Catalog

On the Front Line
ADB Review [ October 2005 ]

Intravenous use of drugs has fueled an explosive growth of HIV/AIDS in Central Asia. A regional approach is needed to deal with this cross-border crisis, but finding effective solutions is not easy

By Ian Gill, (igill@adb.org)
Principal External Relations Specialist

TEMIRTAU, CENTRAL KAZAKHSTAN

We keep about 20 meters behind the two nongovernment organization (NGO) workers as they deliver a box of sterile syringes to some two dozen drug users, halfconcealed among trees and bushes.

PREVENTIVE WORK NGO workers (in blue on the right) distribute sterile needles among drug users: intravenous drug use is the main cause of HIV/AIDS

The drug users are familiar with the NGO staff, Irina and Slava, but are nervous at seeing us, and sharp questions and answers fly back and forth like darts.

Irina’s package of needles is gratefully received, and she and Slava head across open land toward another group of drug users, who are peering suspiciously at us from behind a wall. As we approach, an object lands by my feet with a thump. It is the heel of a shoe and it has been thrown from behind the wall some 30 meters away.

Their mistrust of strangers is understandable. Those caught with drugs, including those infected with HIV/AIDS from intravenous use, cannot expect to be treated lightly by the authorities. Stiff jail sentences are common.

Slava now shows how easy it is to purchase drugs. He introduces us to a young man who disappears down a lane and reemerges minutes later holding a packet with a brown substance. This is known as “poppy straw” (the stalk of an opium plant) that, after being boiled and mixed with other ingredients, is injected into the veins.

Later, we accompany Irina and another NGO worker, Svetlana, as they hand out packets of condoms to sex workers, who cluster around tree-lined side streets waiting for customers. The atmosphere is more relaxed, with the two women bussing sex workers on the cheek and chatting like old friends. As a police car cruises by, Irina says, with a laugh, “Sometimes, the police ask for free condoms—and I give them some.”

Welcome to the front line in the battle against HIV/AIDS in Kazakhstan, which has nearly half the reported total cases in Central Asia.

Drugs are very much part of the HIV/AIDS story in Central Asia, for experts say the use of contaminated needles to inject drugs causes 85% of HIV/AIDS cases and affects mainly young people.

Moreover, the disease is spreading at an alarming rate: recorded cases rose 1,600% in Central Asia from 2000 to 2004, according to the Joint United Nations Programme on HIV/AIDS.

One major cause is the plentiful and relatively cheap supply of heroin that flows from Afghanistan through its northern borders to Tajikistan, Uzbekistan, and Turkmenistan—and the rest of Central Asia.

It is no coincidence that HIV/AIDS infection rates are highest along the major drug trafficking routes between Afghanistan and Russia—in cities like Karaganda, Temirtau, and Pavlodar in Kazakhstan, Tashkent in Uzbekistan, and Osh in the Kyrgyz Republic.

Temirtau, a steel town set up by the Soviets amid the plains of central Kazakhstan, is a typical drug transit center. As production slowed following the collapse of markets after the Soviet Union’s breakup, many who had wheeled and dealed in metals turned to the lucrative drug trade. As a result, Temirtau witnessed an explosive growth of HIV/AIDS in the mid-1990s.

To stem the spread, an NGO, Shapagat (Revelation), distributes needles and condoms from its headquarters in a cramped apartment.

Most of its members are HIV/AIDS positive and many are recovering drug users. Some have been to jail.

EASY ACCESS An NGO worker shows how easy it is to purchase heroin from Afghanistan

Irina’s sad story echoes in many corners of Central Asia.

She is from a well-off family—her stepfather was an engineer in a metallurgy plant—and she tried drugs as a curious teenager in the early 1990s.

“Drugs were so easy to get; it was like going to the store to buy bread. Everyone was trying them,” she recalls. “We had never heard of HIV/AIDS and we had no idea of the dangers of sharing syringes.”

The thrills turned into nightmare when Irina became HIV-positive in 1995. Later, she was arrested for possession of drugs and spent years in jail.

Now 30, Irina, who says she has been drug-free since early 2004, is helping others—and herself—through Shapagat.

Irina has hopes for a normal life. She has a boyfriend, though she says they are not yet considering marriage. She says a doctor told her she might have problems conceiving children.

People with HIV/AIDS say they often experience discrimination in accessing health care, housing, and education.

The Government has a comprehensive program for HIV/AIDS, but those with the disease are required to register, submit to a background investigation, and undergo treatment at prison hospitals. In contrast, Shapagat—formed in 1998 and one of only two NGOs helping those with HIV/AIDS—offers a more compassionate approach and treatment on a confidential basis.

Attitudes may be changing, slowly. Nurali Amanzholov, president of Shapagat, says he has made two presentations to Parliament, which is reviewing HIV/AIDS legislation.

DISTRIBUTING condoms and needles to sex workers

“I have proposed changing the law so that people with HIV/AIDS can be treated as normal people who are ill, not as outcasts and criminals,” he says.

More problematic is the wider problem of trafficking.

Although the states of Central Asia are seeking to refine narcotics laws, develop police services, and cooperate with the international community, the United Nations Development Programme (UNDP) notes numerous serious constraints.

These include the lack of sufficient resources for training and equipment; a weak institutional infrastructure; and corruption among law enforcement agencies, customs officials, and border troops.

Poverty will also accelerate the disease’s spread as local populations become more involved in the drug trade. In Tajikistan, for example, the World Bank estimates that 30–50% of economic activity is linked to narcotics trafficking and that 30% of the population depends on the illicit drug business.

The “stark and troubling reality,” according to the UNDP report, “is that as long as the demand and supply forces abroad continue to drive the illicit drug trade unabatedly, the drug transit problem in Central Asia will remain intractable.”

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