Nelli Kalikova, director of Estonia's AIDS Prevention Center, said that the virus is spreading "like wildfire" in her country. While only 100 people were registered with HIV between 1988 and the end of 1999, there have been 1,200 cases in the last 18 months. The highest number of infected people is in the 15 to 25 age range.
"All the warning signs were there in 1997 - high levels of drug injection, heroin use and sexually transmitted diseases. There was discussion as early as 1995, yet policy makers have reacted slowly and the budget for our AIDS program is minimal. It was even cut in 1999.
"Fighting AIDS must be a priority for this country. Politicians must come together so that all the ministries involved cooperate. If we don't spend more money now, it will cost us more in the future."
So far, only one person has actually contracted HIV in prison, but with more than 300 prisoners infected, there is no room for complacency, she said.
"The experience of other countries shows that AIDS spreads very fast in prisons. And we cannot close our eyes to the fact that drug injection and sex exists in our prisons."
HIV first reached epidemic proportions in Narva, due to close links between the city's drug users and those in nearby St. Petersburg. But now infection levels in Tallinn and all the towns in the northern region of Ida-Virumaa, which includes Narva, have caught up. And the problem is spreading beyond drug users, said Kalikova.
"A lot of people are becoming infected through sex with drug users in Narva. HIV is spreading rapidly to the general population."
Combating the epidemic will take time. Small needle-exchange pilot projects that started three years ago in Narva and Tallinn have had no impact on the epidemic, but the experience has informed the setting up of similar centers in six other towns and cities, which opened this May.
"Opening needle exchanges is not an instant solution, because establishing trust with injecting drug users takes time," said Kalikova. "The World Health Organization says we must be receiving at least 60 percent of them and there are between 10,000 and 14,000 in Estonia. We hope that in six months the centers will be receiving enough clients to stop the epidemic."
Per capita, infection levels in Latvia are lower. But with 432 new cases in the first half of this year, between 30 percent and 40 percent of which are in the country's prisons, Inga Upmerce, deputy director of Latvia's AIDS Prevention Center, stressed the role of politicians and criticized the government's failure to increase the center's budget in recent years.
While a needle-exchange center exists in Riga, it is funded directly by the national AIDS Prevention Center and the Soros Foundation-Latvia.
"Riga municipality doesn't understand the problem," said Upmerce. "Each of the six districts should have an outreach worker, but they all complain it's something unheard of."
With Latvia's coastal cities worst affected, she also highlighted the failure of the port city of Ventspils, Latvia's third largest city, to establish a needle-exchange program.
Currently, Tukums is the only town outside Riga with a needle-exchange center, which the municipality has established on its own, while Jurmala and Olaine have established outreach programs that also exchange needles.
But overcoming prejudice against HIV sufferers is as important as the practical steps, she said.
"There have been two or three instances of sufferers talking about HIV on television and the radio, but it needs to be every month. HIV sufferers here are very good people, but they are afraid to say they have the virus. The situation would change if they started to talk about it."
Lithuania's early efforts to prevent the spread of the virus are responsible for a relatively lower rate of infection, said Giedrius Likatavicius of the country's AIDS Prevention Center. But he warned that with 137 people registered as having HIV in the port city of Klaipeda and 105 in Vilnius, efforts to combat the disease must continue.