Addressing the spread of HIV in Eastern Europe and Central Asia

By Anke van Dam, M.D. and Corie Leifer, MSc.

HIV and AIDS rising
Rates of HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immune Deficiency Syndrome) in Eastern Europe and Central Asia (EECA) are growing alarmingly faster than anywhere else in the world (Bahromov & Weine, 2011). In fact, EECA is the only region where HIV prevalence clearly remains on the rise. The number of people living with HIV has almost tripled since 2000 and reached an estimated total of 1.7 million in 2012 (UNAIDS Global Report 2013). Key populations such as sex workers (SW), men who have sex with men (MSM), and people who inject drugs (PWID) have an increased risk of contracting and transmitting the virus because of the inherent risky behaviors in these activities.

THE CONTEXT
The past. According to the World Health Organization, over the last 30 years, HIV/AIDS has killed 35 million people worldwide. The introduction of Antiretroviral Therapy (ART) has lengthened the lifespan of people with HIV and delayed the onset of AIDS. However, ART is an expensive, lifelong treatment that requires a strict and demanding regimen. To limit the costs and effects, an important approach to conquering this disease remains through prevention. Public awareness campaigns that focus on promoting safe behaviors and providing education on topics such as methods of transmission, dispelling myths, and reducing stigma are crucial in helping to combat the spread of the disease.

The present. Although the number of officially reported cases across the region reaches into the hundreds of thousands, most experts agree that as many 1.5 million HIV-positive individuals already exist in EECA. In 1987, the first case of HIV was registered in the USSR, marking the start of the epidemic in EECA. Despite the late appearance of HIV in the region, it is home to one of the fastest growing epidemics. The relatively late start of the HIV epidemic in this region offers a unique opportunity to develop and implement effective programming to avoid the inevitable health, social and economic catastrophes witnessed in many other parts of the world. But looking at the current rise of HIV cases in this region, it seems that we may have lost this window of opportunity.

The world. Though sub-Saharan Africa still bears a disproportional amount of the burden of HIV, the crisis there has received much awareness and an infinite number of international and domestic organizations work to address this issue (UNAIDS, 2010). On the contrary, in Eastern Europe and Central Asia, the epidemic has received little international attention. The AIDS Foundation East-West (AFEW) is one of a handful of international organizations that addresses the HIV epidemic in this part of the world.

The region. As a product of political, civil, and economic unrest, circumstances that are conducive to the rapid spread of HIV such as poor access to information and public health services as well as high-risk behaviors such as injecting drugs and sex work, are common in countries that were formerly part of the Soviet Union (Bahromov & Weine, 2011).

THE TRANSMISSION of HIV in EECA
People who Inject Drugs (PWIDs). The HIV epidemic in Eastern Europe and Central Asia is typically driven by the unsafe injection of drugs and by onward transmission to the sexual partners of PWIDs. In fact, according to the World Health Organization, 80% of HIV cases in Eastern Europe and Central Asia are related to injecting drug use.

Between 11 and 21 million people worldwide inject drugs, and of those approximately 20% may be infected with HIV.  More specifically, in 2012 UNAIDS estimated that more than 15% of people who inject drugs in Belarus and Tajikistan are living with HIV; more than 20% in Ukraine; and more than 50% in Estonia.  According to the national data, out of 4893 new HIV cases registered among the local population in Kyrgyzstan in 2013, 2816 people (57.5%) inject drugs.

Nearly 22% of the worldwide injecting drug users live in Eastern Europe, compared with 6.5% that live in Western Europe and 14% living in North America. Furthermore, greater than 30% of people who both inject drugs and are HIV positive live in Eastern Europe, compared with less than 4% in Western Europe and 11% in North America.  

HIV has disproportionately affected young people across EECA who are increasingly experimenting with injecting drug use, which has contributed to the rapid growth in the epidemic. However, an increasing percentage of newly registered cases have listed unprotected heterosexual contact as their cause.

ADDRESSING THE HIV EPIDEMIC
Harm reduction. AFEW encourages a harm reduction approach to managing the connection between HIV transmission and injecting drugs. As the name implies, harm reduction focuses on reducing the harm to individuals, communities, and society caused by drug use. It includes policies, programs, and services such as overdose prevention and management, needle and syringe exchange programs, opiate substitution treatment, and condom distribution. Harm reduction aims to alleviate the moral judgment of PWIDs, and encourages a safe environment that promotes healthy behaviors and advocates for their human rights. By creating a supportive environment, including education programs, opioid substitution therapy, and other specialized services, health risks of injecting drug use can be minimized.  

Training Public Officials. AFEW is implementing activities to prevent, treat and care for HIV, based on best practices to the local conditions in other countries across the region. Currently, AFEW carries out programmes in Georgia, Kazakhstan, Kyrgyzstan, Russian Federation, Tajikistan and Ukraine. By providing training to medical personnel and public officials, AFEW aims to improve and integrate medical access and healthcare for the affected key populations (SW, MSM, LGBT, prisoners) and people with HIV or AIDS, to decrease stigma associated with the disease, and to utilize innovative strategies to promote healthy behaviors. It is only with the understanding and assistance of the community that this HIV/AIDS epidemic can be managed.

Capacity strengthening of local NGOs. There is an ever-increasing need for civil society to work with the health system, local, and national governments. By bringing civil society and governmental actors together, AFEW contributes to building a diverse, open society. Capacity building in a sustainable way is a key activity for AFEW in the region. Even as sustainability of local NGOs grows, AFEW continues to provide targeted technical assistance. Capacity strengthening activities include the training of healthcare staff and social workers providing services to key populations. E-learning modules and webinars developed to provide training on client management and continuum of care online also strengthen the capacity of local organizations. Coordinating mass media campaigns to promote solidarity within groups of people living with HIV.

Reducing stigma and discrimination. HIV/AIDS, like many other diseases and illnesses, is highly stigmatized all over the world. This contributes to a low level of seeking healthcare for AIDS- related illness and a lack of formal education about STIs such as HIV resulting in misinformation, which in turn, leads to further stigma (Natecho & Juhl, 2006).

The stigma associated with a positive diagnosis is often a reason given to avoid testing and the possible positive status. Many people would rather not know their status than to risk knowing that they are HIV positive. In fact, in Russia, more than half of the HIV positive people surveyed said that they had experienced discrimination related to their HIV status. Globally, stigma and discrimination are associated with lower rates of HIV preventive services including testing. The trainings and campaigns supported by AFEW work to promote education and decrease stigma. This is an important approach to addressing the HIV and AIDS epidemic, as in many countries and communities, the stigma associated with HIV and the resulting discrimination can be as devastating as the illness itself.

Original source.