HIV Shadow Lengthens Over South Kyrgyzstan

Doctors are warning that the HIV is spreading fast in southern Kyrgyzstan, partly as a result of poor hygiene in hospitals but also through ignorance about how the virus is contracted.



Until recently, the incidence of infection was highest among drug users and sex workers, but the virus is now becoming more common among other parts of the population, including children.



The southern region of Osh has become the epicentre for new cases. Tugolbay Mamaev, senior doctor at the region’s AIDS Centre, said infection rates had now reached a worrying level.



The Kyrgyz health ministry recorded a total of 1,500 cases of infection among the total population of five million in 2007, a 15-fold increase on the level recorded in 2002. Almost half the figure for 2007 - which include existing cases as well as new ones - were in Osh region, and one-third of the total were in the city of Osh itself.



“The distribution of the virus has shifted from the high-risk category to the general population,” said Mamaev, adding that undergoing treatment at beauty salons and tattoo parlours, and also the circumcision ceremony that is standard practice for this predominantly Muslim population, could all be potential sources of transmission.



Last year, Osh region recorded 41 cases of HIV infection among children. It is unclear how they contracted the virus and a special commission is still looking into possible sources. One precaution that has been taken is to require pregnant women to undergo HIV tests.



HOSPITAL HYGIENE UNDER SCRUTINY



HIV and AIDS are relatively new to southern Kygyzstan. The first known case here was recorded only ten years ago. Now the numbers of new cases are increasing by 80 or 90 each year. Last year, Osh region saw 191 new cases.



While officials investigate the rise in infections, many pregnant women believe poor standards of hygiene in the hospitals are at least partly to blame.



One woman named Anna spoke of her concerns when she and her child underwent hospital treatment in Osh.



“What are you supposed to do when you go to hospital for medical treatment and contract a fatal infection as a result?” she asked.



Anna said she had been forced to pay three times the normal fee to ensure that clean new syringes were used for her intravenous injections.



Despite this, she noted that needles from different patients were used to draw the anaesthetic novocaine from one common container.



“I told the doctors about it many times but they didn’t care,” she said. “They were completely indifferent.”



When she heard that HIV had been detected in the hospital, Anna got herself and her baby tested. “Everything turned out fine,” she recalled with relief.



LITTLE AWARENESS OF TRANSMISSION ROUTES



While patients query standards of hygiene in hospitals in southern Kyrgyzstan, doctors insist the main factor behind rising infection rates is the low level of awareness about HIV/AIDS, and the poor quality of the information available.



“Given the current level of awareness, nobody around here is safe from HIV infection,” said Dr Mamaev.



Mamytbek Ismailov, senior doctor at the AIDS centre in the neighbouring region of Jalalabad, agreed. Printed literature about HIV/AIDS had been issued in a variety of local languages but it was clearly not enough, he said.



International donors have done much to help combat the growth of HIV in Kyrgyzstan. The Global Fund to Fight AIDS, Tuberculosis and Malaria has given the country 17 million dollars over the last four years and has pledged a further 28 million over the next five years.



But the money does not filter down to remote country districts, especially in the south. “Nobody seems concerned with the HIV/AIDS problem in rural areas,” said Dr Ismailov.



“At village level, this work is entrusted to the staff of the health and hygiene inspection service and they’re only interested in checking cafes,” he added. “I’d eat my hat if I heard they’d ever visited a school to talk about AIDS”.



Ismailov said staff from his AIDS Centre managed to give one lecture a year in each of the region’s colleges and universities. But this was not enough, he said, adding, “Such work should be conducted at least once a week, but we don’t have the resources.”



Azat Kerimbaev, deputy senior doctor at the Osh Regional AIDS Centre, said getting the message across about safe sex was not easy, and at times the staff faced open hostility from traditionally-minded locals.



He doctor recalled one angry parent telling him, “You’re just advertising condoms. If I find a condom in my son’s pocket, I’ll kill him”.



Several years ago a new book for older children called “Healthy Lifestyle”, caused controversy in Kyrgyzstan because it contained a chapter on safe sex. Some public figures considered it outrageous and accused the book’s authors of encouraging teenage depravity.



