AIDS: UNAIDS Head On Epidemic In CIS

(RFE/RL) Peter Piot, executive director of the Joint United Nations Program on HIV/AIDS (UNAIDS) says the Ukrainian and, to a lesser extent, Russian governments have made considerable progress toward fighting HIV/AIDS. Piot applauded Russian President Vladimir Putin for taking a leadership role against the spread of the disease and for dramatically increasing funding for government sponsored programs. However, he said, Russia and Ukraine are on the verge of a major AIDS pandemic, which is going to hit hard among the youngest strata of their populations. RFE/RL correspondent Nikola Krastev spoke with Piot on May 27 in New York.

RFE/RL: You’ve just returned from two back-to-back trips to Moscow. What are the latest HIV/AIDS-related initiatives in Russia?

Peter Piot: President Putin has really taken on a major leadership role in the fight against AIDS after he chaired a session of the Presidium of the State Council. It was entirely devoted to AIDS, increased the budget, issued a number of measures. We very much welcome that because I am very concerned about the evolution of AIDS in Russia and some of the other countries around Russia -- where up to now insufficient action has been taken against AIDS.

RFE/RL: Are the new initiatives undertaken by the Russian government against AIDS sufficient?

Piot: HIV continues to spread very heavily in Russia and also in Ukraine and the Central Asian republics. The response has been totally inadequate and insufficient, but we see very, very hope-giving signs in major increases in budget -- 10-12 times in Russia and also in Ukraine -- and more action on the ground. But there is a fundamental issue that is not being addressed and that is that of the spread of HIV among injecting drug users. And there we know what works: it is offering substitution therapy to these drug users -- methadone -- so they don’t shoot drugs and through the needle exchange infect each other, that they have access to clean needles, and, of course, that they are helped to kick their habit. The so-called harm-reduction method is not accepted in about all countries in Eastern Europe and Central Asia. As long as that’s not done, I fear that we will see a continuing explosion of HIV driven by a major epidemic of injecting drug users that is there already.

RFE/RL: What are the chances of a person infected with HIV in Eastern Europe or Central Asia receiving proper care or to survive now compared with the situation 10 years ago?

Piot: Ten years ago, basically nobody living with HIV had access to life-saving treatment in Eastern Europe except very rich people who would then go to the West for treatment. Today it’s still at very low levels -- it’s like one-in-10 only compared to one-in-five in [southeast Asia] for example. And why is that? It is because of the fact that many people with HIV in Eastern Europe and Central Asia are injecting drug users [as opposed to sexual transmission prevalent in Africa, North America, and Western Europe] and they are kind of outcasts in society. And there is often a mentality and saying, “OK, these are junkies. Why would we care, why would we pay for their health care?” That is changing now, but also the price of antiretroviral drugs in Eastern Europe is among the highest in the world. It’s higher than in the U.S. often because of the many middlemen, the price structure.

That’s why it is important to have strong leadership to deal with this issue both, on prevention and taking courageous decisions that will make sure that HIV does not continue to spread among young people, injecting drug users. Because Eastern Europe and Central Asia have the youngest epidemic of HIV in the world -- I mean among youngest people -- it’s very often teenagers and people in their early twenties and at a much younger age than in other parts of the world. So it’s about the future of the nation. And that added to a demographic crisis that is there, when you take Russia losing 800,000 people every year, [it] should make AIDS a top priority for national concern and for massive action on the ground in every oblast, every city. And I hope that we are now getting into that phase.

RFE/RL: What are the differences between the HIV/AIDS epidemics in Eastern Europe, on the one hand, and in Central Asia, on the other?

Piot: Both Ukraine and Russia are very heavily affected by the AIDS epidemic to the extent that in Russia we are close to 1 million people living with HIV. In Ukraine, one in every 60 adults is infected with HIV. Originally it was driven entirely by injecting drug use. Now more and more it is sexual transmission -- actually in Ukraine it is already the majority of cases.

