At the end of 2009, more than 33 million people in the world were estimated to be living with the human immunodeficiency virus (HIV). Around 1,900 of them live in Armenia, with some estimates putting the number at 2,400. Although the number of people newly infected with HIV is decreasing in the world, as is the number of Acquired Immune Deficiency Syndrome (AIDS) related deaths, at the heel of 2011, the United Nations Program on HIV/AIDS (UNAIDS) listed Armenia as one of seven countries that experienced an over-25 percent increase in HIV incidence between 2001 and 2009. (Armenia’s neighbor Georgia, as well as Bangladesh, Kazakhstan, Kyrgyzstan, Philippines, and Tajikistan, were also on that list of seven countries.) The Armenian government and civil society continue tackling the problem to treat existing cases and prevent new ones.
AIDS, the final stage of HIV, causes severe damage to a person’s immune system, leaving the body vulnerable to various infections and cancers. In 2010, 148 new HIV cases were reported in Armenia. Since 1988, when the first HIV case was registered in the country, 242 people have died from AIDS, including 40 women and 5 children.
In March 2011, four organizations—Real World Real People, Public Information and Need of Knowledge (PINK Armenia), Positive People Armenian Network (PPAN), and the Women’s Resource Center—came together and formed the Advocacy Group on AIDS (AGA) to campaign for human rights and rid society of the vulnerabilities that place its citizens at risk for HIV infections, according to Anahit Harutyunyan, the president of PPAN.
On May 15, the 28th International AIDS Candlelight Memorial Day, around 100 people gathered in Yerevan’s Lovers’ Park for the sixth year in a row to hold a candlelight memorial vigil for those who lost their lives to the epidemic. During the vigil, which also included a concert, “Bards Against AIDS” activists wore shirts that collectively spelled, in Armenian, “I LIVE WITH HIV.” Rows of candles lit a silhouette of a red ribbon, the international symbol of AIDS awareness, and activists stitched pieces to a quilt—each piece representing a life lost to AIDS. Flash mobs were organized in various spots, including behind the Presidential Office, and red balloons were released into the sky, representing all those who have died from the disease in Armenia.
During the concert and a march, which was organized by the Armenian Red Cross Society, volunteers handed out educational materials and condoms to the public, along with a compilation of five stories from people living with HIV. This was “to show that they, too, are part of our community and need care and support,” Harutyunyan, who was one of the coordinators of the day’s events, told the Weekly.
Memorials were also held in Gyumri and Vanadzor, and cities and towns in over 80 countries.
Stigma, misinformation, and discrimination
AIDS remains a taboo topic in Armenia. Those who are infected with HIV often lead isolated lives, say activists. Others fear getting tested, and this, compounded with misinformation about the virus, leads to new infection cases. In a 2009 Armenian Weekly article, Jirair Ratevosian and Amy Hagopian wrote: “Without appropriate health messages and support structures, vulnerable populations unknowingly engage in behavior that increases their risk of infection. A survey by Armenia’s We for Civil Equality revealed young Armenian men who have sex with men are so poorly informed about HIV transmission that only half of the youngest men (18-30 years old) understood that ‘unprotected sexual intercourse’ was a mode of HIV transmission. Half of those youngest men also believed, falsely, that one may get HIV through shaking hands.”
HIV is transmitted through bodily fluids: sex, including oral sex; pregnancy; childbirth; breastfeeding; and contaminated needles. According to UNAIDS, for every person starting HIV infection treatment, there are two new cases of infection.
The National Center for AIDS Prevention (NCAP) of the Ministry of Health of the Republic of Armenia notes that the main mode of transmitting the virus in Armenia is through heterosexual practices (52 percent), followed by drug injection (39 percent), homosexual practices (1.9 percent), mother-to-child transmission (1.6 percent), and transmission through blood (.3 percent). Over 40 percent of registered HIV cases are in Yerevan.
Although people who become infected with HIV might not develop symptoms for 10 years or longer, they can still infect others. The only way to tell if a person has HIV is to get an HIV test. Over time, almost all HIV infections, if they remain untreated, will progress into AIDS. With the proper administration of HIV medications, an infected person may live to the age of 60 or older, and an infected mother is more likely to give birth to a healthy child.
UNAIDS attributes much of the progress made against AIDS to HIV prevention programs, including education on safer sexual practices, condom use and availability, and programs geared towards drug injectors, such as the availability of sterile needles and drug treatment programs.
Raising awareness about HIV/AIDS is a preventive measure that needs support from all segments of society. Marine Margaryan, the project coordinator for PINK Armenia (http://pinkarmenia.blogspot.com), an organization that promotes human rights and educates the public on sexually transmitted infections, credits her own activism to a certain set of values and principles that she adheres to, and that have directed her into the field of social work and political science.
