimps, each of them having three or four girls aged 15-27 at their homes. And while just a few years earlier Yunusabad used to be a quiet residential area, Olga notes that "now it is the second commercial sex centre of the capital. Most of the sex-workers come from impoverished rural areas." But it is the individual cases of the women that are most telling. Shohida (not her real name) came to Tashkent just two years ago to earn money to help her family. Last year, while working as a waitress in a café, police detained her on suspicion of being a prostitute as she was returning home late at night. "I was brought to the prison-like venereal diseases centre. Hygienic conditions at the centre were very poor and I was afraid of being infected with various diseases and was ready to do anything in exchange for my freedom," the 19-year-old explained. Later a local pimp paid for her release and she became a sex-slave. "Many girls I know have been sent to the venereal diseases centre once or twice and none of us want to be sent there again. So we have to make it up with a pimp as she has connections with the local police," she explained, revealing she sometimes has to serve up to 25 men a day. Volunteers at the Yunusabad trust point recently discovered two HIV infected women among the commercial sex-workers, one of them also being an injecting drug user. "While working with clients we found out that many of them have been raped by men who usually refuse to use condoms even if the prostitute pretends to be HIV infected," volunteers at the centre told IRIN. Education on HIV/AIDS prevention still falls short in reaching all levels of the population. Cheap "commercial sex-markets" continue to emerge in rural towns throughout the country - providing an even more serious threat to the spread of HIV/AIDS, and another challenge for the trust points. "We work closely with 50 mahallas (neighbourhood-community based organisations), 42 schools and 15 high schools located in the district to raise awareness on HIV/AIDS prevention methods," Lola Miralimova, an assistant at the Yunusabad trust point, told IRIN. As a result of successful collaboration with the local Kamolat youth organisation, this summer they attracted schoolchildren to an awareness campaign as well. Some problems for the trust points, however, are more operational. At the moment only three out of the 10 trust points have hotlines, those being inherited from a previous project by the United Nations Office on Drugs and Crime (UNODC). "The SOS project is a continuation of the UNODC project on HIV/AIDS prevention completed in 2003 that targeted capacity building of three trust points in Tashkent. Under the new project we ensured the continuation of the anonymous, confidential and prevention services of three existing trust points and extended their activity with seven similar trust points within the city," Dr Shanasir Shavakhabov, national project manager of SOS, told IRIN. Trust points were provided with computers and would soon be linked with the project network to accelerate HIV/AIDS related data processing, he added. The project works closely with the governmental partner organisations such as the republican addiction clinic centre, which offers drug addicts free consultation and treatment as well as social support with UNODC funds. Drug addicts who contact the trust points and seek help to change their lives are sent to the addiction clinic centre. Meanwhile the SOS project was also aiming to work with the Uzbek prison system to carry out HIV preventive measures in prisons, something still under negotiation with the authorities. Uzbekistan, Central Asia's most populous state, is experiencing a faster growth in its HIV infection rate than sub-Saharan Africa. Though officials from the republican AIDS centre put the number of HIV infected people at just 3,867, experts believe the actual number to be 10 times that figure. Half of the HIV-infected people live in Tashkent, Central Asia's largest city. Recently the World Bank warned countries in the region to confront the impending threat of AIDS or face "unimaginable" consequences. The warning came as officials from Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan gathered in Almaty, Kazakhstan, for the launch of a US $25 million programme to fight the killer disease, funded by the World Bank, Japan and Britain, with minor contributions from the region's governments. Although the faster HIV spread is mainly attributed to the flow of Afghan-produced heroin through the region to Russia and the West, over the next few years the number of infections through sexual transmission is expected to increase.