HIV scores on the heroin highway

تم النشر: 8 نوفمبر 2004 0:00 CET

Eddy Posthuma de Boer

In Tashkent province, Uzbekistan, a bus travelling from Tajikistan to Russia aroused the suspicion of customs officers and, unhappy with the driver's answers, they searched it. Hidden inside was a consignment of heroin with a reported street value of US$ 9 million.

The same day in northern Tajikistan, a Land Cruiser, stopped by police on the road from Dushanbe to Khudzhand, revealed another 24 kilos. The week was warming up along the heroin highway through Central Asia but it was a week much like any other.

The seizures are evidence of growing drug traffic from Afghanistan. Since the fall of the Taliban, the Afghan production of opium has increased immensely. It is believed that the 2003 opium harvest may have reached 4,500 tonnes, up from an estimated 4,000 tonnes in 2002, and heading back to its peak production of 5,000 tonnes in 1999.

The heroin highway — from Afghanistan, through Tajikistan, Kyrgyzstan, Uzbekistan and Kazakhstan, to Russia and Europe — is in full operation once more, and other routes pass through Turkmenistan.

The United Nations estimates that 80 per cent of heroin consumed in Western Europe derives from Afghanistan and Pakistan, and some 25 per cent reaches it via this northern route through the "stans".

A great deal, however, stays in the region feeding its own growing drug habit, a development the Red Cross Red Crescent says is accelerating the spread of HIV/AIDS. An epidemic is under way and most infections have been found among injecting drug users who share needles.

Startling increase in prevalence

The prevalence of HIV/AIDS in Central Asia is mostly educated guesswork. Testing and surveillance are poor or absent. Even blood for transfusion may not be screened for the virus.

Over the past few years, however, what has been measured has shown a startling increase in infection, official rates growing threefold and fourfold annually, and reality thought to be much worse.

Already the scale of the Central Asian epidemic resembles that of sub-Saharan Africa in the early 1980s, and with the latest statistics there is no doubt that far greater efforts to combat HIV are essential if a major tragedy is to be avoided.

Poverty exacerbates the threat. More than a decade after independence, over 80 per cent of the population lives below the poverty line in Tajikistan, as does half in Kyrgyzstan, the World Bank estimates. Most of the poor live in rural areas.

Because of poverty, men leave home to sell their labour in more affluent places, primarily Russia. Away from home, behaviour changes, sex and drugs ease despair and dislocation, and more than money returns to their households.

Because of poverty, women and girls are forced into prostitution and increasing numbers of people are persuaded to work in the drug business.

Porous border

The Panj River follows a tongue of Afghan territory that protrudes past the Pamir mountains into the heart of Tajikistan. For most of their 1,400-kilometre border, it is the Panj that separates the countries.

It is a porous frontier. Its length, a sparsely spread population and mountains into which law enforcement cannot penetrate give drug traffickers freedom to operate. One of the busiest routes has run from Khorog, the capital of Gorno Badakhshan, Tajikistan's autonomous Pamiri east, to Osh, a southern Kyrgyz town that is a major hub for the traffickers.

What has happened in these towns, and the spread of HIV the drugs have brought them, provide both an insight and a warning.

Khorog has probably peaked as a player on the heroin highway. But Gorno Badakhshan's location ensures it stays in the game. A major poppy-growing area adjoins it and the Wakhan Pass, a narrow Afghan strip between Gorno Badakhshan and Pakistan, is awash with drugs for Osh.

There is another telling factor. Gorno Badakhshan is the poorest corner of the poorest country of the former Soviet Union.

A crisis in the autonomous region cannot be found in official statistics. Officially 23 people are living with HIV/ AIDS in Gorno Badakhshan.

Bodurbet Bodurbekov, director of the region's HIV/AIDS centre, is the first to concede that this is far from reality. Asked what that is, he says, "Ten, 20 times more." On one thing there is consensus: the need for greater HIV/AIDS preventive action.

The Tajikistan Red Crescent is busy informing youth, who make up 43 per cent of the population. Information campaigns on HIV and drugs target schools, universities and marketplaces. A theatre group tours schools with dramatized versions of messages.

Time bomb

Figures acquired by the Netherlands Red Cross from senior officials in national agencies would suggest the number of drug users in Tajikistan is 60,000 to 80,000, and 80,000 to 100,000 in Kyrgyzstan. Osh province in Kyrgyzstan has a large concentration of them. Heroin is easy to find in Osh, costing one US dollar a fix. Growing crime and prostitution pay for it.

According to official figures there are 2,000 drug users in Osh province but most sources say that is nonsense. Enormous statistical differences are the norm in Central Asia. Officially, Kyrgyzstan has 5,600 drug users. Yet based upon scientific research in two specific regions, the State Commission on Drug Control contends it could be 100,000. So what could that mean for HIV?

Anywhere in Central Asia the answers can only be speculative. Controls are not in place to measure it. The Kyrgyzstan Red Crescent says simply that the danger is plain to see.

HIV is already a factor in the rise of tuberculosis, the most common AIDS-related cause of death. In the Kyrgyz province of Osh, there are now 126.4 cases per 100,000 people, and up to 147 in one district. These are alarming figures and, though they are pockets, compare to the worst in the world.

Could Osh be sitting on a time bomb? "Not only Osh," says the Kyrgyz Red Crescent's regional youth coordinator, Nurgul Moldobaeva. "All the elements required to cause a disaster are in place in Kyrgyzstan. But if people are informed, if they understand, the danger can be dealt with."

So far information has not spread well, as the Red Crescent has found touring villages with awareness programmes.

Focus on youth

Supported by the Netherlands Red Cross in Bishkek and Chuy, Issyk-Kul, Naryn and Talas provinces, and by the British Red Cross in southern Osh, Jalal-Abad and Batken, the Kyrgyz Red Crescent's main focus is on youth.

Working to prevent the use of drugs as well as to spread knowledge about HIV and AIDS, it operates in schools and universities, on the streets, and through Red Crescent youth centres throughout the country.

Plays, rock concerts, quizzes and contests, processions and disco parties are used to reach young people in towns and communities.

On a winter night in Bishkek, project coordinator Asel Ibraimova and friends are hopping round the discotheques with a 20-minute floorshow and a large supply of condoms. Television and newspapers follow them and on the ill-lit street of the second club, sex workers slip into the shadows.

On schedule inside the house music dies, the lights go up. A young man called Azamat steps forward. "Have you ever tried blowing up a condom?" he asks.

A condom-blowing contest follows. The audience howls and screams but there is method in Azamat's madness.

"So," he says at last, "how much do you know about HIV?"

There's a series of questions with prizes for people who shout correct answers. Before they leave, young volunteers go table-to-table, distributing condoms and literature.

Outside, the sex workers have re-emerged and cars are cruising round. "Hey," yells a man from his window, seeing the Red Crescent emblem. "Do you people have a condom for me?"

"Sure," laughs a girl and wanders over. "I also have a leaflet. If I were you, sir, I'd read it."

This article first appeared in Red Cross, Red Crescent Magazine