Uzbekistan: Reducing harm through sports and safe fixing

Published: 3 December 2004 0:00 CET

Ilmira Gafiatullina, in Uzbekistan

In a bid to preventing the spread of HIV, the Red Crescent in Central Asia has gone beyond its existing activities to raise awareness among the public, to offering direct support to groups with risky behaviour, such as drug users, commercial sex workers and their clients.

Based on the harm reduction approach, the Uzbekistan Red Crescent has opened six posts in the cities of Namangan and Fergana offering needle exchanges, condom distribution, free testing for HIV and support groups.

Safe fixing

News of these facilities spread round the communities fast and soon reached the targeted groups. Many would have come immediately but fear of being caught by the police made them delay their a visit.

To ease access into those living in the shadows, the Red Crescent teamed up with people who have contact with drug users and sex workers.
Irina Kirgizova, a lecturer from Fergana University, is one of them. She had experience distributing condoms and syringes for another organization. She was paid for her work “At that time I was desperate for money. Then the programme was stopped because of a lack of funds,” she explains.

Now she is back doing outreach work through the Red Crescent, but her motivation is different. “As soon as I got acquainted with some of the drug users and sex workers, I realized how vital it can be to support them. It is not my business to criticize or instruct them. I can help in a very practical way – giving safe fixing, showing first aid basics in case of overdose or explaining what HIV means.”

In Central Asia, injecting drug use and increasing unsafe sex among young people are the driving forces behind the rapidly expanding HIV epidemic. Between 70 and 90 per cent of HIV cases are caused by injecting drug use.

Drugs are relatively cheap: in some places heroin is believed to be cheaper than alcohol.
In the areas like the Fergana valley in Uzbekistan, which lies on the main heroin trafficking route from Afghanistan to Russia, and then west, soft and hard drugs are readily available. By some estimates, in a region with a population of about 50 million, there could be as many as 500,000 drug users, many of them using dirty needles.

The majority of injecting drug users are young and sexually active, and so sexual transmission is also responsible for a significant proportion of new infections.

The Red Crescent’s policy of reaching out to these marginal groups is often questioned: Why, people ask, is aid being directed to those whose behaviour is considered unacceptable, while other community needs have not yet been met?

“We cannot control the spread of HIV by neglecting drug users, sex workers and their clients. They are all members of our communities. Minimizing risk among them, we strive to protect others,” says Nargiza Shukurova, HIV programme coordinator with the Ukbekistan Red Crescent.

Outreach workers like Irina Kirgizova provide a vital link. There is an obvious need to bridge the gap in knowledge about the virus and sexual transmitted diseases (STDs). In general, awareness of HIV/AIDS and safe behaviour among the population is low.

To ensure that the correct knowledge is channelled to groups at high risk, the Red Crescent initiated training sessions. Among the participants are former injecting drug users. “Step by step, through the whole course, people involved in outreach learn more about the virus, ways of transmission, preventive measures, and first aid,” Nargiza continues.

Women and girls forced by extreme poverty and long-lasting unemployment into prostitution are at a high risk of HIV and STDs. They rarely have a chance to protect themselves, as condom use in general is very low.

In the city of Namagan, there are a number of neighbourhoods famed for cheap sex. In one of them, in a dormitory, the Red Crescent runs a post, distributing condoms to commercial sex workers.

“Advertisements about free condom distribution are placed in taxis, discos and restaurants and now more and more sex workers are coming to pick some up,” Tulganoi Khodjaeva, who is in charge of the post, says.

It took some time for her to convince female inhabitants of the dormitory to use condoms, as most of them never did. Now the stock of condoms will soon need replenishing. It seems this post is a success.

Offering alternatives

As 80 per cent of people living with HIV in the region are under 30, the Red Crescent keeps its focus on youth and especially on the part it calls the “bridge population”.

“Young people tasting life and taking risks are a concern for us,” Inna Jurkevich, the International Federation’s regional health delegate, says.

“They do not always live on the fringes of society. But while they are experiment with drugs or having injecting drug users as sex partners, they might be exposing themselves to HIV. More than that. These people might be building a bridge for the virus into mainstream society,”

While the Red Crescent continues to raise awareness among youth about HIV, many issues related to sex and injecting drug use are still taboo in Central Asia. But change is slowly happening. Young people are starting to talk about their problems in public – from the stages of professional and amateur theatres, designing posters for adults or putting on puppet shows for children.

“It was not easy to start talking about condoms and safe behaviour to friends I see every day and have a fun with,” says Timur, a 19-year-old volunteer at the Namangan Red Crescent branch. “They were joking at the beginning for a while. But they soon turned to be more serious and very interested in safe sex and how sexual diseases and HIV can be transmitted.”

Timur is the one of a large group of students, all Uzbekistan Red Crescent volunteers, who are confident to approach their peers and talk openly about “sensitive” issues.

The Red Crescent is supporting other ways of promoting a healthy lifestyle. One group of young people offers sport as an alternative to risky behaviour. Bekzod Ortykov leads a karate club with the backing of the Red Crescent branch in his home Namangan city. He promotes a positive spirit and builds up the characters of the boys and girls. The Red Crescent makes these exercises regular, free and open to those who choose a healthy life style.

This was how Zamir (not his real name) found himself practicing karate. He gave up injecting drugs two years ago. At first, he found it difficult to resist the temptation to get a dose. The only way was to focus on physical exercises.

“It took some time to get into shape,” Zamir says. “Now, I no longer think about drugs. I like sport, I am happy to come into the club three times a week. This is a new start for me”.
Zamir’s success might be a good answer to critics of the harm reduction programmes. “It is possible to make a real difference for many of those exposed to the risk of HIV,” Jurkevich says.

“We can achieve more in preventing the spread of the virus by breaking down the barriers of stigma surrounding those who are on the edge between life and death. To accept and respect their needs, to gain their trust and make the preventive measures closer to them is a challenge that we have to meet”.

Apart from Uzbekistan, HIV/AIDS control programmes are going on in Kazakhstan and Tajikistan. The programme is supported by the Italian Red Cross, which has been giving assistance to drug users through its Villa Maraini Foundation for almost 30 years. These days its proven approach is taking root along the ancient Great Silk Route.

The HIV epidemic in Central Asia is significantly underestimated. Officially, there are 6,706 recorded HIV cases. However, surveillance data compiled by the Centers for Disease Control and Prevention (CDC) estimates that the total number of people living with HIV/AIDS in Central Asia is around 90,000.

Based upon projections for the year 2005, this number will rise to 1.65 million without concerted efforts to target interventions.