Former Soviet Bloc Hit by Skyrocketing Rate of HIV
By THOMAS H. MAUGH II, LA TIMES MEDICAL WRITER
Eastern Europe and the former Soviet Union now have the fastest-rising rates of HIV infection in the world, with the number of HIV-positive people in Russia growing fifteenfold in the last three years, the United Nations reported Wednesday.
Troubled economies, an epidemic of intravenous drug abuse, poor government health services, high rates of unprotected sex and widespread ignorance about the disease, particularly among young people, all have brought parts of the former Soviet bloc to the edge of a medical disaster, officials said.
The highest rate of infection in the region is in Ukraine, where at least 1% of the population is now infected with the virus, officials said. The actual figures may be considerably worse--in both Ukraine and Russia, experts think the incidence of the disease is grossly underreported. "We never thought it could come to these levels in Europe," Dr. Peter Piot, head of the Joint U.N. Program on HIV/AIDS, said at a press conference in Moscow.
"This is the first time that any European country has seen this level of infection," Piot said, referring to Ukraine's figures. "The window of opportunity to avert a major epidemic in this region is narrowing, if it is not already closed."
In total numbers, the HIV infection rate in Russia and Eastern Europe remains well below the level in Africa, which remains the hardest-hit region of the globe.
But the course of the disease so far in the former Soviet-bloc nations is particularly striking. For all their economic problems, nations in the region have far more resources to fight the disease than do most African countries. Indeed, the report noted that Poland, in sharp contrast to its neighbors, has managed to keep the rate of HIV infection under control.
Poland's success was one of the few bits of good news in the U.N.'s annual report on the disease, which is traditionally released just before World AIDS Day on Dec. 1. Uganda and Cambodia also have had some success in reducing HIV levels, the report noted.
40 Million Are Living With HIV
Worldwide, 5 million people became infected with the AIDS virus this year--800,000 of them children. That brought the total number of people living with HIV to 40 million. Since AIDS was first recognized 20 years ago, an estimated 22 million people have died of it, 3 million of them this year. AIDS is now the fourth leading killer worldwide, although it is still well behind the leader, heart disease.
"This is unequivocally the most devastating epidemic humankind has ever faced," Piot said.
In sub-Saharan Africa, there were an estimated 3.4 million new HIV infections this year and 2.3 million deaths from AIDS. In Swaziland and Botswana, a third of all adults are HIV-positive. In West Africa, where the epidemic began much more slowly and infection rates have traditionally remained low, 5% of adults are now infected in five countries, including Nigeria.
Some of the sub-Saharan countries are expected to lose 20% of their gross national product by about 2020 because of the disease.
In Asia, the number of new infections rose above 1 million for the first time this year, bringing the total to 7.1 million. The overall prevalence remains relatively low in the region, but the numbers are "dangerously deceptive," Piot said, because they mask much more severe epidemics in limited populations that threaten to spread to the general population.
The major subpopulations include intravenous drug users and prostitutes. In Indonesia, for example, 15% of people who inject drugs were HIV-positive in surveys in 1999/2000. Now the incidence is 40% in Jakarta and other cities. Among drug-using prisoners in Bali, 53% are infected.
The number of infected has now risen above 1 million in China, more than double the 1999 figure. Reported HIV infections rose by 67.4% in the first six months of 2001, and many authorities believe the actual numbers may be two to three times as high.
A serious epidemic has arisen in Henan province, where many tens of thousands of rural residents became infected after selling their blood to collecting centers that did not follow basic safety procedures.
Seven Chinese provinces are experiencing local HIV epidemics, largely as a result of drug abuse. In some areas, HIV prevalence is at least 70% among such populations. Another nine provinces are on the brink of epidemics for the same reason.
The Chinese government is finally beginning to grapple with the problem, Piot said, and organized its first major AIDS conference earlier this year.
"But nowhere is the rate rising faster than in Eastern Europe," Piot said. There were an estimated 250,000 new infections in the region this year, bringing the total to more than 1 million.
Estonia, with a population of 1.4 million, had 12 reported cases of HIV infection in 1999, but 1,112 in the first nine months of this year. In Russia, 40,000 new infections were reported in the first six months of this year. By comparison, three years ago, authorities reported 11,000 cases as the cumulative total since the epidemic began in the country.
In the Central Asian republics of the former Soviet Union, half of all cases are in people under the age of 20. That reflects a worldwide spread of the disease to younger populations, who often are poorly informed about its causes and how to prevent it.
"About one-third of those living with AIDS are aged 15-24," the U.N. AIDS report said. "Most of them do not know they carry the virus. Many millions more know nothing or too little about HIV to protect themselves against it."
In Eastern Europe and Russia, drug use is a major ingredient of the epidemic. An estimated 1% of the population in the region uses injected drugs, and needle-sharing is the norm. Sex is also crucial. Among newly detected cases, the ratio of men to women was 4 to 1 but is now 2 to 1, indicating that young women are increasingly at risk.
Syphilis Also on Rise in Russia
Reflecting the high level of sexual activity, the incidence of syphilis in Russia is now 157 cases per 100,000 people, up from 4.2 per 100,000 in 1987. (The U.S. rate is now 2.2 cases per 100,000--a record low for the country.)
Knowledge of AIDS is woeful in much of the region. UNICEF studies show that more than half of teenagers in the former Soviet bloc do not even know what AIDS is, much less how the virus is transmitted and how to protect against it.
"It's not only that knowledge isn't applied," Piot said. "It's simply not there."
Even in the high-income countries of North America and Europe, new HIV infections are on the rise once more, largely because of increases in unsafe sexual practices and the misconception that anti-AIDS drugs have brought the epidemic under control.
"All the emphasis is put on control, which has had a major impact, but prevention has been neglected and education has been neglected," Piot said. "The price that we will have to pay for that neglect is very high."