The reintroduction of the free market into the former Eastern Bloc countries has unleashed a health catastrophe.
Average life expectancy has plummeted and is down to 56 years in the former Soviet Union. Health experts are now warning that unless urgent action is taken, Eastern Europe faces an AIDS epidemic to equal that currently gripping Africa, where over two million people died of HIV/AIDS in 2003.
The recently released UNAIDS report, AIDS epidemic update, conservatively puts the number of people infected with HIV in Eastern Europe and Central Asia at a 1.5 million. In 1995 there were just 30,000 HIV-positive individuals recorded in this region, but by 2001 this had risen to one million.
According to the report, the AIDS epidemic in Eastern Europe and Central Asia shows no signs of abating, with 230,000 people newly infected with HIV in 2003. The worst-affected countries are the Russian Federation (with one million people affected by HIV), the Ukraine and the Baltic states.
Estonia shows the sharpest relative increase, with 5.5 cases per million recorded in 96 rising to 1067.3 in 2001. In the Russian Federation, cases have risen from 10.3 to almost 600 per million over the same period, where the epidemic is said to be growing at a fearsome rate but is only “in its early stages.” The disease has been detected in all but one of the country’s 89 territories.
According to UNAIDS, the number of cases reported almost certainly grossly underestimates the extent of those living with HIV.
During 2003, new infections in Eastern Europe and Central Asia ran from 180-280,000, some six to seven times as many as in Western Europe, where the average cost to delay the breakout of AIDS in an HIV-infected person is estimated to be $10,000 a year. In 2002, Russia spent an average of just $92 on the health of each of its 144 million citizens. Deaths due to HIV/AIDS during 2003 in Eastern Europe and Central Asia were estimated at 23-37,000, ten times the number in Western Europe.
A World Bank report published September 2003, Averting AIDS Crises in Eastern Europe and Central Asia, notes that the spread of HIV among the economically active population will adversely affect annual economic growth rates, which could decline by up to one percent, with up to three percent additional health costs. Falling fertility rates in some countries (Belarus, Moldova and Russia) mean the dependency ratio (the ratio of the economically non-active to active) could rise, “putting a strain on social protection systems”, the report states. Already under funded and failing health and welfare provisions would struggle to provide even a minimal level of care for those infected with HIV, let alone treat patients who go on to develop full-blown AIDS.
The World Bank report declares, “Surveillance is so important that the Bank regards it as part of its operational imperative in Eastern Europe and Central Asia,” and is making HIV/AIDS control measures a condition for countries receiving certain funding.
Discussion of the rapid spread of HIV/AIDS in Eastern Europe also dominated the European AIDS Conference, held in Warsaw in November. “In this part of European continent, the situation is sometimes worse than in Africa, where the number of infections is tragic, but at least they are starting to do something,” said conference chair, Professor Christine Katlama of the Paris Pitie-Salpetriere hospital. “I often count more people receiving treatment in Mali than in some of these countries where it is more difficult to find drugs than in Senegal,” Professor Katlama added.
Delegates issued a warning that without effective preventative public health policies, Eastern Europe could face an AIDS epidemic on the scale of that which has plagued Africa. As in Africa it is the young who are being hardest hit by the rise of HIV/AIDS in Eastern Europe. The collapse of the Stalinist regimes throughout the former Eastern Bloc countries in the early 1990s and the rapid introduction of the capitalist market bankrupted most industries and led to massive unemployment. Cultural, welfare and health provisions were gutted; states could no longer afford to meet the social needs of the population.
Many young people lost any chance of finding a secure and relatively well-paid job. At the same time, sections of the old corrupt bureaucracy sought to maintain their positions and acquire fortunes by engaging in criminal activity, such as drug trafficking. As a study in British medical journal The Lancet notes, the spread of HIV is “closely linked with a rise in injecting drug use that developed after the collapse of the Soviet Union during the 1990s, in the midst of a severe socio-economic crisis and at the time when Afghanistan became the world’s largest opium producer.”
A diversification of trafficking routes through Central Asia and Eastern Europe brought relatively cheap heroin to the streets of Moscow, Kiev and Tallinn. The UNAIDS report observes that drug use, a “relatively new phenomenon”, has “taken hold amid jolting social change, widening inequalities and the consolidation of transnational drug-trafficking.... Extraordinarily large numbers of young people regularly or intermittently engage in injecting drug use, and this is reflected in increasing HIV prevalence among injecting drug users throughout the former Soviet Union.”
The first outbreaks of HIV were reported in 1995 among injecting drug users in Odessa and Nikolayev in southern Ukraine. Now there are an estimated three million injecting drug users in the Russian Federation, with 600,000 in the Ukraine.
Many of these drug users are young males. One study in St Petersburg found that 30 percent were less than 19 years old and the figure is 20 percent in the Ukraine. In Moscow, a survey of young people aged 15-18 found that 12 percent of males had injected drugs. According to UNAIDS, overall across Eastern Europe and Central Asia nearly 25 percent of injecting drug users are aged under 20.
Contaminated equipment and shared needles leads to the disease spreading rapidly among those who inject drugs.
The prevalence of drug use among prostitutes, who then engage in unprotected sex, is spreading the disease. Unsafe sex, particularly the failure of young people to use condoms, is also providing a vector for transmission of the disease. “According to one survey in the Russian Federation, fewer than half of teenagers aged 16-20 used condoms when having sex with casual partners,” the UNAIDS report notes.
Based on data from 27 countries in the region, the Lancet study concludes, “An epidemic fuelled by heterosexual transmission is emerging”. In addition, since homosexuality is severely stigmatised throughout most of the region, there are concerns about “hidden epidemics” occurring in this group.
The Lancet study leaves no doubt as to what chain of events has precipitated the present epidemic:
“The profound social and economic upheaval which took place in the former Soviet Union in the 1990s has resulted in a sharp increase in the incidence of substance abuse, prostitution, HIV, and other sexually transmitted infections....
Rapidly declining socio-economic conditions and increasing inequity bring a sense of despair and hopelessness that is fertile ground for HIV transmission through increased risk behaviour including prostitution and drug use; a struggling economy means fewer resources for prevention and care.”
UNAIDS: AIDS epidemic update, December 2003
World Bank: Averting AIDS Crises in Eastern Europe and Central Asia, September 2003
HIV in central and eastern Europe, Francoise F Hammers and Angela M Downs, published in the Lancet, March 2003 (site requires registration, which is free)