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A Ticking AIDS Time Bomb in Eastern Europe

Much attention at Barcelona’s AIDS conference has focused on Africa and Asia, but HIV is spreading like wildfire through Eastern Europe. Russia has experienced a 15-fold increase in infections in the last three years.

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This young woman with AIDS in Rumania has little hope of receiving the latest AIDS drugs.

HIV/AIDS is spreading rapidly through the countries of Eastern Europe and the epidemic there looks set to grow considerably, according to UNAIDS, the United Nations HIV/AIDS program. The countries of the former Soviet Union suffer from some of the world’s fastest growing infection rates.

UNAIDS says approximately one million people are living with HIV/AIDS in Eastern Europe and Central Asia, more than double the number in 1999. A report released at the end of last year reported that the number of infections was rising faster here than in any other region of the world.

While reported HIV infections were few and far between as late as 1995, in the past six years there has been a strong and steady rise. In some countries, like Estonia and the Russian Federation, reported cases have skyrocketed in the past three years. The number of reported HIV infections in Estonia almost quintupled between 2000 and 2001.

Fertile Ground

Many Eastern European countries provide fertile ground for the rapid spread of HIV infection. Social instability and economic insecurity have led to a rise in the number of injection drug users and to more people resorting to sex work to survive.

Drug use has become a common feature of school life in many cities and needle sharing is commonplace. Surveys in some Russian cities show that condom use among sex workers is erratic at best.

While social and cultural norms are being liberalized in many countries, the accompanying public awareness or prevention campaigns have not followed suit. In fact, public health services in many countries have deteriorated or are almost non-existent.

The majority of HIV infections in Eastern Europe occur among young people, and chiefly are due to injection drug use. UNAIDS estimates that up to 1% of the population of the countries in the Commonwealth of Independent States is injecting drugs.

However, HIV risk is still high among men who have sex with men. While laws penalizing homosexual sex have been struck from the books in the Russian Federation, gay men remain highly stigmatized, and there are few examples of HIV prevention programs aimed at them.

The hardest-hit country in the region – and in fact, in all of Europe – is Ukraine. It is estimated that nearly 1% of Ukrainians carry the infection.

Hope on the Horizon?

Despite the gloom, there are a few bright spots on the Eastern European HIV/AIDS map, particularly in Poland, the Czech Republic, Hungary and Slovenia. In these countries, well-designed national programs have met with some success and helped slow the rise of HIV infection.

Another cause for cautious optimism has been the unveiling of several potential new weapons in the fight against the epidemic at the International AIDS Conference in Barcelona.

Much talked about has been the vaccine being developed by the US biotechnology company VaxGen. Donald Francis, VaxGen’s president, said the vaccine had worked on chimpanzees and expressed optimism about trials due to begin later this year. It will be the biggest HIV vaccine trial ever, involving some 16,000 participants in Thailand.

"If all goes well, (the vaccine) could be available by the end of 2004 or early 2005," Francis said.

Experts, however, dampened enthusiasm that an effective vaccine could be less than five years away. Many experts say that VaxGen’s vaccine will not work on its own and that developing protection against the virus is still a long way off.

Another new drug unveiled at the conference, a so-called "fusion inhibitor" called T-20 developed by Roche Holding AG of Switzerland and Trimeris Inc. of the US, could offer hope for those resistant to current therapies. Tests of the drug on patients running out of treatment options showed the drug slashed the amount of the virus in the blood.

But all these drugs are expensive – a T-20 treatment regiment would cost a patent an estimated $10 000 - $12 000 (10 000 – 12 000 euro) per year – and out of reach of the majority of people with AIDS around the world.

Such therapies are far removed from the reality of the injection drug user on the streets of Kiev or the sex worker in Moscow.

On Tuesday in Barcelona, protestors shouted down the US Health and Human Services Secretary Tommy Thompson, accusing the US of not doing enough to help poor people with the disease. On Monday, AIDS activists protesting the high prices of AIDS drugs stormed Roche’s exhibition, chanting "Greed kills, access for all!"

The new treatment options coming out yearly mean that AIDS no longer has to be the automatic death sentence it once was. But for people in poor countries, who account for 95% of HIV infections and who cannot afford expensive "drug cocktails" and experimental treatments, it largely still is.

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