Uzbek Aids Timebomb?

Tuesday, 22 February, 2005

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IWPR Central Asia

Uzbekistan may be sitting on an Aids timebomb. Unless proper measures are taken to control the spread of HIV, there could be an explosion in the numbers of deaths from the disease in the next few years, health experts warn.

"I would describe the situation as serious," said Rudick Adamian, Uzbek UNAIDS programme adviser. A report released by the organization quoted government figures which showed that HIV cases have doubled since last year.

However, local professionals say the problem is far worse. Official surveys, they say, focus only a small number of registered drug-users from Tashkent and nearby Yangiyul.

By the end of November last year, government statistics reported 190 HIV-positive cases in Uzbekistan. One month later the figure had risen to 230.

Adamian believes the authorities are beginning to sit up and take note of the situation. "The government response to the crises has been positive so far. The authorities are taking the situation seriously, expanding their own efforts and asking for more international help."

An initiative launched by deputy health minister Bakhtior Niyozmatov earned him a UN-sponsored prize, awarded annually to the person who made the largest contribution to combat the spread of AIDS.

Niyozmatov had come up with the idea of setting up needle and syringe exchanges known as 'Points of Trust', set up in 12 centres throughout Uzbekistan.

However, they are not openly advertised and have not managed to overcome public reluctance to address the issue.

The situation is critical for drug-users. The UN report, quoting official statistics, claims 80 per cent of Uzbekistan's registered intravenous drug-users are victims of HIV and AIDS. "There is no room for complacency," said Adamian.

Health professionals are also worried that increasing sexual promiscuity will fuel the growth in Aids cases.

"Apart from the fact that most addicts are not registered anyway, no one is tackling the much more dangerous issue of sexual behaviour," said a senior Uzbek nurse who preferred to remain anonymous.

"It's much safer to speak about addicts whom everyone knows are 'dirty' and 'anti-social'. On the other hand, speaking about your 'respectable' neighbour who goes on business to Malaysia and has unprotected sex with a hotel prostitute is a taboo subject.

"Or your best friend, a woman, who goes to Iran on business and the only currency she takes with her is her own body."

"We don't like to think we ourselves are part of the problem, and we Uzbeks certainly don't like to talk about it."

The nurse has been increasingly alarmed at the incidence of sexually transmitted diseases in women visiting her clinic. She was further shocked, however, on hearing her boss forbid her from revealing the true diagnosis to her patients.

"I was told to say that they had a minor infection, because to tell them the truth would in the words of my boss 'upset marital harmony'. The sad fact is that many Uzbek men have mistresses once they have had enough children or their wives have lost interest in sex. Most don't even think about using contraception. Many have several partners during their marriage."

The nurse's fears and suspicions were confirmed by Dr Jay Dobkin, a leading AIDS researcher who has worked in Kazakstan. Dobkin, addressing the Open Society Institute on Jan 12 at the Columbia-Presbyterian Medical Centre, New York, cited the "considerable rise" in the number of syphilis cases between 1985-97 in the region.

Syphilis cases often reflect AIDS figures. For Dobkin they were an "ominous indicator" and precursor to the rapid spread of HIV/AIDS.

According to Dobkin's estimates, there are now upwards of 300,000 intravenous drug users in Central Asia - 90 per cent of whom are through to share needles. A decade ago there were virtually no addicts.

Such statistics would indicate that Uzbekistan's official figures for both drug users and HIV cases are rather conservative.

Widespread ignorance and prejudice exists about AIDS among Uzbeks of all ages.

"We are muslim enough not to talk about sex, promiscuity, or infidelity, but not muslim enough not to take part in them all," said a doctor at a local childrens' hospital, who also preferred not to be named.

"If we want to broadcast on TV about AIDS we have to be so careful not to upset or offend people. We can never really explain the full horror. If we encourage so-called 'safe sex' we will be accused of encouraging promiscuity among young people.

"We have to pretend everything is fine, even though beneath the morality of much of our life hides a lot that is rotten. People don't understand the implications of their behaviour and won't until it is too late."

Until a few years ago, AIDS could be easily blamed on foreigners who had brought the disease to a 'clean' country.

Thirty-three foreigners were among the 190 cases reported last year. They were duly deported. And, every year on November 1 foreigners working in the provinces are obliged to undergo an HIV test. Indeed, popular belief is that they brought the virus to the country.

People are terrified of contracting the virus and routinely screen themselves before and after admission to local hospitals.

Untested blood is routinely used in transfusions, particularly with donor-relatives. Doctors are reluctant to test blood because of the costs involved. "No blood is screened," said the children's doctor.

Since people believe AIDS is connected with foreigners and poorly resourced hospitals rather than drugs and sex there is no stigma attached to having had a test. Indeed, it's believed the more you have, the safer you are.

So, very few understand the mechanics of HIV transmission. As such, they fail to appreciate the need for them to change their sexual habits.

The very idea of providing government-sponsored sex education would cross social and religious boundaries.

In people's minds it is far safer to confine AIDS and HIV to the squalid underworld of the drug trade. But people need to come to terms with reality if a real disaster is to be averted.

Jennifer Balfour is a regular IWPR contributor