AIDS Epidemic in Former USSR

So many new cases of the HIV (Human Immunodeficiency Virus) infection have been detected in the Ukraine, Belarus and Russia that experts say the extent of the epidemic and the long-term effects could equal that caused by the Chernobyl nuclear disaster in the eighties.

AIDS arrived late in this part of the world, or, rather, reaction to its impact has been delayed by at least a decade. Now the sudden outbreak of a disease for which there is no known cure has sent shock waves through the three most prominent member-states of the Commonwealth of Independent States (CIS).

"The rapid rise in sexually transmitted diseases and drug abuse following the break-up of Soviet values and lifestyles and the opening of the borders have made Ukraine, Russia and Belarus particularly vulnerable to the disease," says Lev Khodakevich, a representative of UNAIDS, the United Nations program on HIV and AIDS.

"It could be our next Chernobyl except that it has a greater destructive potential," he said. In the largest known outbreak of HIV on CIS territory, some 370 people tested positive in a small Belorussian town of Svetlogorsk, about 100 miles south of the republic's capital Minsk.

The testing period lasted three months. Officials believe the actual figure could be higher. Up to that point, only 156 people were registered as HIV-carriers in Belarus.

"What happened in Svetlogorsk doesn't surprise me. If there is such an epidemic in one small location, imagine, what the situation is in larger cities," says Alexander Goliusov, the chief AIDS expert in Russia's Health ministry.

"The same thing is happening here, all over the country," he said. Officially, there are only 1,402 official HIV cases in Russia. This is quite likely just the tip of the iceberg, officials say. Real figures may be as much as four times higher.

Independent AIDS activists argue that the actual number of cases is 20 times higher than the official statistics. But even if these estimates seem meager compared to the United States, where 500,000 have contracted the virus, it is the dramatically climbing rate of infection that worries experts.

Head of the government-run All-Russian AIDS Center, Vadim Pokrovsky, says while 200 new cases were discovered in 1995, some 205 appeared in the first six months of 1996 alone. He expects this figure to double by the end of the year.

The spread of HIV is much harder to estimate in the vast Russian hinterland beyond Moscow. There are few anonymous testing centers. Local government medical facilities are understaffed and underequipped and controls on the spread of epidemics are lax.

Ukraine is the hardest-hit. In 1995 the situation there exploded into a full-scale epidemic, when the number of HIV- carriers went up from 183 to 1,490 within one year. National health officials say there are now 8,500 HIV-positive people registered in the Ukraine.

The center of the crisis is the Black Sea port of Odessa with 1,385 cases of infection, about 40 percent of which appeared in the first half of this year. More than 100 new cases are registered every month by city hospitals.

"Unofficially the total number of infected is thought to be as high as 30,000. This summer the Odessa authorities have even opened a special prison reserved for HIV-infected criminals," Vladimir Grinin, Itogi Moscow newsmagazine Ukraine correspondent told IPS.

Other hard-hit regions include another port, Nikolayev, with 750 cases, and the seaboard resort areas of Crimean peninsula and the Donetsk, the center of the Ukraine's mining region. The country's capital, Kiev, currently has 135 cases.

The burst in the rate of the spread of HIV is even more worrying to the local health specialists because for some time the ex-USSR republics seemed to be relatively immune from the virus, on a rampage in the rest of the world since the beginning of last decade.

Although the acquired immuno deficiency syndrome became a recognized problem in the Soviet Union in the late 1980s when the first AIDS patient was registered, a Russian who worked as an interpreter in one of African countries and contracted the disease through homosexual contacts, the numbers of infected remained relatively low.

This even prompted one Moscow newspaper to claim that due to their constitution and blood characteristics, Slavic people resisted the virus naturally. The first alarms sounded when more than 260 children were found infected by HIV in a hospital in the city of Elista, capital of the southern Russian republic of Kalmykia. They had been infected through transfusions of tainted blood.

For it is through blood that HIV is predominantly spread in the CIS republics. With hospital blood banks now monitored, the AIDS virus finds its inroads into the general population through the rapidly rising number of drug addicts sharing contaminated needles.

"All the people in Svetlogorsk were infected in this way," says Alexander Goliusov. "And if at the beginning of the year we had only three cases of HIV due to intravenous drug use in Russia, today we have 205. This is one of the stages of the epidemic that has passed through many countries."

It is the same in the Ukraine where the number of people who have transmitted HIV through shared needles outstrips the number who have passed it on through sexual intercourse. A report by the Ukrainian Center for AIDS Prevention says 83 percent of all new cases were caused by contaminated syringes. In Odessa alone 50 percent of the infected are drug users.

"Once the virus landed among the Odessa drug community it started to spread very rapidly," said Lydia Andruyshak of the national AIDS committee at a recent UNAIDS conference in the city. With the collapse of the Soviet Union imported and locally-brewed drugs have become readily available across the CIS.

One of the most favored is called "poppy straw" or "khimiya." A murky brown resinous extract from poppy seed, it is reported to be more potent and habit-forming than heroin. Base for opium, the drug is frequently sold in used syringes.

"I have seen one teenager on a skateboard shooting up his leg through the jeans right after he bought the drug," an unidentified police officer told MK daily after the raid.

Drug abuse is widespread among low-income people. They have no money for new syringes. There are no syringe exchange points in the affected countries. Most of them also feel themselves outcasts and would be unwilling to participate in any such venture anyway. Russia and Belarus have rescinded an old Soviet law making drug use a criminal activity. The Ukraine still holds to it.

And with little access to anonymous testing drug addicts are reluctant to take the AIDS test for fear of discrimination and possible prosecution. Under Russian law HIV-carriers may be put on trial. If they have sexual intercourse and thereby expose their partners to the virus, they can also be charged with committing an offense.

While the current rise in the rate of infection is likely to prod the governments of the three CIS republics to adopt a more constructive approach towards risk groups, the poor state of their economies makes wide scale national or joint CIS efforts in this direction unlikely.

"We have no time to get scared. We have to work," says Alexander Goliusov, stressing that the most effective way to battle the disease is through prevention. However there are currently no national anti-AIDS programs in Russia. Although Moscow allocated six billion rubles for a public awareness campaign in 1996, the Health Ministry is still waiting for the money to come through.

In this situation international aid could become the catalyst of local programs. In Odessa the $50,000 grant from the United Nations was used to start up a pilot program which could later be implemented in other Ukrainian regions as well, local press reports said.

The program, which is also to receive support from the municipality, envisages the creation of a network of "Trust Points" where drug addicts can get medical and psychological help as well as free condoms and needles.