AIDS - Europe's New Plague
By: Dr. Sam Vaknin
Also published by United Press International (UPI)
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December 2, 2002
Updated: October 2009
Chron.com
reported that, in late October 2009, terrified AIDS experts pleaded with
Russian officials to dump Russia’s abstinence strategy for curbing the spread
of HIV, a “strategy” that is yet another example of the pernicious wishful and magical
thinking common there. Russia is enduring a silent but veritable epidemic, which
is in the throes of spiraling out of control. The physicians urged Russia to
adopt evidence-based successful strategies like needle-exchange programs and
heroin substitutes such as methadone for drug addicts.
The region which brought you the Black Death,
communism and all-pervasive kleptocracy now presents: AIDS. The process of
enlargement to the east may, unwittingly, open the European Union's doors to
the two scourges of inordinately brutal organized crime and exceptionally
lethal disease. As Newsweek noted, the threat is greater and nearer than any
hysterically conjured act of terrorism.
The effective measure of quarantining the
HIV-positive inhabitants of the blighted region to prevent a calamity of medieval
proportions is proscribed by the latest vintage of politically correct
liberalism. The West can only help them improve detection and treatment. But
this is a tall order.
East European medicine harbors fantastic
pretensions to west European standards of quality and service. But it is
encumbered with African financing, German bureaucracy and Vietnamese
infrastructure. Since the implosion of communism in 1989, deteriorating
incomes, widespread unemployment and social disintegration plunged people into abject
poverty, making it impossible to maintain a healthy lifestyle.
A report published in September 2002 by the
European regional office of the World Health Organization (WHO) pegs at 46 the
percentage of the general population in the countries of the former communist
bloc living on less than $4 a day - close to 170 million people. Crumbling and
desperately underfunded healthcare systems, ridden by corruption and cronyism,
ceased to provide even the appearance of rudimentary health services.
The number of women who die at - ever rarer -
childbirth skyrocketed. Transition has trimmed Russian life expectancy by well
over a decade to 59, lower than in India. People lead brutish and nasty lives
only to expire in their prime, often inebriated. In the republics of former
Yugoslavia, respiratory and digestive tract diseases run amok. Stress and
pollution conspire to reap a grim harvest throughout the wastelands of Eastern
Europe. The rate of Tuberculosis in Romania exceeds that of sub-Saharan Africa.
In November 2002, UNAIDS and WHO published
their AIDS Epidemic Update. It stated unequivocally: "In
Eastern Europe and Central Asia, the number of people living with Human
Immunodeficiency Virus - HIV - in 2002 stood at 1.2 million. HIV/AIDS is
expanding rapidly in the Baltic States, the Russian Federation and several
Central Asian republics."
The figures are grossly understated - and
distorting. The epidemic in Eastern Europe and central Asia - virtually on the
European Union's doorstep - is accelerating and its growth rate has surpassed
sub-Saharan Africa's. One fifth of all people in this region infected by HIV
contracted the virus in the preceding 12 months. UNAIDS says: "The
unfortunate distinction of having the world’s fastest-growing HIV/AIDS epidemic
still belongs to Eastern Europe and Central Asia."
In the past fifteen years, AIDS has been
suddenly "discovered" in 30 large Russian cities and in 86 of its 89
regions. Four fifth of all infections in the Commonwealth of Independent States
- the debris left by the collapse of the USSR - are among people younger than
29. By July 2002, new HIV cases surged to 200,000 - up from 11,000 in December
1998.
In St. Petersburg, their numbers multiplied a
staggering 250-fold since 1996 to 10,000 new instances diagnosed in 2001. Most
of these cases are attributed to intravenous drug use. But, according to Radio
Free Europe/Radio Liberty, 400 infected women gave birth in a single hospital
in St. Petersburg in the first nine months of 2002 - compared to 149 throughout
last year. About one third of the neonates test HIV-positive within 24 months.
The disease has broken loose.
How misleading even these dire data are is
revealed by an in-depth study of a single city in Russia, Togliatti. Fully 56
percent of all drug users proved to be HIV-positive, most of them infected in
the last 2 years. Three quarters of them were unaware of their predicament. One
quarter of all prostitutes did not require their customers to use condoms. Two
fifths of all "female sex workers" then proceeded to have unsafe
intercourse with their mates, husbands, or partners. Studies conducted in
Donetsk, Moscow and St. Petersburg found that one seventh of all prostitutes
are already infected.
An evidently shocked compiler of the results
states: "The study lends further credence to concerns that the HIV/AIDS
epidemic in Russian cities could be considerably more severe than the
already-high official statistics indicate." The region's governments claim
that 1 percent of the population of countries in transition - still a hefty 4
million people - use drugs. But this, too, is a wild underestimate. UNAIDS
itself cites a study that concluded that "among Moscow secondary-school
students ... 4% had injected drugs".
Quoted in Pravda.ru, The Director of the
Federal Scientific Center for AIDS at Russia's Ministry of Health, Vadim
Pokrovsky, warns that Russia is likely to follow the "African model"
with up to an 80 percent infection rate in some parts. Kaliningrad, with a 4
percent prevalence of the syndrome, he muses, can serve as a blueprint for the
short-term development of the AIDS epidemic in Russia.
Or, take Uzbekistan. New infections
registered in the first six months of 2002 surpassed the entire caseload of the
previous decade. Following the war in Afghanistan, heroin routes have shifted to
central Asia, spreading its abuse among the destitute and despondent
populations of Azerbaijan, Kazakhstan, Georgia, Kyrgyzstan, Tajikistan and
Uzbekistan. In many of these countries and, to some extent, in Russia and
Ukraine, some grades of heroine are cheaper than vodka.
