[Go To Best Hit] Title:  Former Soviet Union Faces "Exponential Growth" in HIV/AIDS (U.S., international agencies working to slow disease) (920) Author:  Charlene Porter (Washington File Staff Writer) Date:  20020614 Text: Washington -- Unusually high rates of intravenous drug use and commercial sex activity are risk factors that may lead to an HIV/AIDS epidemic in Eastern Europe and the former Soviet Union which could be as fatal as that now seen in sub-Saharan Africa, according to experts in the disease. A coalition of U.S. health agencies, international agencies and nongovernmental organizations (NGOs) is working across the region to prevent what officials describe as "exponential growth" in HIV/AIDS and tuberculosis cases. "We're not here to predict and watch it happen," said Dr. Kenneth Castro, director of Tuberculosis Elimination at the U.S. Centers for Disease Control and Prevention (CDC). "We're here to intervene." Castro, an epidemiologist, spoke at a June 13 panel discussion in Washington sponsored by the Global Health Council, an international organization of health care professionals. Last December the Joint United Nations Program on HIV/AIDS (UNAIDS) sounded an alarm in its annual global census on the AIDS epidemic. Eastern Europe and the former Soviet states are experiencing "the fastest-growing epidemic in the world, with the number of new HIV infections rising steeply," said the report, titled "AIDS Epidemic Update." Statistics on the occurrence of HIV/AIDS are notoriously difficult to gather in Eurasia, experts say. The numbers of officially diagnosed cases available from health ministries may not include a large number of people who don't know they have the disease or are afraid to be tested because of the stigma attached to it. The U.S. Agency for International Development (USAID) said there were more than 103,000 reported AIDS cases in Russia in 2001. An Associated Press report early in 2002 cited 250,000 cases. "Several factors are creating a fertile setting for the epidemic: mass unemployment and economic insecurity beset much of the region; social and cultural norms are being increasingly liberalized; and public health services are steadily disintegrating," according to "AIDS Epidemic Update." Experts at June 13 briefing said that intravenous drug use is the single greatest contributor to the rapid transmission of HIV/AIDS in the region. Epidemiologist Dr. Tim A. Clary cited a direct correlation between the appearance of cases in Russia and Ukraine and known drug trafficking routes. In the states of Central Asia, Clary said, some data indicates that as many as 30 percent of the population is involved in the drug trade in some way. Afghanistan has long been a major source of the world's opium poppies from which morphine and heroin are derived. Drug trafficking has become a regional problem as the crops are transported out of landlocked Afghanistan to drug markets in other parts of the world. Many public officials in the former Soviet states have been slow to confront the spread of disease, these experts say, because it is mainly affecting a stigmatized and marginalized segment of the population. "Sharing needles is a very fast way" for HIV/AIDS to be transmitted by drug users, Clary said. But the disease won't stay confined to that population, he added, because it can be transmitted sexually to non-drug users. Eurasia is experiencing "an epidemic of injecting drug use," according to Nina Schwalbe, director of the Open Society Institute's Network Public Health Program. Complicating the problem is the fact that many people inject drugs only "once or twice a year at a party" and don't think of themselves as drug addicts or habitual users. They don't recognize the risk they're taking by sharing needles and don't heed the warnings, Schwalbe said. Clary reported that USAID has spotted a similar pattern of intermittent risk-taking among young women who work as occasional prostitutes when they need extra money. He says it is difficult to judge whether these women are unaware of the risk of disease or whether they're willing to take that risk because they have few other options for making money. Russia and Central Asia have also experienced a sharp increase in tuberculosis cases in the past decade, said the CDC's Castro. The occurrence has more than doubled, from 34 per 100,000 in 1992 to 90 per 100,000 in 2000. In contrast, the U.S. rate is 5.8 cases per 100,000. He said USAID and CDC are involved in a variety of initiatives in the region with nongovernmental and government agencies to expand awareness about tuberculosis, HIV/AIDS and their risk factors, and to decrease stigmatization about both diseases. Clary said there is less of an 'attitude of denial' in Eastern European and former Soviet governments compared with what he encountered several years ago. For example, the president of Ukraine declared 2002 to be the year of the fight against AIDS. The health bureaucracies of the region are still hampered by a Soviet-era organizational structure, Clary said, which he sees as an impediment to rapid progress. For example, experts who deal with sexually transmitted diseases and those who deal with tuberculosis have little institutional communication. The panel said it is in the best interests of the West to focus increased attention and resources on these diseases, not only for humanitarian reasons but also because of the large numbers of travelers moving between the West and Eurasia. Schwalbe called the HIV/AIDS epidemic in the region 'Ebola with wings,' a potential health threat that will not remain confined within national borders. (The Washington File is a product of the Office of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov) NNNN Product Name:  WASHINGTON FILE Document Type:  ARTICLE Keywords:  HIV/AIDS; DISEASES; ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS); FORMER SOVIET UNION; RUSSIA; 15A CP/LF Thematic Codes:  15A Languages:  ENGLISH Originating Team:  02061401.TGI