RIGA - Ilze was 16 when she found out she was HIV-positive. "I was really sick with pneumonia or something, and I went to the doctor. I hadn't heard very much about HIV before, but I took a test just in case," she recalls.
"When I found out that I tested HIV positive it was a big shock. I told my mom first. She took it harder than I did. She was crying and hugging me."
When asked how she acquired the disease, Ilze says she wasn't sure, but she thinks it was her boyfriend. Four years later, she is able to share the ways that HIV affects her day-to-day life.
"It's scary because you always have to worry about getting hurt, and you have to keep the people who are trying to help you away from you. Most of the people I'm around know about my disease, but a few people at work don't," Ilze explains.
Although the number of new infections remains low, the spread of HIV is continuing at an alarming pace in the Baltic states. If Latvia had only 958 cases of HIV in 2000, then by the end of 2004 it had 3,033 's an increase of 216 percent. Just four years ago, Estonia had 486 HIV cases. Now it has some 4,600.
"In 2001, the HIV epidemic spread among drug users, and that's when we had a major increase of new cases 's 1,474 newly infected people were registered," said Nelli Kalikova, an Estonian MP and expert on the subject of HIV/AIDS.
Even Lithuania, which has traditionally had the lowest number of HIV infections in the Baltics, is on a similar path. From 266 cases in 2000, the country has seen a 215 percent rise to 840 cases at the end of 2004.
On a positive note, while the total number of HIV infections is steadily increasing, the number of new cases is declining: new cases last year in Latvia fell by one-fifth to 334. In Lithuania, there were 135 newly registered cases last year, compared with 397 two years ago.
Experts believe that the spread of HIV has slowed, due to new syringe-exchange programs and counseling centers, which now operate in 13 Latvian cities. Anti-AIDS information and education campaigns have also played a role.
"If we look at the statistics, we will see that the number of new HIV cases in Latvia has been decreasing since 2002, but of course the total number is growing," deputy director of the AIDS Prevention Center, Inga Upmace, said. "It couldn't be any other way."
WILDFIRE
Generally, Eastern European trends in the spread of HIV/AIDS have direct applicability to the Baltic states. Between 1995 and 1997, for instance, there was an HIV infection "explosion" in Russia, Ukraine and Belarus, which later proliferated in the Baltics, including Russian regions in the area (St. Petersburg and Kaliningrad).
But experts from all three countries say the disease is spreading primarily among drug users and male prisoners.
Inmates run an exceptional risk of being infected due to the inextricable connection between intravenous drug use and imprisonment. An uncontrollable epidemic inside prisons cannot be excluded, experts say.
Last year risk groups in Estonia and Latvia included young people, (intravenous) drug addicts and their sexual partners, homo- and bisexuals, as well as prison inmates.
"In 2001 there was a big HIV explosion in Estonia, when the virus spread among drug users. We had 1, 474 new cases of HIV," explains Nelli Kalikova. Currently Latvia lists 3,044 HIV-infected people, and most of them 's 2,140, or 70 percent 's were infected through the use of intravenous drugs. But last year this group saw the biggest decline in new HIV cases, down by 88 people from 2003.
Lithuania, meanwhile, appears to be facing two distinct epidemics 's one affecting needle users in regions bordering Kaliningrad (Russia) and the other spreading among homosexuals in Vilnius. Generally, however, the low prevalence of HIV in Lithuania can be attributed to joint efforts between the Lithuanian AIDS Center and other authorities, which responded to situational changes and learned from examples set by other countries.
According to experts at the Lithuanian AIDS Center, an increasing number of people have contracted HIV through sexual contact over the past three years, but the predominant method of contraction remains intravenous drugs (74 percent), with 101 infections recorded last year.
The present situation in Lithuania is complicated due to parallel epidemics of HIV, sexually transmitted infections and drug use. While very large numbers of intravenous drug users are uninfected, they still constitute the largest threat for the future.
"Lithuania is surrounded by countries with a very high HIV epidemic," explains Alvydas Laiskonis, head of Lithuania's service for infectious diseases. "According to official figures, Lithuania has indeed been much less affected. But we do not have any anonymous or free HIV-testing, where anyone could just walk in to get a test. Free testing is possible if you're considered to be a member of a risk group. Testing services are very centralized (only one AIDS center in Vilnius) and we do not have a network across the country."
"I think that the HIV epidemic in Lithuania is mostly 'underground,'" says Laiskonis.
Few people like to speak about it, but ethnicity also defines risk-groups in the spread of HIV. Drug users in the Baltics are highly concentrated among ethnic Russians and other minorities, which in Lithuania comprise only 15 percent of the population. (In Estonia and Latvia the corresponding percentage is 25 and 35, respectively.) And this could also prove why there are fewer cases in Lithuania, experts from the other two Baltic states explain.