Ominously, reports the European enter for the
Epidemiological Monitoring of AIDS, as HIV cases among drug users decline, they
increase exponentially among heterosexuals. This, for instance, is the case in
Belarus and Ukraine. The prevalence of HIV among all Ukrainians is 1 percent.
Even relative prosperity and good governance
can no longer stem the tide. Estonia's infection rate is 50 percent higher than
Russia's, even if the AIDS cesspool that is the exclave of Kaliningrad is
included in the statistics. Latvia is not far behind. One of every seven
prisoners in Lithuania has fallen prey to the virus. All three countries acceded
to the European Union in 2004. Pursuant to an agreement signed in 2002 between
Russia and the EU, Kaliningrad's denizens will travel to all European
destinations unencumbered by a visa regime.
Very little is done to confront the looming
plague. One third of young women in Azerbaijan and Uzbekistan never heard of
AIDS. Over-crowded prisons provide no clean needles or condoms to their
inmates. There are no early warning "sentinel" programs anywhere.
Needle exchanges are unheard of. UNICEF warns, in its report titled
"Social Monitor 2002", that HIV/AIDS imperils both future generations
and the social order.
The political class is unmoved. President –
now Prime Minister - Vladimir Putin never as much as mentions AIDS in his
litany of speeches. Even Macedonia's western-minded and western-propped late president,
Boris Trajkovski, dealt with the subject for the first time only in December
2002. Belarus did not bother to apply to the United Nation's Global Fund to
Fight AIDS, Tuberculosis, and Malaria or to draw approved resources from the
World Bank's anti-TB/HIV/AIDS project.
In many backward, tribal countries -
especially in the Balkan and in central Asia - the subjects of procreation, let
alone contraception, are taboo. Vehicles belonging to Medecins du Monde, a
French NGO running a pioneer needle exchange program in Russia, were torched.
The Orthodox Church has strongly objected to cinema ads promoting safer sex.
Sexual education is rare.
Even when education is on offer - like last
year's media campaign in Ukraine - it rarely mitigates or alters high-risk
conduct. According to Radio Free Europe/Radio Liberty, the St. Petersburg AIDS
Center carried out a survey of 2000 people who came to be tested there and were
consequently exposed to AIDS prevention training. "Neither the men nor the
women had changed their high-risk behavior", is the unsettling conclusion.
Ignorance is compounded by a dismal level
personal hygiene, not the least due to chronically malfunctioning water,
sanitation and electricity grids and to the prohibitive costs of cleansing
agents and medicines. Sexually transmitted diseases - the gateways to the virus
- are rampant. Close to half a million new cases of syphilis are diagnosed
annually only in Russia.
The first step in confronting the epidemic is
proper diagnosis and acknowledgement of the magnitude of the problem.
Macedonia, with 2 million citizens, implausibly claims to harbor only 18
carriers and 5 AIDS patients. A national strategy to confront the syndrome was
published only in 2003. Though AIDS medication is theoretically provided free
of charge to all patients, the country's health insurance fund, looted by its
management, is unable to afford to import them.
In a year of buoyant tax revenues, the
Russian government reduced spending on AIDS-related issues from $6 million to
$5 million. By comparison, the U.S. Agency for International Development
(USAID) alone allocated $4 million to Russia's HIV/AIDS activities in 2001.
Another $1.5 were given to Ukraine. The same year, Russia blocked a $150
million World Bank loan for the treatment of tuberculosis and AIDS.
Money is a cardinal issue, though. Christof
Ruehl, the World Bank's chief economist in Russia and Murray Feshbach, a senior
scholar at the Woodrow Wilson International Center for Scholars in Washington,
put the number of infected people in the Russian Federation at 1-1.2 million.
Even this figure - five times the official guesstimate - may be irrationally
exuberant. A report by the US National Intelligence Council forecasts 5-8
million HIV-positives in Russia by the end of the decade. Already one third of
conscripts are deemed unfit for service due to HIV and hepatitis.
Medicines are scarce. Only 100 of St.
Petersburg's 17,000 registered HIV carriers receive retroviral care of any
kind. Most of them will die if not given access to free treatment. Yet, even a
locally manufactured, generic version, of an annual dose of the least potent
antiretroviral cocktail would cost hundreds of dollars - about half a year's
wages. At market prices, free medicines for all AIDS sufferers in this vast
country would amount to as much as four fifths of the entire federal budget,
says Ruehl.
Some pharmaceutical multinationals -
spearheaded by Merck - have offered the more impoverished countries of the
region, such as Romania, AIDS prescriptions at 10 percent of the retail price
in the United States. But this is still an unaffordable $1100 per year per
patient. To this should be added the cost of repeated laboratory tests and
antibiotics - c. $10,000 annually, according to the New York Times. In 2002, the
average monthly salary in Romania was $100, in Macedonia $160, in Ukraine $60.
It was cheaper to die than to be treated for AIDS.
Indeed, society would rather let the tainted
expire. People diagnosed with AIDS in eastern Europe are superstitiously
shunned, sacked from their jobs and mistreated by health and law enforcement
authorities. Municipal bureaucracies scuttle even the little initiative shown
by reluctant governments. These self-defeating attitudes have changed only in
central Europe, notably in Poland where an outbreak of AIDS was contained
successfully.
And, thus, the bleak picture is unlikely to
improve soon. UNAIDS, UNICEF and WHO publish country-specific
"Epidemiological Factsheets on HIV/AIDS and Sexually Transmitted
Infections". The latest edition, released this year, is disheartening. Under-reporting,
shoddy, intermittent testing, increasing transmission through heterosexual
contact, a rising number of infected children. This is part of the dowry east
Europe brings to its long-delayed marriage with a commitment-phobic European
Union.
Also Read:
The Dying Breed - East European Healthcare
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