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Is Russia's HIV/AIDS problem worse than Africa's?
  http://blog.foreignpolic, Posted By Elizabeth Dickinson Wednesday, September 8, 2010 - 12:25 PM
The New York office director of UNAIDS, Bertil Lindblad, is worried about the one region of the world where HIV infections are increasing, even as rates in the rest of the world level off. It's not in Af rica or Asia, or even Latin America. It's Eastern Europe -- countries like Russia and Ukraine -- where a recent UNICEF report notes that increases in infection rat es of as high as 700 percent have been seen since 2006.
"There is an urgent need for the whole Eastern European and Central Asian region to act quickly," Lindblad said this morning. "This is really quite scary given the fact that there is denial, and so much stigma and homophobia [in that region.] This could really create huge problems if HIV continues to spread from smaller groups in the popula tion to wider."
It's HIV/AIDS's silent crisis, one that has been underway for the last decade. The region is home to a quarter of all injection drug users in the world (3.7 million), and this is where the epidemic is believed to have begun. These users are young -- most of them teenagers. But from there, HIV spread to sex worke rs (the majority of whom are also under 30), and now has fully moved into the everday lives of men and women in the region, married and unmarried. A mark of the epidemics progression -- from specific populations into the majority -- is the new incidence of HIV among women, who account for 40 percent of all new infections (that's up from only 24 percent at the turn of the century.) The stigma att ached to the disease -- and more importantly, to the groups of people percieved to be the majority infected with it -- is the biggest obstacle to doing anything about the disease. "Those living with HIV have been silenced and excluded, and risky behaviours borne of futility and hopelessness have been sanctioned or repressed," the UNICEF report notes. Government officials are said to be resistant to admitting the scale of the problem, and today that country remains a difficult places for AIDS advocacy, says Lindblad, who formerly worked in the UNAIDS office in Moscow.
But where there is challenge such as this, there is also often opportunity. Russia, I would think, should have a very serious interest in addressing this crisis. For starters, because AIDS threatens to exacerbate its larger demographic problem -- that of a fast-shrinking population. But the other point might be even more convincing: The injection drug users are using heroin. And that heroin comes from Afghan poppies. For Russia, tackling the illegal drug market in Afghanistan -- one which fuels the insurgency -- is a serious national security issue.
-- More than thirty years a go the first cases of AIDS were appearing in hospitals across United States, Europe and in Central Africa. The first published reports of this unusual disease appeared in 1981. It took a further two years before the cause, a retrovirus named the Human Immunodeficiency Virus, was identified.
The initial media responses to this sexually transmitted disease were hysterical with reports of police demanding protective clothing, funeral directors unwilling to bury the dead, and fears that AIDS would spread rapidly through entire populations laying waste to humankind.
It soon became apparent that HIV was difficult to transmit requiring dire ct contact with blood or body fluids. By 2000 the shape of the epide mic was clear. In most of the wealthy world it is primarily a disease of marginalized populations with specific patterns of behaviour that put them at risk. These include injecting drugs users and men who have sex with men without using protection. Across much of Latin America and Asia it is a limited disease affecting largely specific groups. --
But there are areas where AIDS is a serious and growing problem. In Russia, Ukraine and some of the other former Soviet countries HIV transmission through injecting drug users is affecting significant proportions of young men and is spreading quickly. They in turn pass the disease on to their partners, who may then transmit it to their children. While the absolute numbers are not high, the proportionate impact will be significant. Of course, good old fashioned peer pressure might help edge them along as well. And when the U.N. General Assembly meets later this month, one of the side conversations, according to Lindblad, will be a discussion on HIV/AIDS "co-hosted by the government of China, the government of Nigeria, and UNAIDS," specifically, the Chinese premier and the Nigerian president (South Africa's President Jacob Zuma was also supposed to come, but had to cancel.) "That could influence other big countries such as Russia, for example, to turn around."
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