(December 2001) Eastern European and Central Asian countries face the troubling news that HIV infections in the region are increasing more rapidly than anywhere else in the world, with unsafe drug-injecting practices responsible for the vast majority of infections.

Latest statistics from the Joint United Nations Programme on HIV/AIDS (UNAIDS) reveal an estimated 250,000 new infections in 2001, bringing to 1 million the number of people living with HIV in the region.

The epidemic’s exponential growth in the Russian Federation continues, with a doubling of new infections every year since 1998. The total number of infections since the epidemic began here climbed to 129,000 in June, up from close to 11,000 reported at the end of 1998. The first half of 2001 alone accounted for more than 40,000 new infections, says UNAIDS.

Infections in many parts of the former Soviet Union are overwhelmingly related to needle sharing among young drug users — young men in particular. Given the high likelihood of transmission as a result of such practices, high levels of other sexually transmitted infections in the general population, and the fact that young people are sexually active, experts fear that a huge epidemic may be in tow.

“Given the current evidence, a much larger and more generalized epidemic is a real threat,” says the UNAIDS’s AIDS Epidemic Update: December 2001.

The good news is that with the epidemic still at a relatively early stage in the region, massive prevention efforts to reduce needle sharing among injecting drug users and to discourage risky sexual behavior among young people could rein in the epidemic.

With 1 percent of adults 15 to 49 years infected with HIV/AIDS, Ukraine has the highest prevalence in the region. Reported infections have also escalated in Estonia, from 12 in 1999 to 1,112 in the first nine months of 2001.

Experts say the causes and consequences of the epidemic in the region are interwoven with other development challenges, including widespread unemployment, economic uncertainty, migration, gender inequity, and the steady collapse of public health services. The United Nations Development Programme (UNDP) says the social, economic, and cultural transformations taking place in the region have provided fertile ground for the rapid spread of HIV/AIDS.

UNDP notes, for example, that social disruption and destabilization in the region has resulted in increasing numbers of single parents, alcohol and drug use, and rising delinquency among young people. All of these factors disproportionately affect women.

A June 2001 report by the World Bank’s Environmentally and Socially Sustainable Development Sector Unit for Europe and Central Asia says the changes have exposed women to new risks, including poverty, gender-based job discrimination, deteriorating maternal health care, loss of state support for child care, gender-based violence, and a dramatic increase in the trafficking of women.

UNDP points out that relatively little attention has been paid to serious social and health issues in the region during the last decade, when much of the focus has been on economic development and ensuring the survival of emerging democratic institutions.

The British AIDS education and medical research charity AVERT also sees socioeconomic instability in the former Soviet territories fueling drug use, commercial sex, and, consequently, the spread of HIV. However, AVERT points to some positive signs, including political and legal reforms that could potentially curb transmission of the virus.

“For instance, instead of relying on ineffective mass screening of the population to track and control HIV, most countries are using a range of channels to inform and educate their citizens about the virus,” says AVERT. “Also, the region is increasingly turning to proper HIV surveillance in sentinel populations, for example, in sex workers, pregnant women, injecting drug users, or people with sexually transmitted infections.”

UNAIDS says the region also needs to employ vigorous prevention efforts to equip young people with such services as HIV information, condoms, and life-skills training. The agency says special steps are needed to include HIV-related information in school curricula and to extend peer education to young people who are out of school and without employment.


Yvette Collymore is senior editor at the Population Reference Bureau


Eastern Europe and Central Asia, HIV/AIDS Features, End of 2001

Epidemic began: Early 1990s

Adults and children with HIV/AIDS: 1 million

New infections: 250,000

Proportion of those 15 to 49 years old with HIV/AIDS: 0.5%

Percent of infected adults who are women: 20%

Main mode of transmission: injecting drug use

Source: UNAIDS, AIDS Epidemic Update: December 2001.


References

Joint United Nations Programme on HIV/AIDS (UNAIDS), AIDS Epidemic Update: December 2001: www.unaids.org

AVERT, “AIDS in the Russian Federation, Ukraine, and Belarus”: www.avert.org/ecstatee.htm

United Nations Development Programme, “Social Economic and Governance Dimensions of the HIV/AIDS Epidemic in Eastern Europe, CIS, and Baltic States”: www.undp.lt/en/?id=36

World Bank, Social Development in Europe and Central Asia Region: Issues and Directions, June 2001 (Washington, DC: World Bank Environmentally and Socially Sustainable Development Sector Unit, 2001).