Catalog

Rehab with a Heart
ADB Review [ October 2005 ]

The Kyrgyz Republic lost its HIV/AIDS-free status less than a decade ago. It has developed a progressive treatment program that could serve as a regional model

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

BISHKEK, KYRGYZ REPUBLIC

The drug rehabilitation center sits in a tranquil enclave at the end of a driveway. Outside, visitors talk quietly on benches beneath shady trees.

Inside, a small woman, energetic and plain-spoken, is a magnet for drug users, some of them infected with HIV/AIDS.

FIGHTING BACK Dr. Batma Estebesova chats to drug users: a progressive approach treats addiction as a sickness

Dr. Batma Estebesova, founder of SOTSIUM, a nongovernment organization (NGO) that helps wean drug users from their habit, sits behind a computer.

In 1995, the Kyrgyz Republic was considered the last HIV-free country by the World Health Organization. A year later, the Kyrgyz Republic recorded its first case of HIV/AIDS but the number of new infections jumped tenfold from 14 cases between 1997 and 2000 to 149 in 2001.

“We now have 735 recorded cases of HIV/AIDS and 82% are from drug use,” says Dr. Estebesova, who is also president of a countrywide NGO network that includes SOTSIUM.

To combat the disease’s rapid proliferation, observers note that the Government national assistance, including the Joint United Nations Programme on HIV/AIDS (UNAIDS) and United Nations Development Programme, and NGO participation.

Supporting NGOs like SOTSIUM is paying off for both the authorities and those living with HIV/AIDS. For, in addition to providing clean needles and condoms, Dr. Estebesova runs a compassionate program that treats drug users as people with a disease rather than as deviants or criminals.

For her progressive work—SOTSIUM was established in 1998—Dr. Estebesova was last year’s joint recipient of the Jonathan Mann award for media and NGO work in the field of HIV/AIDS (the award is named after the crusader against global poverty and illness who died in an air crash in 1999).

“Do you want to see what drugs can do to you?” asks Dr. Estebesova. She takes us into a room where a beautiful woman shows us, without shyness, a shocking wound—a large abscess that has eaten away much of her leg.

Next, two women in their 40s enter the office and obtain a bag of new syringes. They are not bothered at all by the presence of strangers.

Like the woman who heads it, this rehab center in Bishkek exudes a refreshing openness that matches its humane methods of treating those with drug and HIV/AIDS problems. Such an environment is still unusual in Central Asia, where the legacy of heavy-handed state control remains.

TECHNICIANS testing blood samples at the National AIDS Center in Bishkek

Under the Soviet system, notes one leader in the fight against HIV/AIDS, “You focused on the individual to maintain the health of society. You commanded that patients be tested, you demanded answers. With HIV, we understand other methods are needed. We ask for cooperation.”

Interestingly, Dr. Estebesova, a psychiatrist as well as a medical doctor, used to work for the Government as deputy head of the state narcology center, but she developed her modern attitudes from 25 years of working in narcology and alcoholism.

She recognizes that drug addiction, like alcoholism, is a sickness and she supports the 12-step program of Alcoholics Anonymous, the worldwide mutual help program that marks its 70th anniversary this year.

“One of the most important things is to take the suffering person out of the old environment and create a new one,” she says. “We offer to exchange needles with drug users to try to draw them into the program.”

The sympathetic approach has produced positive results. Many former drug users are now volunteer outreach workers and others are counselors. SOTSIUM also has a 24-hour “hotline” for those in distress.

SOTSIUM’s program includes 2,000 drug users—a fraction of the estimated 100,000 drug users countrywide—and Dr. Estebesova points to evidence of success.

“In the beginning, only 14% of drug users under our program used disposable syringes,” she says. “Now 60–80% of users do so.” Moreover, as a result of awarenessraising, those with HIV/AIDS in the program are now more selective in their choice of sex partners and tend to use condoms more frequently than before.

Significantly, she says, “We are considering establishing a regional center and discussions are ongoing as to whether it should be in Kazakhstan or the Kyrgyz Republic.”

Such a center is sorely needed not only to provide effective treatment but also to reduce ignorance, fear, and stigma in public attitudes toward people with HIV/AIDS.

INFORMATION Ads promote awareness of the dangers of contracting HIV/AIDS through unprotected sex and sharing needles

Funding is an important issue, but support may be forthcoming.

In March, the World Bank approved a $25 million grant for a Central Asia AIDS Control Project, cofinanced by the United Kingdom’s Department for International Development in the amount of $1.9 million, which has the support of the governments of Kazakhstan, Kyrgyz Republic, Tajikistan, and Uzbekistan.

“The governments are putting money into this regional project to strengthen capacity for surveillance, training, and information sharing to develop strategies for cross-border issues that sit outside national strategies,” says Chris Lovelace, Senior Manager for Central Asia Human Development in the World Bank.

The project explicitly encourages cooperation between public services, NGOs, and the private sector and is inviting proposals from state organizations such as the national AIDS center and NGOs like SOTSIUM.

It will focus on issues that require regional cooperation such as surveillance, testing, and training and will target vulnerable groups like intravenous drug users, sex workers, homosexuals, migrants, and truck drivers in epidemiological “hotspots,” including cross-border areas.

For people living with HIV/AIDS, the hope is that it will also help remove the stigma that hinders the battle against the disease.

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