The UN General Assembly begins a three-day special session on the global pandemic of HIV/AIDS today. UN member states are expected to adopt a declaration setting out guidelines for fighting the disease. Governments from Eastern Europe and the former Soviet Union are being challenged by regional activists to act more swiftly in both prevention and treatment of the disease, which has spread mostly among intravenous drug users. UN correspondent Robert McMahon looks at prospects for the conference.
United Nations, 25 June 2001 (RFE/RL) -- The special UN session on HIV/AIDS is attracting almost 20 heads of state from Africa and hundreds of other officials and activists from the continent, which has been devastated more than any other by the disease.
The session will adopt a declaration that is intended to provide a global strategy for fighting HIV/AIDS and mobilize funds to help boost efforts. But experts say the example of Africa has already been ignored too long in the region of the world where the highest rise in rates of infection is now being reported -- Eastern Europe and the former Soviet Union.
In absolute numbers, the disease has spread in that region on a far lower scale than in sub-Saharan Africa. But the Joint United Nations Program on HIV/AIDS, known as UNAIDS, still considers the region a major area of concern.
The director of UNAIDS, Peter Piot, told journalists last week (21 June) that he hoped the General Assembly session will spur leaders from Eastern Europe into action after their slow initial response to the crisis.
"I think it's not a secret that the response and the commitment at the political level to deal with this is not commensurate with the potential, particularly with the potential epidemic. And [Eastern Europe] is a region that has an opportunity, just as in Asia, to prevent it going to a situation as we're seeing in Africa."
But few countries in the region are sending high-level delegations to the special session. According to Kasia Malinowska-Sempruch, who directs HIV/AIDS prevention efforts at the Open Society Institute, this reflects a general feeling that the disease is an isolated epidemic that only concerns drug abusers.
Malinowska-Sempruch, who is Polish, tells RFE/RL that leaders in the region are reacting the same way authorities in Africa did before the rate of infection spiraled out of control:
"It's very disheartening because it shows we're not serious enough about it yet. It's not terrifying or urgent enough and, unfortunately, I think it's not terrifying and urgent enough because the people who are becoming infected are drug users."
UNAIDS estimates that the number of people infected by human immunodeficiency virus, or HIV, in the region was at least 700,000 at the end of 2000 -- nearly double the level of 1999. The majority of HIV infections are traced to intravenous drug use. Official estimates put the number of such users at between 2.3 million and 4 million at the end of 2000.
Drug use has soared during the past five years, and UN studies show that HIV infections have risen wherever trafficking in drugs occurs -- in particular, throughout Central Asia, the Caucasus, and the Balkans.
Needle-sharing in these countries is common, and the resulting blood-to-blood transmission spreads the disease more rapidly than sexual contact. But the growing sex trade in countries like Russia, Ukraine, and Moldova have caused HIV infections to rise sharply there as well. In the Russian enclave of Kaliningrad, for example, between 40 and 80 percent of sex workers are believed to be HIV-positive. And intravenous drug use is reported to be high among sex workers in Minsk, Moscow, Odessa, and Donetsk, putting them at even greater risk of infection.
Governments throughout the region have expressed alarm at both the growing drug trafficking and spread of HIV/AIDS, but have so far relied on non-governmental organizations and international agencies to address the problem.
Kyrgyzstan, whose delegation at the UN special session will be headed by Vice President Osmonakun Ibraimov, is the only Central Asian country to be represented at that level. Turkmenistan, Tajikistan, and Uzbekistan will be represented by their UN ambassadors.
A diplomat with Kyrgyzstan's UN mission, Zamira Tohtohodjaeva, tells RFE/RL that her country sees the session as an opportunity to seek more effective measures at halting the spread of HIV/AIDS:
"It's very important to learn from the other countries, to learn more about the progress made in other countries, and to find out, maybe, [what new approaches] the [final UN] declaration will propose to fight this."
She says Vice President Ibraimov, who addresses the General Assembly Tuesday (26 June), hopes to draw attention to the difficulty in stopping the spread of disease among injecting drug users and commercial sex workers.
The Open Society Institute on 22 June issued a report promoting what it calls "harm-reduction programs" to slow the epidemic. The programs stress the need to provide clean needles to addicts. Research during the past 15 years has shown that needle- and syringe-exchange programs reduce HIV prevalence and help abusers start on the road to drug treatment.
Malinowska-Sempruch, who runs the Institute's international harm-reduction development program, says there has been some acceptance of clean needle programs at the local government level. But she says the approach needs national backing to become more effective:
"We actually truly believe that there needs to be a range of services that is available for drug users, but I think what we want to do today is make sure that people don't get infected. This is the urgency. This is what needs to happen today. Yes, drug-treatment programs are, of course, important, but a drug-treatment program of $100,000 is going to care for 100 drug users or maybe 50, [whereas] a needle-exchange program of $100,000 is going to save many lives."
But another activist in the region, Ukrainian doctor Konstantin Lezhentsev, says the emphasis needs to be on treatment of those currently infected. Lezhentsev works with Doctors Without Borders on AIDS treatment programs in southern Ukraine. He has been lobbying the Ukrainian government to press for affordable antiretroviral drugs for the rising number of infected -- now estimated at more than a quarter of a million people.
Lezhentsev says the high-risk communities -- intravenous drug users and sex workers -- are resistant to education campaigns aimed at changing their behavior, in part because it means they may have to acknowledge they have a fatal disease. He says in Western countries preventive efforts did not become successful until treatment drugs became more widely available -- about five years ago. This, he says, removed the fear factor:
"When people have deep fear -- deep fear [of] HIV -- it doesn't permit them to accept the message. And part of the activities to reduce this fear is what was done in the developed countries. But HIV/AIDS is not a death penalty. It's a chronic infectious disease."
UN experts have estimated that by 2005, it will cost more than $9 billion per year to treat HIV/AIDS on a global scale. They recommend that about half of that money be allocated to Africa, where the disease is most widespread.
But officials from Eastern European governments say they are also hoping to qualify for some of the funds raised as part of an international effort initiated by UN Secretary-General Kofi Annan, ahead of the General Assembly special session.