Important note: Information in this article was accurate in 2007. The state of the art may have changed since the publication date.
International Federation of Red Cross and Red Crescent Societies - February 27, 2007
Claire Doole in Temirtau
Clutching a large bag of condoms and syringes, Sasha makes his way to a truck stop opposite the entrance to the Mittal Steel factory, the largest employer in the central Kazakh town of Temirtau. It's 18:00 as he checks his watch, the time workers clock off. Nervously, two women approach Sasha as he hands over the bag to help them with their work.
For the past five years, Lena, 29, and Urla, 30, have sold themselves to workers from the steel plant for as little as US$ 6. They say they have little choice as they need the money to feed their heroin addiction, a habit that costs them around US$ 20 a gram.
"Prostitution," sighs Urla, "is like sinking into mud. It sticks to you, preventing you from ever washing yourself clean."
Urla is HIV-positive and one of the 20 or so women Sasha will talk to over the next few hours about practising safer sex, using clean needles and being regularly tested for sexually-transmitted infections.
Sasha, 27, a former drug user who is HIV-positive, is today a full-time HIV trainer on the staff of the Kazakh Red Crescent Society. It is his personal experience, as well as his commitment to fighting the disease, that has made him a key activist in the National Society's prevention efforts in Temirtau, which has the highest levels of HIV infection in Kazakhstan.
Heroin highway
More than 1,300 of the town's 180,000 residents are HIV-positive, accounting for 80 percent of cases nationally. Most of those infected are injecting drug users who share needles.
Temirtau, a depressed mining town, lies on one of the many drug-trafficking routes that have opened up from Afghanistan across Central Asia to Russia and Europe, after the fall of the Taliban.
But the problem is not just particular to Temirtau. Kazakhstan has the highest rate of infection in Central Asia, with HIV cases reported in all its major cities. In the past decade, the number of those infected has risen to 6,616 from 548, although unofficially, the number is believed to be at least three times higher.
In a country with an estimated 250,000 heroin users and 20,000 sex workers, many of whom use drugs, the Kazakh Red Crescent Society has made HIV prevention one of its priority programmes.
Equal to Equal
Peer education has proven to be the most effective approach. Since the programme began in 2005, 56 sex workers and two former drug users have become volunteers. They persuade their colleagues to go for testing or visit the increasing number of centres, run by the State or the Red Crescent, where drug users can get clean needles and syringes. In a climate fuelled by stigma and discrimination it is difficult work and they receive toiletries, mobile phones and internet cards as incentives.
However the Red Crescent's biggest peer education effort is directed at young people between the ages of 15 and 29. This age group is the one most at risk of HIV infection, whether through unprotected sex or drug use, accounting for more than 60 per cent of new infections.
More than 1,000 young people in Kazakhstan are involved in spreading the HIV prevention message to their peers. In schools and universities, on the streets, and in the discos, volunteers from the age of 14 distribute condoms and information on sexually-transmitted infections.
However the increasing risk to young people of contracting HIV has heightened fears within the Red Crescent of an HIV disaster.
"I fear for my daughters and for my friends who take drugs," says Sholpan Ramazanova, a health coordinator for the Kazakh Red Crescent. "Despite the best efforts of the Red Crescent, NGOs and the government, the number of infections is still rising."
Sasha, however, is determined to do his utmost to prevent other young people like himself from succumbing to the disease that has ruined so many lives.
"I took risks, shared needles and had unprotected sex, and look what happened to me. I got infected with HIV at 19. I am determined that others don't make the same mistake."
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