Nurali Amonzholov knows all to well the problems of addiction and HIV. The former drug addict and HIV-positive 33-year-old heads up Shapagat, a local NGO based in Temirtau in northeastern Kazakhstan, a city described by health officials as "ground zero" for AIDS in Central Asia.
Working alongside a dedicated group of volunteers, the father-of-two works tirelessly to provide assistance and support for those infected with HIV, a group largely forgotten in this vast country, about 40 percent of whom have no access to proper housing, and many suffer from a lack of education and job opportunities, not to mention health care.
"Not everything is well done, but we try," he told IRIN. Whereas some government assistance was forthcoming, he noted, much more was needed to stem the pandemic and its impact.
CURRENT SITUATION FOR HIV
Compared to other countries, Kazakhstan enjoys a relatively low prevalence of HIV, although the number of drug-related cases continues to be a major cause of concern. In almost 85 percent of all registered cases, virus transmission occurred through injecting drug usage.
According to government statistics, there are 47,241 registered intravenous drug users (IDUs) in the resource-rich nation, but according to independent estimates the number is closer to 250,000 - and this in a country almost the size of India, but with a population of only 16 million.
"There is between 3 percent to 4 four percent of HIV prevalence among injecting drug users nationwide," Dr Rudick Adamian of the United Nations Joint Programme on HIV/AIDS (UNAIDS) in Kazakhstan and Central Asia told IRIN in the commercial capital, Almaty.
While some 3,700 HIV-positive cases have been registered since the disease was first detected in 1987, many health experts believe there are 10 times that number. Whatever the facts of the matter are, it is the issue of addiction that has become the focus of both government and international attention - not just in Temirtau, but nationwide.
TEMIRTAU - A CASE STUDY IN ADDICTION
Although the first HIV case in Temirtau was detected in 1990, it was not until 1996 that health officials became truly alarmed. "That year was a new phase for HIV in Kazakhstan," Kuanysh Bekzatov, the deputy director of the government’s Republican AIDS Centre in Almaty, told IRIN, saying that it was in Temirtau that the history of HIV in Kazakhstan began.
In one year alone, 36 people tested positive for the virus - all of them addicts. One year later, of the 437 new cases registered nationwide, 400 were in Temirtau. Today, the city has the highest rate of infection in the whole of Central Asia.
How the city of 176,000 earned that distinction is largely a by-product of history. Established during World War II in Karaganda, Kazakhstan’s largest province, the once prosperous city of mainly ethnic Russian industrial workers was renowned as the steel capital of the Soviet Union. Jobs were plentiful, school and health facilities excellent, with people converging in the city from far and wide seeking opportunities. In its heyday, the Temirtau steel works employed 40,000 workers - almost a quarter of the total population.
Following the collapse of the Soviet Union in 1991, however, that atmosphere changed forever. As the newly independent Kazakhstan moved towards a market economy, the heavily subsidised factory began laying off workers, leaving thousands unemployed. By 1996, the factory had all but closed, and the local economy lay devastated.
According to Dr Sholpan Baimurzina, the director of the government’s AIDS centre in Temirtau, the whole life of the city changed. Scores left the area while others sat idle in the streets, first turning to alcohol and then drugs - mainly crack. "People stopped believing in the future - it was inevitable," she told IRIN. "Imagine the mind-set of the people: everything they knew, everything they had worked for was over."
And when the first IDU-related HIV case surfaced, health officials were caught off guard. "We weren’t ready for the onslaught."
While there are some 1,500 IDUs registered in Temirtau, most believe their number to be closer to 8,000, far more than in the provincial capital, Karaganda city, the country’s second largest, just miles away. Having the largest number of IDUs in Kazakhstan imposes an immense burden on Temirtau - a city still reeling from the economic turmoil of just a few years back.
Of the 97 patients at the city’s main tuberculosis hospital - a disease that increased exponentially following the demise of the Soviet Union - six, all addicts, are HIV positive. "The combination of TB and HIV is particularly dangerous," the hospital's Dr Sergali Aubakirov told IRIN. Of 145 such cases registered between 1998 and May 2003, 42 had died.
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