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Kazak HIV Scare Reveals Broader Healthcare Problems
Although the Kazak authorities are taking the discovery of multiple cases of HIV infection in the south of the country extremely seriously, the crisis highlights broader problems in the underfunded health sector which critics say will be hard to sort out even with a fresh injection of cash.
Reports of children infected with the virus, which can lead to AIDS, have been in the public domain for three months. But it still came as a shock when Health Minister Yerbolat Dosaev announced on September 18 that the number of children diagnosed as HIV-positive in South Kazakstan region had climbed to 55.
Two days later, President Nursultan Nazarbaev sacked the health minister and South Kazakstan regional governor Bolat Zhylkyshiev, and promised to oversee further investigations himself. The head of the health ministry’s quality control body, Ualikhan Akhmetov, was also dismissed.
Nursulu Tasmagambetova, the head of South Kazakstan’s health department, had by then already stepped down, and three senior doctors in the region were sacked in July after central government sent in a commission led by Anatoly Belonog, Kazakstan’s chief doctor, to investigate reports that 15 children had contracted HIV.
As of October 3, the regional health department reported that 72 children had been diagnosed as HIV-positive, and five of them had died, according to the Kazakstan Today news agency. Eight mothers had also been found to have the virus. Twenty of the children were receiving treatment, some with anti-retroviral drugs, and 11 babies were in an infectious diseases hospital.
Health officials have conducted mass testing of 9,093 of the 10,175 children believed to be at some risk of having been infected.
Prosecutors have launched a criminal case under a provision making it illegal to infect others with HIV, although no one has been charged yet.
The precise source of the infection has yet to be identified, although Belonog said in July that his commission narrowed the cause down to non-sterile equipment and infected donor blood.
According to Irina Savchenko, coordinator of a United Nations HIV/AIDS programme for Kazakstan, Kyrgyzstan and Turkmenistan, pinpointing the exact origin of the infection will be problematic.
“There are probably numerous sources of infection, and it will be difficult to find them all. The most important point is that a chain of infection has begun, and HIV has spread within medical institutions. The transmission routes should have been cut off immediately,” she said.
When he announced his findings in September, Dosaev placed the blame firmly on negligent medical practices in South Kazakstan - hygiene standards during blood transfusions were poor, disposable items like syringes were re-used, and the system for registering blood donors was inadequate. He said his investigation had revealed that medical equipment bought for the children’s hospital in Shymkent was sold on the black market.
While acknowledging that his own ministry had failed to purchase certain items of expensive equipment for South Kazakstan, Dosaev insisted that the infections should be blamed on local doctors and managers breaking the rules.
The provincial governor retorted by saying his region received far less money than the national average for healthcare, including blood donor facilities.
Because it involves such large numbers of children, the South Kazakstan HIV scandal has become a major national issue, with members of parliament pressing for action.
The case is also worrying because many of the symptoms of failure seem to be common to other parts of the country. In the course of its investigations, the health ministry inspected hospitals, blood transfusion clinics, and HIV/AIDS centres across the country – and found a catalogue of problems. In particular, blood donor centres were unhygienic and poorly equipped, storage facilities were substandard, doctors were not properly trained and basic procedures were ignored.
An illegal drug user in Shymkent told IWPR on condition of anonymity that local clinics commonly accepted blood from addicts simply because they were happy with the minimum payment of 700 tenge (less than six US dollars) for a donation.
“I know for certain that one drug addict who has been diagnosed with AIDS gave blood, and they did not ask her if she had the HIV virus,” she said.
In response to the crisis in South Kazakstan, the government has come up with an extra 53 million dollars for a national HIV/AIDS programme over the next four years. But will money alone help address the systemic problems that have emerged?
Yerasyl Abylkasymov, a member of parliament who has spoken out on the South Kazakstan scandal, says a lot of money has already been spent with no apparent effect.
“There are 6,400 people diagnosed with AIDS in Kazakstan, and about 800 of them have died. Unofficial figures show at least 50,000 people infected [with HIV],” he told his colleagues in parliament. “Now look at these figures: the World Bank and other international organisations have allocated 27 million dollars in grants to combat AIDS….. Now we are asking where this money has gone?”
Rozlana Taukina, a human rights activist, has a pessimistic answer to how the money will be spent. “As ever, immense funds will be written off or stolen. In a system mired in cheating and theft, people will never be protected from AIDS,” she told IWPR.
“It will take a year to buy enough syringes and institute hygienic practices with one needle per patient. But then they will start to economise again and the syringes will appear on sale at chemists’ shops.”
Yerlan Tanzharykov, a doctor at a cancer clinic in Almaty, Kazakstan’s second city, said the theft and re-sale of equipment was routine.
“Nurses get less than 100 dollars a month; they spend a quarter of this on transport to work, and many of them don’t have housing. But they can sell the disposable needles they ‘save’ at the market. This is a serious temptation, and one that is hard to resist if you have hungry children to feed at home,” he said.
Eduard Poletaev, a political analyst and editor of the Mir Yevrazii journal, said, “As long as medical employees remain low-paid workers, it will be difficult to eliminate negligence by doctors.”
Poletaev went on to suggest that the thefts by low-level staff are only part of a wider web of corruption that extends to senior healthcare managers.
The HIV scandal has undermined public confidence in the healthcare system, which has already seen a number of negligence cases brought to court. In January last year, the health ministry was required to pay compensation to 29 parents who brought a legal action, in a case involving 2,000 children vaccinated with a poor-quality tuberculosis vaccine, about half of whom suffered complications.
Trust in the system has been further dented by the slowness of senior managers to react when the crisis first began to emerge.
According to political analyst Oleg Sidorov, “This situation is a kind of barometer of the professional standards among Kazakstan’s administrative class.”
Gaziza Baituova is an IWPR contributor in Taraz.
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