An AIDS-awareness demonstration in the Kyrgyz city of Osh in December 2005 (RFE/RL)

When you look at Central Asia we are at the very early stages of an HIV epidemic. It started with being transit countries for heroin coming from Afghanistan. But from transit countries, they’ve become consumer countries, that’s the first step. And the second step is always that these are the populations that are first being infected. There it is still very largely confined to injecting drug users and the question is whether in the countries, which are predominantly Muslim countries, there will also be sexual transmission -- the spread through sexual transmission like we’re seeing in Russia and in Ukraine. We don’t know -- it's too early to say. So it is a very different situation at the moment.

RFE/RL: What is the level of prejudice toward people with HIV/AIDS in Eastern Europe compared with that in Central Asia?

Piot: The impression is that the stigma and the discrimination is very bad all over the region. Some of that has to do with homophobia. When I look at Central Asia, the first thing is that many people don’t even know about AIDS at all.

RFE/RL: What is the social perception of HIV/AIDS in the United States and Western Europe, on one side, compared to Eastern Europe and Central Asia, on the other?

Piot: When you look at the 1980s in the U.S. and in Europe, there was a terrible stigma and discrimination around AIDS. The leadership, the top leaders in the countries didn’t want to talk about it. President [Ronald] Reagan did not talk about AIDS until the last days of his presidency. That’s an indicator how embarrassing it was to talk about AIDS in public because of its association with homosexuality and so on. In Western Europe, [it was] the same.

But we are over that largely, although there is still discrimination, people still are denied jobs. But it has improved in a tremendous way, thanks to, one -- good legislation, but also to particularly good campaigns. People have become far more tolerant for these issues.

I think we see a good improvement in countries like Ukraine, less so I would say in Russia, it’s starting there. And that is in the first place thanks to the work of organizations of people living with HIV. In Ukraine we see quite a good improvement in terms of acceptance of people living with HIV and rejection of discrimination and stigma. And I think that is a tribute to, in the first place, to the people living with HIV who organized themselves and in every region of the country they are going to speak in schools -- there is a face, and everybody sees that people with HIV are people like you and me, are like anybody else.

In Russia, we’re not there yet. Even if we have cities like Irkutsk where there is very high HIV prevalence -- it is up to 4 percent of the adult population -- it is only beginning now that people with HIV are being organized. The government has not done major anti-stigma campaigns but all that is now being planned. I expect that we will see very good development, positive developments over the next few years.”

RFE/RL: What’s the level of Russian and Ukrainian preparedness to meet the goal of the upcoming UN high-level meeting on AIDS -- universal access to treatment to anyone affected by HIV/AIDS by 2010?

Piot: I think that countries like Ukraine and Russia have the means to provide universal access to treatment and prevention for everybody who needs it. By the means, I mean the money, the institutions, and the education level, which is very good. What has been lacking up to until recently was political will and that is changing. The federal budget for AIDS in Russia has been increased dramatically. There is now a National Council on AIDS that the president has declared will be established. Its composition and its location is not known yet as far as I am aware. Up to recently, AIDS was dealt with from a fairly junior position within the Health Ministry. It is now becoming much more visible and a senior issue, which is good for the bureaucracy.

What I see is not happening is business -- big business is absent. Gazprom TV is doing quite some communication and education around AIDS, but I am talking about the employers. That’s an obvious place to start to make sure that people don’t become infected. That’s actually good for the bottom line of the company. So there is still a lot to be done, but I think now the train is out of the station and we are seeing a good development. We see also here at the high-level session of the UN General Assembly [that] the Russian delegation is led by the minister of health and social affairs, Mikhail Zurabov. He’s a quite an influential man and he comes with a strong delegation, with members of the Duma and so on. I think we’re moving in the right direction, and it’s about time.”

RFE/RL: Could you say a few words on the Central Asian governments’ resourcefulness in fighting HIV/AIDS?

Piot: Central Asia has countries that are oil-rich countries and it has very poor countries. There will be a need for financial support from the outside to stop this AIDS epidemic in Central Asia. And unfortunately the international community is not yet engaged enough for that.