But as Ilze's case shows, the disease breaks out of drug dens and prison cells to infect non-drug users as well. The growing number of HIV-infected women is a new and dangerous trend. Previously there were far more HIV-infected men than women in Latvia. For example, in 2001 there were 180 HIV-infected women against 627 HIV-infected men. Last year the proportion changed considerably with 121 women and 213 men among newly registered HIV cases. Experts explain that for women, the risk of getting HIV through heterosexual contacts was at least three times as high as for men.
Without a robust system of prevention, they say, the worst is yet to come.
PREVENTION
"Prevention is the most important element and the best possible tool to fight HIV/AIDS, and that's why we took an early action to confront the virus: special educational programs for different age groups were launched," says Saulius Caplinskas, director of the Lithuanian AIDS Center.
"Still, the most intensively national response targets the most vulnerable groups [young people]. International partners are supporting numerous projects and programs across the region. External support must be carefully co-ordinated in order to maximize the impact of valuable resources," he adds.
On Oct. 1, 2003 the Lithuanian government approved the National HIV/AIDS Prevention and Control Program for 2003 's 2008. The program sets two top priorities, including improving treatment of and reducing discrimination against people with HIV/AIDS, and prevention among vulnerable groups. The plan calls for more then 120 prevention measures to be implemented within five years. Long-term goals are to prevent further spread of the virus, to stabilize the epidemic and to reduce HIV-related harm to society.
"There is not a country in the world where the government provides enough money for social needs. Therefore, Lithuania is not an exception. Our center is getting only about half a million dollars from the government and NGOs each year," says Caplinskas.
Latvian expert Inga Upmace says there are two governmental programs in Latvia 's one for prevention (170,000 lats, or 242,000 euros) and one for anti-retro-viral treatment (1.4 million lats).
"The budget for prevention is stable, but it has not increased remarkably for the last five to seven years. And unfortunately, it's not enough money for prevention works, regarding the fact that the total number of HIV positive people is growing from year to year, and medical treatment is needed all the time. We already have more than 3,000 HIV positive cases, but by 2015 this number could reach 6,000 's 7,000," says Upmace.
To improve the situation, the AIDS Prevention Center, along with the Health Ministry, has attracted additional money from donors, including the Soros Foundation, the United Nations Development Program, and Norway. Together they have mustered $312,450 since 1997. Funds were largely spent on HIV prevention among intravenous drug users (education, information, HIV testing, syringe exchange and condom distribution).
"During 2002-2004 we founded the network of HIV prevention programs for injected drug users in 11 cities, which allowed us to reduce the number of new HIV cases in 2002," says Upmace. "Now we are working on a new proposal for the European Commission to do more population research on needle drug users' sexual partners and also young girls."
Estonia's Kalikova says that the country's HIV testing lab has been under-financed by the government, despite its awareness of future costs. "Now our financial support is mainly provided by the Global Fund," she says.
In 2003, Estonia and the Global Fund concluded a contract whereby the fund would provide $10 million to support Estonia's battle against HIV/AIDS, on conditions that Estonia would not decrease its own funding for prevention and would adhere to the goals of the National HIV/AIDS Program.
"For the next two years, we are planning to receive about 75 million kroons (4.8 million euros) from the Global Fund, while the government can provide us only about 18 million kroons," complains Kalikova.
Coordination
There are several factors governing the spread of HIV/AIDS, which are similar in all three Baltic states, experts say. Therefore, a complex, multi-area approach is required in order to achieve the goals of preventative work. Several concept papers, strategies and active programs are currently being prepared, the implementation of which would directly or indirectly facilitate the process of solving HIV/AIDS related issues.
In Lithuania, it would appear that work on public awareness is reaching completion. As Caplinskas explains, 90 percent of the population is aware of HIV and the ways it could be contracted. In Estonia and Latvia, however, the situation on that matter is different. Nelli Kalikova said that people in Estonia know don't know about HIV until they are asked about how it is contracted.
"A lot of people in Estonia think that it's not and never will be their problem," she says.
"It's very hard to tell right now if the public awareness has improved. That issue needs in-depth research, for which a lot of money is needed. And unfortunately we can't afford it," Upmace says, in response to public awareness in Latvia.
Finally the main program, which was mentioned by all three Baltic states' AIDS Center representatives as a top priority during the next couple years, is the program on drug-addiction prevention strategy.
Generally, only people with AIDS have full access to medical treatment. People living with HIV, however, need early access to adequate treatments and care instead of waiting until their symptoms become severe.
As for Ilze, she now lives with her mom, who gives her a lot of support. The 20-year-old decides whom to tell about her HIV status on a case-by-case basis.
"It mostly depends on the person," she says. "A few of my friends know. They really can't believe it because I'm so young. Young people usually don't want other people knowing stuff, but once you get it off your chest, you feel so much better."
Having HIV has also impacted Ilze's hopes for her future.
"I would like to have a baby when I get older, but I'm worried that if I have a baby, he or she will get HIV."
