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Former Soviet states at AIDS tipping point

Mexico City - experts are concerned that some of the states that emerged from the former Soviet Union are on the brink of widespread HIV/AIDS epidemics, the global AIDS conference heard on Wednesday.

Concentrated cases of infection among intravenous drug users, sex workers and gays are now placing some countries "on the verge of a generalized epidemic," Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, TB and Malaria, told a special session here.

"I'm very concerned about the epidemic in the region, very concerned," Kazatchkine said, saying experts fear entrenched HIV epidemics among high-risk groups could leap into the general population.

Last year 110,000 people became infected by the human immunodeficiency virus (HIV) in Eastern and Central Europe, bringing the tally to around 1.5 million, according to figures issued last week by the UN agency UNAIDS. Around 58,000 people died of AIDS.

Almost 90 percent of those infected live in either Russia (69 percent, or 1+ mln) or Ukraine (29 percent), and the majority are intravenous drug users, sex workers and their various partners.

At the session devoted to the AIDS pandemic in 12 countries, speakers said there had been some progress towards rolling out antiretroviral drugs to those in need but money and political support were lacking.

Efforts to prevent the spread of HIV were stuttering at best.

Stigma and homophobia, which provide fertile conditions for letting the virus propagate in silence, were deep-rooted, the experts said.

Needle-exchange programs, a proven [???] method of discouraging the spread of the virus through tainted hypodermics by drug users, were only now getting off the ground.

More than half of the countries had policies, legislation or regulations that were an obstacle to care, treatment and prevention.

According to UNAIDS, only one person in every four badly infected individuals has access to the lifeline treatment in Eastern Europe and Central Asia.

"The fight against HIV is a new problem. It's very challenging and it involves a lot of issues," said Farida Tishkova, of the Tajik Scientific and Research Institute for Prevention Medicine.

"Some of the work we do can be incompatible with the laws and practices of our countries."

A Ukrainian field worker, Anna Koshikova, said that heterosexual incidence of HIV in the general population in her country had increased in the last year or so, emerging out of vulnerable niche groups.

Koshikova, with the All-Ukrainian Network of People Living with HIV/AIDS, said people with HIV found more tolerance in the big Ukrainian cities, but in the countryside could be driven out by stigma.

"When a village finds out that a person has HIV, life becomes very difficult, almost impossible. Their children can't go to school, there could be physical violence, they may not receive medical help because they are afraid of revealing their [HIV] status.

"Many decide to move."

At present, 8,000 people in Ukraine receive treatment, but there has been a problem with imported antiretrovirals that are below standard and lack sufficient active ingredients to repress the virus, she said.

"There's a very high level of corruption in government and non-transparency in [drug] procurement. It's a huge problem," she said. [Any free funding corrupts]

According to UNAIDS statistics, the average prevalence of the AIDS virus across the region, a category that also includes Bulgaria, Romania and the former Yugoslav states of Croatia and Bosnia-Hercegovina, was 0.8 percent among people aged 15-49 in 2007, a doubling since 2001.

Prevalence varied from 0.1-0.2 percent in most of the Caucasus and Central Asia, to between 1.0-1.5 percent in Russia and 1.5 to 2.0 percent in Ukraine.

Infection numbers are rising in Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan and especially Uzbekistan, which "now has the largest epidemic in central Asia," according to the updated UNAIDS assessment of the pandemic.

Source: AFP, 7 August 2008

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