AIDS - Europe's New Plague
By Sam Vaknin
Author of "Malignant Self Love - Narcissism Revisited"

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 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.

UNAIDS and WHO have just published their AIDS Epidemic Update. It states
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 eight 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 this year, 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 will accede to
the European Union in 2004. Pursuant to an agreement signed recently 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 Vladimir Putin never as much as
mentions AIDS in his litany of speeches. Even Macedonia's western-minded and
western-propped president, Boris Trajkovski, dealt with the subject for the
first time only yesterday. 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 is not due until June next
year. 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 last year. Another $1.5 were given to
Ukraine. Russia blocked last year 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. The average monthly salary in
Romania is $100, in Macedonia $160, in Ukraine $60. It is 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.

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AUTHOR BIO (must be included with the article)



Sam Vaknin ( http://samvak.tripod.com ) is the author of Malignant Self
Love - Narcissism Revisited and After the Rain - How the West Lost the East.
He served as a columnist for Global Politician, Central Europe Review,
PopMatters, Bellaonline, and eBookWeb, a United Press International (UPI)
Senior Business Correspondent, and the editor of mental health and Central
East Europe categories in The Open Directory and Suite101.

Until recently, he served as the Economic Advisor to the Government of
Macedonia.

Visit Sam's Web site at http://samvak.tripod.com