“I believe that if someone wants to have a developed country, he or she should not remain indifferent toward its problems and challenges,” she told the Armenian Weekly. “It is the responsibility of the people to be active and caring citizens.”
Margaryan highlighted the need for social activism as an important tool in molding a nation’s future. “We are the creators of our future—not the government or anyone else,” she said. “The issues of vulnerable and marginalized groups remain unaddressed. There is a wide range of problems that the country faces, so I, as a professional, decided that I have the responsibility to help others to overcome their difficulties. In my work, I try to provide care and support to the ones who are in need of that.”
Margaryan said she only wants a dignified life for members of her society. It can be frustrating at times to talk with those who can’t understand why she’s chosen her line of work. That is when “you understand that you have faced a wall of illiteracy and non-tolerance,” she said. “At these kinds of points, you start to search for inner strength to continue your work and [to] just spread love, which lacks nowadays.”
Prevention and treatment
In 2007, the Armenian government passed a law on “Prevention of Disease Caused by Human Immunodeficiency Virus,” and the NCAP, which was established in 1989, has organized training seminars, encouraged research, and worked towards raising awareness on the issue. The program aims to create a multi-sectorial response to HIV, in collaboration with international and national organizations, allocating resources to HIV prevention, treatment, support, monitoring, and funding.
The country is also engaged in regional and international efforts. Armenia’s ambassador to the UN, Garen Nazarian, told the Weekly that a delegation headed by Armenia’s deputy minister of health would soon be arriving in New York to participate in the 2011 UN General Assembly meeting on AIDS, scheduled to take place from June 8-10.
UNAIDS is working in support of the Armenian government’s National HIV and AIDS Prevention Strategy, in establishing a National HIV/AIDS Monitoring and Evaluation System, and collecting data on HIV prevalence and at-risk behaviors among different groups.
Diasporan organizations are also aiding the national effort against HIV/AIDS. The Armenian Relief Society (ARS), for instance, established the HIV Education and Prevention Project at the ARS Mother and Child Clinic and Birthing Center in Akhourian, Armenia, which cares for more than 8,000 women every year. The project, funded by the World AIDS Foundation, was a collaborative effort between the ARS and the University of Massachusetts, Amherst, consisting of a three-part plan: education and prevention; testing and counseling; and treatment and monitoring. A decentralized HIV/AIDS education and prevention model provided training to local healthcare professionals, teachers, and patients of the clinic. The project’s goals were met in 2007.
World Vision (WV), a Christian humanitarian organization with branches throughout the world, has also launched an HIV and AIDS prevention program in Armenia. They conduct healthy lifestyle education, targeting youth, adolescents, migrants, and their family members.
According to the NCAP, the majority of injecting drug users—39 percent of the HIV transmission mode in Armenia, who happen to all be male—had at one point lived in Russia or Ukraine. The two countries have a one percent or higher HIV prevalence, according to UNAIDS, while Ukraine has the highest infection rate in Eastern Europe and Central Asia. Armenian migrants seeking work in those countries constitute a high-risk group; hence, World Vision-Armenia’s focus on migrants.
WV-Armenia also supports government efforts to conduct courses on “HIV and AIDS Prevention and Safe Behavior Promotion” in grades 8-9. Teachers also receive training in HIV/AIDS. Together with NCAP and UNAIDS, WV-Armenia has launched poster campaigns featuring Armenian celebrities to raise awareness on HIV/AIDS.
Active since 2006, PPAN’s mission has been to “establish a society where PLHIV [People Living with HIV] will feel as full members and will not avoid speaking about their HIV status,” according to Harutyunyan. The organization does this by challenging stigma and discrimination, ensuring patients have access to affordable or even free treatment, providing patients with balanced nutrition, and working to prevent the spread of HIV, other sexually transmitted infections, and drug use.
Trends of AIDS in Armenia
According to NCAP, the first HIV case was registered in Armenia in 1988, and transmission occurred through heterosexual intercourse. That same year, the first AIDS case was also registered. The first death from AIDS was recorded in 1989, the year the NCAP was established. In 1990, the first case of transmission through drug injection was registered. The first female HIV case was recorded in 1996; the first transmission through homosexual intercourse in 2000; and the first child HIV infection and death in 2001.
Though the number of infections through drug use decreased by more than 50 percent between 2002 and 2007, the overall number of yearly registered infections has increased significantly. Between 1988 and April, 30, 2011, 1,040 HIV cases were registered in Armenia—747 males and 293 females, 22 of them children—according to NCAP, though the estimated number is closer to 2,000. In 2001, the number of reported cases was 169, and in 2010, 148.