There are an estimated 500,000 drug users in Central Asia
The World Bank has announced a $27-million program to help four Central Asian countries prevent the spread of HIV/AIDS. Health experts are worried that the region is ripe for an explosion of the disease, due mainly to the rising number of intravenous drug users. A World Bank official who managed the AIDS project for Central Asia says that the initiative, if handled properly, could end the threat of an epidemic in five years and provide a template for regional cooperation on other issues.
Washington, 16 May 2005 (RFE/RL) -- The prevalence of HIV/AIDS in Central Asia remains relatively low, but its rate of increase -- from virtually no cases to thousands in the past 10 years -- has alarmed health experts and regional leaders.
The World Bank project announced last week creates a regional AIDS fund to improve prevention efforts among Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan.
World Bank specialist Joana Godinho, who directed planning of the project, told RFE/RL the region is in a situation of "intense risk" due to its location in the Afghanistan-to-Europe drug corridor.
"We know there is an estimate that there are at least half a million drug users in Central Asia. The majority of the drug users these days inject the drugs so there is a very risky situation," Godinho said. "If you put this together with the migration, which is intense from these countries to Russia, Europe, and even within Central Asia -- from Tajikistan to Kazakhstan, for example -- you have mobility, you have the drug users, you have the prostitution. So all the factors are in place."
Combating the disease is complicated by the parallel spread of tuberculosis, which is endemic in prisons.
Godinho said the most effective AIDS prevention requires action across a range of societal sectors. The fund, she added, will aim to spur coordination between the public and private sector as well as between different public services.
"The regional AIDS fund will give incentives for the countries to come together," she said. "So for example, if the AIDS centers of two countries submit a proposal they will have more chances [for funding] than if it is a proposal submitted by only one of the AIDS centers."
The regional fund's initial priorities are efforts aimed at preventing infection in high-risk groups -- for example, intravenous drug users, those working in the sex trade, and migrants. Activities will include information campaigns and the distribution of condoms to sex workers and clean needles to drug users.
The World Bank project is the first coordinated AIDS-prevention campaign in the region and constitutes a milestone of large-scale cooperation in Central Asia.
Godinho said Central Asian governments have observed the devastating impact of AIDS in Africa, where prevention measures were undertaken slowly. She said they also appear to have heeded the bank's warnings about the economic impact of ignoring such a health crisis.
"One argument the bank has been using is the economic argument," she said. "So if they don't prevent the epidemic, [they should understand] what may happen not only in epidemiological terms, in terms of people that will die and be sick but also in terms of costs for health systems, for the household and for the economy. And all of them are very sensitive to these economic arguments."
The project links together existing AIDS-prevention efforts in the four countries, each of which has approved a national strategy for fighting the disease. The four belong to the Central Asia Cooperation Organization (CACO), which will receive and disburse the AIDS fund through a regional project-management unit.
Godinho said Turkmenistan also showed signs of interest in the project, but the government never made a formal request for help, as required by the bank. She said Ashgabat has yet to approve a strategy for dealing with the disease and has failed to acknowledge any problem exists.
"Officially, for external purposes, they only acknowledge two cases, so it's like they think there is no problem in Turkmenistan, although that is not the case. Then they are not as advanced as other countries in terms of having approved an evidence-based strategy," Godinho said.
The procurement process for specific funding in the regional project is due to begin in July. The first disbursement of funding for AIDS prevention projects is expected to start in September.
The World Bank project announced last week creates a regional AIDS fund to improve prevention efforts among Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan.
World Bank specialist Joana Godinho, who directed planning of the project, told RFE/RL the region is in a situation of "intense risk" due to its location in the Afghanistan-to-Europe drug corridor.
"We know there is an estimate that there are at least half a million drug users in Central Asia. The majority of the drug users these days inject the drugs so there is a very risky situation," Godinho said. "If you put this together with the migration, which is intense from these countries to Russia, Europe, and even within Central Asia -- from Tajikistan to Kazakhstan, for example -- you have mobility, you have the drug users, you have the prostitution. So all the factors are in place."
Combating the disease is complicated by the parallel spread of tuberculosis, which is endemic in prisons.
Godinho said the most effective AIDS prevention requires action across a range of societal sectors. The fund, she added, will aim to spur coordination between the public and private sector as well as between different public services.
"The regional AIDS fund will give incentives for the countries to come together," she said. "So for example, if the AIDS centers of two countries submit a proposal they will have more chances [for funding] than if it is a proposal submitted by only one of the AIDS centers."
The regional fund's initial priorities are efforts aimed at preventing infection in high-risk groups -- for example, intravenous drug users, those working in the sex trade, and migrants. Activities will include information campaigns and the distribution of condoms to sex workers and clean needles to drug users.
The World Bank project is the first coordinated AIDS-prevention campaign in the region and constitutes a milestone of large-scale cooperation in Central Asia.
Godinho said Central Asian governments have observed the devastating impact of AIDS in Africa, where prevention measures were undertaken slowly. She said they also appear to have heeded the bank's warnings about the economic impact of ignoring such a health crisis.
"One argument the bank has been using is the economic argument," she said. "So if they don't prevent the epidemic, [they should understand] what may happen not only in epidemiological terms, in terms of people that will die and be sick but also in terms of costs for health systems, for the household and for the economy. And all of them are very sensitive to these economic arguments."
The project links together existing AIDS-prevention efforts in the four countries, each of which has approved a national strategy for fighting the disease. The four belong to the Central Asia Cooperation Organization (CACO), which will receive and disburse the AIDS fund through a regional project-management unit.
Godinho said Turkmenistan also showed signs of interest in the project, but the government never made a formal request for help, as required by the bank. She said Ashgabat has yet to approve a strategy for dealing with the disease and has failed to acknowledge any problem exists.
"Officially, for external purposes, they only acknowledge two cases, so it's like they think there is no problem in Turkmenistan, although that is not the case. Then they are not as advanced as other countries in terms of having approved an evidence-based strategy," Godinho said.
The procurement process for specific funding in the regional project is due to begin in July. The first disbursement of funding for AIDS prevention projects is expected to start in September.