Fight against HIV/AIDS continues

Efforts to mitigate the spread of HIV/AIDS in Kazakhstan are proceeding well, despite an increase in rates of sexual transmission. Central Asia's largest state enjoys a relatively low prevalence of the disease. "In general, our assessment of the situation is positive," said Valery Chernyavskiy, portfolio manager for Kazakhstan's grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria, speaking from Geneva. "They are using the national programme and working very closely with their partners - both local and international," he said, referring to the work of the Kazakh government. The programme aims to prevent the transmission of HIV by promoting changes in behaviour and so reducing the vulnerability of high risk groups such as intravenous drug users (IDUs), commercial sex workers (CSW) and men having sex with men (MSM). It also provides information and knowledge about HIV/AIDS in order to promote more healthy lifestyles amongst young people. The work is intended to support continuing national efforts to strengthen HIV/AIDS control and prevention activities, while increasing civil involvement in actions aimed at reducing the effects of the epidemic. Medical treatment is also provided by the programme in the form of both care and psycho-social assistance to individuals living with HIV/AIDS. Officially some 4,600 HIV/AIDS cases have been registered in Kazakhstan, the vast majority believed to have been caused by intravenous drug use. Experts believe the real number to be now closer to 20,000. There had been some difficulties with funding in the early stages of the programme. Of the US $6.5 million Kazakhstan had been due to receive for years one and two, it received only $6.2 million, when there were problems with the implementation of a pilot methadone programme. However, on 12 August, as part of the second tranche of the $22.4 million five year grant to Kazakhstan, the Global Fund confirmed $15.6 million for years three, four and five of the programme. "The first instalment of the second tranche will be dispersed in November for the first six months of year three, in order to ensure that there are no interruptions in the programme's activities," Chernyavskiy said. "It's 95.4 percent of the budgeted amount for year one and two. It was 300,000 less, but that was because they had not yet introduced methadone treatment," he added. Despite this issue, according to Chernyavskiy, Kazakhstan's government, alongside its partners, is rising to the challenge. "There are about 40 non-governmental organisations deeply involved in this. We have a pretty good combination of government and non-governmental organisations, working with international partners," he explained. He noted that as in other countries of the former Soviet Union, the main problem had been access and capacity to work with vulnerable groups such as drug users, in order to increase behaviour reducing the spread of the virus. "They have to reach 60 percent plus of these groups in order to ensure that they will have some form of sustainability. Number two, we need to have 100 percent access to anti-viral treatment," the fund official stated. In spite of such progress, the decision to 'green light' the next $15.6 million in monies was not without conditions. "In the original proposal they aimed to keep a few thousand drug users on methadone therapy but due to political commitments - or not [lack of] commitments - until now they have not started methadone therapy - but this is [only] one of the components," said Chernyavskiy. With methadone, the problem was mainly related to the political will of the current government. The previous government had agreed to try it as a pilot scheme but the present government had maintained it has some reservations, he explained. "Nevertheless, we have official confirmation from the government that they will start two pilot areas in this component very soon. Therefore, we have allocated 1.5 million of the 15.6 million for this," he added. Meanwhile, recent figures provided by the official Kazakh Republican AIDS Centre, reveal an increase in the number of HIV infections through sexual transmission, which is a significant development in Kazakhstan's efforts to mitigate the spread of HIV/AIDS. "Evidence suggests that sexual intercourse as a mode of transmission is increasing," Irina Savtchenko, UNAIDS country coordinator for Kazakhstan, Kyrgyzstan and Turkmenistan, said from the Kazakh commercial capital of Almaty. She noted that while sexual intercourse had accounted for only five percent of registered cases in 2001, that figure had risen to 29 percent in 2004. The knowledge and understanding of HIV/AIDS remains rather low among injecting drug users and commercial sex workers, according to Savtchenko. She said that the behaviour of injecting drug users is still not safe. "Less than 50 percent of intravenous drug users report using condoms during sexual intercourse," the UN official claimed, adding the potential for the further spread of the virus amongst these groups, as well as in the general population remains very real.