Turkmenistan in AIDS Denial

Turkmen medical professionals are growing increasingly concerned official reluctance to address HIV infection in the republic may fuel an AIDS epidemic.

Secrecy and denial are commonplace in the isolated republic, which maintains that there’s little possibility of Turkmen catching the HIV virus that leads to AIDS.

One Turkmen analyst, speaking on condition of anonymity, said, “The unofficial ban on diagnosing infectious diseases - along with significant cutbacks in medical staff - are helping to create favourable conditions for epidemics such as hepatitis, tuberculosis and, most terrifying of all, HIV/AIDS.”

While poverty, drug use and prostitution are all pushing the rates of infection up, sources claim that the health ministry has banned its staff from listing AIDS as a cause of death, or even admitting the that HIV-positive patients admitted to state hospitals are suffering from the virus.

One nurse at the capital’s infectious diseases hospital told IWPR that one young man was transferred to the facility just before New Year and immediately rushed into a ward of his own.

While doctors would only say that the patient was suffering from “an unknown infection” and forbade any contact with him, the nurse, speaking on condition of anonymity, told IWPR that the young man was an AIDS sufferer, but that the hospital’s health chief had ordered that this information be kept secret.

One former patient at the hospital told IWPR that a similar event had happened in July 2004, while he was receiving treatment for suspected hepatitis.

“A patient was brought to the hospital and given a separate ward, which was very strange, as the hospital was full to overflowing that summer with people from all over the country.

“The doctors and nurses who entered the patient’s ward did so wearing masks and shoe covers. Officially we were told that he was suffering from severe food poisoning, but one of the orderlies later told us that he had AIDS.”

Observers believe that this is typical of the attitude of the authorities, led by president-for-life Saparmurat Niazov, who likes to be called Turkmenbashi, or “Leader of all Turkmen”.

Turkmenbashi has declared the 21st century to be the “golden age of the Turkmen people”, and this had led to a policy of hushing-up all negative news in the republic – particularly that relating to the spread of diseases such as AIDS.

According to official statistics, there have only been two cases of HIV infection among citizens of the country from 1989 to 2004 – a figure trumpeted as a triumph of the government’s prevention work.

However, an IWPR source in the Turkmen health ministry, speaking on condition of anonymity, claimed that there are more than 300 confirmed cases of HIV infection in Ashgabat alone, with the real figure believed to be far higher. More than half of those infected are women, with an average age of only 23 years.

These figures are considered to be classified, according to the source, and health ministry employees have been ordered to not to write down the cause of a death as “AIDS”. About ten people are known to have died of AIDS-related illnesses in the capital in the past two years alone.

Analysts fear that official denial of the dangers of HIV infection is contributing to its spread.

One doctor who used to work on the state AIDS-prevention body said that with no resource centres for sufferers, or discreet blood-testing services available to those who fear they have been infected, the situation appeared bleak.

“We conduct programmes and attend international conferences, and talk about our work with young people and teenagers, but we constantly announce that there is no AIDS in our country,” he told IWPR.

“In fact, only a few brochures have ever been distributed, and only a handful of events are held about HIV and to explain the nature of AIDS.

“The Turkmen people were largely ignorant of the problem and they remain so. Meanwhile, the virus is increasingly being spread through unprotected heterosexual sex, and is now at risk of spreading away from the gay community and drug users and into the population at large.”

One sexual diseases specialist told IWPR, “In my work I encounter people with venereal diseases every day, but never as many in my clinic as I’ve treated recently.

“This is the result of the current wave of cheap prostitution. It is frightening that more than half of these sex workers accept payment in drugs and are not worried about sharing needles - not to mention the fact that they do not use condoms to protect themselves from disease.”

The rising rate of infections is also being blamed on the large number of young people in the poverty-stricken republic who are injecting drugs. Medical professionals believe that as many as 35 per cent of all intravenous users share needles, which drastically increases the risk of HIV transmission.

Turkmenistan’s prison system is another prime source of HIV infection, due to overcrowding and rudimentary healthcare for inmates.

One prisoner who was amnestied late last year told IWPR, on condition of anonymity, that Turkmen prisons are “completely unsanitary”.

“Half the prisoners are drug addicts, and syringes are passed from one person to the next,” he said. “This creates the risk of the swift spread of HIV infection and other infectious diseases including hepatitis. Venereal diseases are also spread in prison.”

Observers also believe that the state’s measures to limit the introduction of the disease from outside the republic are ineffective.

A 1992 directive prevents foreign citizens from being issued with entry visas unless they produce a certificate showing them to be HIV-negative, but government insiders note that this rule only applies for stays longer than ten days.

One foreign ministry official, who asked not to be named, said, “The idiocy of the situation is that a foreign citizen who stays in the country for up to ten days does not need to present a certificate - as if he cannot infect anyone in [that time] - but if he extends his visa he needs to present a certificate that he does not have HIV infection.

“But these certificates are issued by the national infectious diseases hospital and like everything else in this country, they can be secured with a bribe!”