ALMATY, July 8 (AFP) - Hampered by poverty, drugs and their leaders' authoritarianism, the former Soviet Central Asian republics could be next in line for a sharp increase in HIV cases, health experts warn.
While HIV has been attracting headlines elsewhere in the world it has also been quietly spreading across the steppes, deserts and mountain ranges of the five Central Asian republics that broke from Moscow in 1991 -- Kazakhstan, Turkmenistan, Kyrgyzstan, Tajikistan and Uzbekistan.
Although official statistics on the virus in the isolated region are sketchy, estimates by the Atlanta-based Centre for Disease Control (CDC) and by other institutions suggest that HIV is taking advantage of recent political and social upheavals and is poised to take a massive toll.
CDC has estimated Central Asia's total number of HIV carriers at 90,000 and has said that within two years the number could reach 1.65 million out of a total population of 58 million.
The World Bank's top official in the region Dennis De Tray recently warned that the countries could "begin (the) fight now and it will be difficult and expensive, or wait five or 10 years and it will be unimaginably expensive, not simply for governments but in terms of lives and lost development."
Probably most vulnerable is Tajikistan, a country whose state institutions remain devastated by civil war in the 1990s and where Afghan-produced heroin -- closely tied to HIV's spread throughout the former Soviet Union -- retails at less than the price of a bottle of beer.
While addicts sharing needles pass the disease around cities, many of the million migrant Tajiks who bring money home from Russia each autumn also bring HIV contracted from commercial sex workers to the rural areas where they mostly live.
"My girlfriend started selling heroin, then we both got hooked -- after a day the needle we use is passed on to clients," said Ruslan, a 32-year-old resident of the Tajik capital Dushanbe.
Tajikistan at least is relatively open to donors and non-governmental groups needed for prevention work among addicts and young people. But this is hardly true of Turkmenistan -- another country on the heroin route from Afghanistan -- which says it has only two HIV carriers.
A declaration by Turkmenistan's autocratic President Saparmurat Niyazov that the 21st century would be "drug-free" has meant a virtual ban on public discussion of heroin, while the government has crushed virtually all non-governmental organisations, observers say.
"I believe that HIV prevalence in Turkmenistan is hardly lower than in other countries," said Alexander Kossukhin, a programme officer at the regional office of UNAIDS, the United Nations body responsible for AIDS combating activities.
Meanwhile Central Asia's most populous country Uzbekistan shares Turkmenistan's lack of public information about HIV, lack of effort to combat it and the criminalisation of homosexuality -- seen as a key obstacle to prevention work in prisons.
Oil-rich and relatively Western-oriented Kazakhstan, which is somewhat ahead in monitoring and combating HIV, has found that 40 percent of its prison inmates engaged in homosexual activity, making them particularly vulnerable, Kossukhin says.
Even in Kazakhstan police harass and arrest volunteers who distribute clean needles in accordance with the state-authorised anti-HIV programme. And on the streets of one defunct industrial town in Central Kazakhstan 50 percent of commercial sex workers have been found to be HIV positive.
For countries independent for only 13 years and buffeted by instability in neighbouring Afghanistan the threat posed by HIV could not be starker.
"HIV serves to increase poverty, so it's a problem of security," Kossukhin warned.
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