Ingrid Udden in Budapest
The enduring disaster in sub-Saharan Africa looms large over another World AIDS Day. Statistics of European victims pale in comparison. But statistics can be misleading. On this December 1, there is need to consider a disturbing fact: HIV is spreading faster than ever in Central Europe and the virus knows no borders. A drastic increase in preventive measures is required if we are to avert another catastrophe.
The problem with disasters is that people pay little heed until they are overwhelmed by them.But the writing is already on the walls of Russia, where an epidemic has seen 129,000 new cases of HIV infection reported over a period of 18 months.
Key to developments is “the heroin highway”, the drug avenue that runs north from Afghanistan, through Central Asia to Russia, and then turns west into the Baltic region and Central Europe. The HIV pattern emerging in Central Asia already resembles Africa’s in the early 1980s but it is intravenous drug use rather than sexual contact that is primarily spreading the virus. More than 800,000 drug addicts have been recorded there, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS), and young people are taking an ever more prominent position among them. More than 90 per cent of HIV cases are drug-related and Central Asian HIV prevalence has already trebled this year.
The picture is no less alarming in the Baltic region. While prominence has been given to neighbouring Russia’s epidemic, Estonia and Latvia reveal an upward spiral. The figures themselves appear modest but the size of the increase is dramatic. Through the second half of the 1990s, Estonia was averaging 10 new cases a year. In 2000 the figure lept to 390, and the first eight months of this year brought 1,131.
Latvia has seen a rapid increase since 1998, when the number of reported HIV cases jumped to 163 from 25 the year before. In 1999 there were 241, in 2000 466, while by September the 2001 tally had reached 547. As in Estonia, it is mainly drug related. Some 82 per cent of new cases are found among intravenous drug users which makes harm reduction programmes of needle exchange and methadone distribution, absolutely vital. The Latvian Red Cross is already collecting 6,000 used syringes a month from addicts in the capital, Riga. By the end of the year there will be up to eight new services in the countryside.
The problem is not confined to drugs, either. While most new HIV cases in Estonia and Latvia have been among intravenous users, patterns elsewhere tell us that the epidemic could soon spread into the general population.
Even in countries where no upward spiral is evident, the International Federation of Red Cross and Red Crescent Societies is anxious that far more prevention be undertaken.
In Bulgaria a mere 300 cases of HIV are recorded and it is feared that this gives the population a false sense of security. While the true picture in any case is likely to be worse, and the northern epidemic can impact upon everyone, there are other complications. Sex is the main means of transmission in Bulgaria and there is a high rate of other sexually transmitted infections (STIs). Syphilis and hepatitis B are booming and where STIs gain ground, HIV is never far behind.
We are responding but our response is often hampered by the taboo that remains around AIDS and the virus that causes it.Two decades after AIDS was first recognized, stigma and discrimination against people living with HIV and AIDS remain major hurdles. Discrimination is more than a violation of human rights. It discourages people from being tested, leaves them unaware of their HIV status, and unwilling to accept or discuss it. Some authorities likewise bury their heads in the sand. Worldwide, stigma is contributing to millions of deaths and new infections.
An International Federation survey in Central Europe has shown how shortcomings in procedures and education are contributing. While testing is almost universally anonymous, confidentiality is by no means guaranteed. Many health workers do not encourage testing either and provide inadequate HIV counselling.
Sex education that covers STIs is mandatory in most of the region but many curricula exclude it. Teachers are not trained, or lack knowledge, and sex is presented from a religious viewpoint. A state evaluation of sex education in one country rated a decrease in condom use a positive factor.
We have to face up to new challenges, and we have to create space to talk openly
Ingrid Udden is Central Europe Health and Care Delegate of the International Federation of Red Cross and Red Crescent Societies. She contributed this World AIDS Day comment to the International Herald Tribune