North Caucasus: The AIDS Taboo

Infection with HIV and the spread of AIDS in the North Caucasus is such a taboo that professionals fear the rising number of cases is just the tip of an iceberg.



In Chechnya, official statistics published in December show the number of HIV-positive cases had reached 560. This included 57 married couples, as well as 14 minors. The total number of women infected was 97.



Fifteen deaths from AIDS were recorded in Chechnya last year.



However, as doctors at Chechnya’s Centre for Preventing and Combating AIDS point out, this data is based on studies conducted among only 17 per cent of the population. That means the rest of the iceberg remains invisible and its size can only be guessed at. Experts at the centre estimate the real number of HIV-positive people at between 1,800 and 2,000.



Yet no one really knows. According to United Nations figures, Russia as a whole has the largest AIDS problem in Europe and 860,000 people are HIV-positive. Other more pessimistic forecasts estimate that there are 1.4 million infected people or approximately one per cent of the entire population.



In the North Caucasus, a combination of local factors exacerbates the Russia-wide problem. In Chechnya, many of the problems are purely technical. The diagnostic centre lacks equipment and its laboratory was only able to work restricted hours from August to November last year. Once new testing systems donated by aid agencies arrived in November, data collection improved immediately.



Increased drug use is one of the major reasons for the spread of HIV infection.



"In 53 per cent of cases, people have been infected through intravenous drug use,” said Khedi Aidamirova, head doctor of Chechnya’s AIDS prevention centre. “In the remaining cases, people have become infected through sexual contact. In addition, there are a number of cases where the virus has been transmitted vertically from mother to child, during pregnancy or breast-feeding."



Thirty-six-year old Zakir, a resident of the Chechen capital Grozny, has been a drug addict for the last 20 years. His attempts to get himself clean ended in a relapse when the second Chechen conflict began in 1999. In autumn that year, Zakir's wife took their son and daughter to Ingushetia as refugees, while he stayed behind and returned to his half destroyed home in Chernorechye, on the outskirts of the Grozny. He started to inject drugs, funding the habit by looting ruined and empty houses, dismantling gas stoves and tearing up linoleum and tiles to sell.



Zakir soon fell into the hands of the police, and he was sent to a prison camp in the central Russian region of Udmurtia. There he was diagnosed as HIV-positive.



Once Zakir had served his time, he returned to Grozny, telling his wife that the prison doctor had fabricated the diagnosis. His wife believed him, but he took another blood test and was confirmed as infected. He is now one of 17 patients being treated at the Grozny centre.



Leich Khekhaev, who heads the institution’s epidemiology department, is worried about the stigma attached to HIV infection.



"We know that our 17 patients are infected with HIV, but even in the best cases we know very little about them,” said Khekhayev.“We aren’t allowed to carry out preventive measures in their families. But the most frightening thing is that these people remain anonymous carriers of the virus in their own close circle. Because they fear discovery, they are prepared to sacrifice the lives of their wives and children.”



Health professionals say prejudice leads people in the North Caucasus to believe that AIDS is a problem for Africa and the West, and perhaps in other parts of Russia, but certainly not in their own region. Doctors at the Chechen centre say they have been threatened by members of the local security forces who have been told they are HIV-positive.



Some of those found to be infected refuse to believe their test results and have them checked elsewhere. And others still simply spurn all contact with doctors, afraid of what the public will think of them.



Prejudice is extremely strong. The AIDS centre shares a building with Grozny's main maternity hospital. Standing outside the latter, Malina Abdurazakova, who had come to visit her niece, voiced a common view.



"I’d heard we have this illness here, but somehow I didn't attach any meaning to it,” said Madina.“Here I can see how many people are dropping into the centre's laboratory to have tests. In the main it’s young people. I’ve thought about my daughter marrying someone like that – someone who at first sight looks positive in every way, but is HIV-positive."



Chechnya’s eastern neighbour Dagestan, without the excuse of devastating conflict, is suffering from a similar invisible HIV and AIDS problem.



A total of 123 new cases have been announced in Dagestan over the last nine months.



The situation is worst in the southern town of Derbent.



“As of January 1 [2005], there were only 21 cases of people registered as HIV-positive [in Derbent],” said Abdul Abdullayev of Dagestan’s Centre for Preventing and Combating AIDS. “By the beginning of this year, the number had risen to 83. That is, the increase over one year was almost 300 per cent.”



As in Chechnya, shared needle use is a major problem and 52 of the 83 people infected in Derbent have a drugs problem.



"It’s considered shameful to talk about AIDS here,” said Samira, 23, who works as a trader in Derbent. "It’s as if when you talk about AIDS, you’re talking about sex - and we don't discuss that in our society."



Zagid Kurbanov has owned a chemist shop in the city for the past decade, and serves behind the counter himself. "After the ten years that AIDS has been present in the town, most customers are still embarrassed to buy condoms," he said.



Derbent has had its own immunisation centre where tests can be conducted, but laboratory head Svetlana Gamzatova, said, "Few people want to have tests. It’s only if they are applying for a job. That’s the local mentality. Even though we guarantee complete anonymity, this is a small town and people are scared of being seen outside the AIDS clinic.”



Psychologist Irina Rudakova, head of the Genesis Women's Crisis Centre, confirmed that HIV and AIDS are the biggest taboo in Dagestan.



"Over the five years that the centre has been working we have advised women on various problems, even incest,” she said. “But we haven’t had a single case of someone infected with HIV. This is the most taboo of subjects."



There is widespread ignorance in the North Caucasus about the issue, with most people apparently unaware that an HIV-positive diagnosis is not a death sentence. But it seems prejudice is the biggest problem.



"I wouldn’t socialise with a friend who had AIDS," said Yarakhmed, a student in Derbent. "And if, God forbid, I fell ill myself, I wouldn't tell anyone. Not even my relatives. Everyone would turn their backs on me."



Amina Visayeva is editor of Vecherny Grozny newspaper. Rinat Turabov is a correspondent for MK-Dagestan in Derbent.