Needle exchange vital to stem AIDS: experts

BARCELONA

Needle exchanges for intravenous drug users, law reform and erasing the stigma of drug addiction are vital for preventing Eastern Europe from becoming the next region to be wrecked by AIDS.

That is the message being put across at the International AIDS Conference here by doctors and social workers who tremble at the unfolding crisis in the former Soviet bloc.

For many, the picture ominously resembles the one that prevailed a dozen years ago in Southern Africa, when the human immunodeficiency virus (HIV) inched out of niche groups and then exploded among the mainstream population.

"Those of us who have worked in the area of HIV in this region have spent well over 10 years talking about the social, economic and human factors that make our countries susceptible to HIV," says Kasia Malinowska-Sempruch, a native of Poland, who heads a program on intravenous drug use at George Soros' charity, the Open Society Institute.

"Now in 2002, we no longer speak of what may be - HIV and AIDS have arrived and, as everywhere else, the virus is causing destruction."

Right up until 1994, the recorded incidence of HIV in the former Soviet-bloc countries was zero.

In 1995, things began, slowly but terrifyingly, to change. Today, the pandemic is growing faster in this region than in any other in the world.

In 2001, according to the U.N. agency UNAIDS, the incidence rate rose by a third, from 750,000 to a million.

The eye of the storm is Russia, where there are almost 200,000 officially registered HIV infections although experts say the true tally is likely to be five times higher.

The situation is also dire in neighboring Ukraine, where close to 1 percent of the population is estimated to have the virus.

Ninety percent of infections in Russia are among intravenous drug users, and the figure is around 75 percent in the Ukraine.

But, as the bitter experience of tackling the disease elsewhere has shown, HIV doesn't respect neatly-defined, small social groups often marginalized from the rest of society.

Where there is drug addiction, there is prostitution. And where there is prostitution there is a means of catapulting the virus into mainstream society, via the clients of infected sex workers.

In the Ukraine, "more people, mostly women, appear to be contracting HIV through sexual transmission and more pregnant women are testing positive for HIV, suggesting a shift of the epidemic into the wider population," UNAIDS warned in a report last week.

The biggest weapon against the threat, says Malinowska-Sempruch, is to tackle drug addiction without prejudice, so that the problem is dealt with openly rather than driven underground.

Her organization is promoting initiatives under which addicts can exchange clean needles for old ones - an idea also backed by the World Health Organization, the American Medical Association and other agencies - and treatment programs that offer methadone as a means of gradually weaning drug users from heroin.

Such thinking still has a long way to go, though. "Rigid and repressive drug policies in many countries mean that such programs are few and far between," she notes.

Changes to punitive anti-drug laws and more tolerant policing are also essential.

"We've heard reports of parents in Central Asia watching their children die of overdoses, so afraid of police harassment of the entire family that they will not bring them to a hospital," she says.

Addressing the region's drug problem will also require help from outside, for most countries' public health systems remain mired in crisis after the fall of the old Soviet system.

A study released at the AIDS forum found that in the 24 countries in Eastern and Central Europe and the former Soviet Union, just 2 percent of people diagnosed with HIV were being given anti-retroviral drugs.