AIDS activists seek to shift world focus

TORONTO -- The AIDS epidemic is growing faster in Eastern Europe and Central Asia than anywhere else in the world, fueled by rampant intravenous drug use.

In the past decade, the number of HIV infections soared to more than 1.5 million in those regions , and deaths from the disease nearly doubled from 2003 to 2005. One study released this week at the 16th International AIDS Conference reported that up to 2 percent of adults in the two regions regularly inject heroin and other opiates.

With much of the world's attention and money focused on Africa, Quarraisha Abdool Karim of Columbia University said yesterday that governments and foundations must not forget about Eastern Europe and Central Asia. ``[We must] ensure we bring the best of what we know to turn the tide around in these countries, so we don't see the same situation we saw in sub-Saharan Africa," she said.

In 2005, 220,000 people were newly infected in Eastern Europe and Central Asia, and 53,000 adults and children died. In sub-Saharan Africa, rates of new HIV infection peaked in the late 1990s, and some countries have shown declines since.

Over the past five years, the major global initiatives to provide AIDS medications have largely targeted Africa and the Caribbean. At the same time, governments in Eastern Europe and Central Asia have been slow to recognize and address their AIDS problem.

While 160,000 people in Eastern Europe and Central Asia need AIDS medications, only 21,000 are getting them.

Injection drug users are especially unlikely to receive the medications, because government health agencies and physicians worry that the drugs will be wasted on addicts.

``We know that treatment scale-up has been slowest in areas where injection drug use is highest," said Dr. Kevin De Cock, the director of the AIDS division at the World Health Organization.

De Cock said that his agency has moved to contain the outbreak in Eastern Europe and Central Asia, but acknowledged formidable challenges.

``It is the part of the world where the epidemic has grown most in recent times," De Cock said. ``When you have drug-using epidemics, they can truly be explosive."

In Uzbekistan, where drug use and prostitution combine to spread the virus, infections rose from 28 in 1999 to 2,016 in 2004.

Drug users -- often too poor to buy fresh needles and with judgment clouded by the drugs -- share tainted hypodermics, allowing the AIDS virus and other infections such as hepatitis C to spread easily. In one city in Belarus, 74 percent of injection drug users are HIV-positive.

Overwhelmingly male, the addicts can transmit the virus to their wives and girlfriends through sexual contact.

Specialists in addiction treatment reported this week that drug services in the region are scarce, so users have difficulty finding methadone and other medications used to wean them from drugs. In three nations -- Armenia, Belarus, and Kazakhstan -- there is not a single clinic to dispense methadone, according to global health specialists.

Mark Wainberg, cochairman of the AIDS conference, said that encouraging widespread HIV testing will be crucial to controlling the rise in infections.

``The key is to get people tested, and they need to get the results right now, while they're sitting in the doctor's office," Wainberg said.

When people know their HIV status, specialists said, they are more likely to adopt behaviors that prevent them from giving the virus to someone else. For drug users, that can mean not sharing needles.

A recent report from the World Health Organization found that while most Eastern European nations have a few needle exchange programs, there aren't enough to make a significant dent in the AIDS epidemic. Researchers estimate that at least 60 percent of drug users in a country need to participate in a needle-swapping program in order to slow HIV transmission.

The emergence of the AIDS epidemic in Eastern Europe and Central Asia, specialists said, is the latest example of how the war on AIDS is really a series of smaller battles, each with its own distinctive challenges. In few places are the stakes higher than in South Africa. One of every 7 people in the world infected with HIV lives in that country.

The AIDS Conference, which attracted about 24,000 delegates, ended yesterday with a series of unusually vigorous attacks on the government of South Africa for failing to sufficiently respond to the epidemic. The government of President Thabo Mbeki has been broadly criticized, both internally and externally, for continually denying the scope of the AIDS crisis and for even questioning whether HIV medicines work.

Stephen Lewis, the UN special envoy for HIV/AIDS in Africa, described South Africa as ``the unkindest cut of all."

``It is the only country in Africa," Lewis said, ``whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state. The government has a lot to atone for. I'm of the opinion that they can never achieve redemption."

Asked to respond to those charges, a representative of the South African Embassy in Washington yesterday referred a reporter to the Ministry of Health headquarters, which was closed.

Stephen Smith can be reached at stsmith@globe.com.