Since then, public figures such as the clergy have tried to be more constructive, helping shoulder the burden of public education on this sensitive topic.





Muslim clerics have discussed HIV/AIDS with their congregations, but according to one imam who wished to remain anonymous, the campaign has not yielded much in the way of results.



“First, the imams themselves know little about this issue. Second, the people who visit mosques are devout people who are usually far removed from the world of drug addiction and prostitution,” he said, adding that in his view it was the latter groups that needed education programmes.



A growing number of programmes address drug addicts and sex workers. According to Mamaev, injecting drug users can get free disposable syringes every day.



But he says these outreach programmes have not yet spread their net wide enough, although 85 per cent of HIV-positive people in Kyrgyzstan are recorded as habitual drug users.



“To get real results, we need to cover at least 60 per cent of drug users but so far we’ve only been working with 20 per cent of them,” said Mamaev.



AFGHAN OPIUM CONNECTION



Osh’s role as a hub for HIV infection reflects its strategic position on international drug routes. The city acts as depot and transmission point for heroin and opium coming in from Afghanistan via Tajikistan for onward shipment to Kazakstan, Russia and the rest of Europe.



Antonio Maria Costa, executive director of the United Nations Office on Drugs and Crime, UNODC, told a meeting of former Soviet heads of state in October that more than 200 tons of heroin - 20 per cent of Afghan production – was smuggled through Central Asia in a year. Kyrgyz security officials say between five and seven per cent of Afghan exports pass through their country, which would mean 10 to 14 tons based on the UNODC estimates. Much of this goes via Osh.

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Inevitably, the flow of illicit drugs means they are cheap and readily available at this early stage in their journey, and the seemingly unstoppable growth in Afghan opium production has inevitably fuelled heroin use in southern Kyrgyzstan.



Kyrgyz police say there are 7,500 officially registered drug addicts, of whom 4,200 are intravenous users. More than 1,700 of these addicts live in the Osh region, and most inject drugs.



But data from the Osh AIDS Centre suggest the official figures grossly underestimate the real scale of the problem, and indicate that the total for this one region is at least 15,000.



“Drugs are very accessible here,” Dr Mamaev noted. “In addition, many young people turn to the drugs trade because of the area’s economic problems.” Osh region is one of the poorest in the country.



Many young drug users have criminal records and according to Dr Kerimbaev, are extremely careless about their health.



“These people care about absolutely nothing,” he said. “I never saw any of them in hysterics or even shedding a tear after receiving a positive test result for HIV.”



He sees a clear connection between organised crime and the rise of HIV. “I’ve never heard of the drug mafia suffering a setback, so the number of people with HIV/AIDS is bound to increase,” he said.



INCIDENCE HIGH AMONG TRANSIENT POPULATIONS



Another factor behind the intensive spread of HIV is that prostitution has become big business in the south. Local newspapers are fuller than ever of advertisements for apartments rented by the hour or night.



“You have such apartments in every high-rise block,” one resident of Osh city claimed, adding that many of the “night moths”, as prostitutes are known here, come from neighbouring Uzbekistan.



Uzbekistan is thought to have the highest rate of HIV infection in the region, with about 38 carriers for every 100,000 members of the population, and the rate of new cases is rising fast.



Karasuu, home to a famous wholesale market, is typical of the new HIV epicentres in southern Kyrgyzstan. It holds second place to Osh city for recorded infections.



Thousands of migrants from Uzbekistan, China and other countries work temporarily in the market here, living in the backs of their lorries and conducting transient sexual relationships.



“Nighttime carousing with prostitutes is a pretty usual thing round here,” says Bakhtiar, 30, who sells Chinese clothes at the market.



Whether awareness programmes will be enough to halt the spread of HIV in an area like this is unclear. But if the battle for hearts and minds does not start being won soon, experts fear Kyrgyzstan’s south will one day be dealing with an epidemic of far larger proportions.



Abdumomun Mamaraimov is an IWPR contributor in Jalalabad.