San Francisco Chronicle - Thursday, July 11, 2002
Sabin Russell, Chronicle Medical Writer

The link between HIV infection and injection drug use was one of the earliest discoveries of the epidemic. But it is only recently that disease trackers have detected signs of a rapidly spreading drug-related outbreak in Eastern Europe and Asia that is also threatening to reach into the general population.

"Central Asia is a bomb waiting to explode," said Kasia Malinowska-Sempruch, a native of Poland who directs a drug-related AIDS program for the Open Society Institute.

Financed by maverick philanthropist George Soros, the Open Society Institute urges that the world adopt successful "harm reduction" tactics such as needle exchange programs that are credited with rolling back an outbreak of HIV among drug users in San Francisco.

The highest increases in the rate of HIV infections are in the former Soviet Union. As many as 840,000 Russians are estimated to be infected with the AIDS virus, the great majority of them drug-related cases.

A quarter-million Ukrainians, or 1 percent of the population, are HIV- positive, the highest infection rate in Europe. Three out of 4 infections are among drug users or their sexual partners, and ominously, rates of pregnant women with HIV are rising -- suggesting a shift toward a heterosexual epidemic similar to Africa's.

Malinowska-Sempruch delivered a spellbinding speech Tuesday at the 14th International AIDS Conference, warning that the triumph of democracy in Eastern Europe and the fall of the Soviet Union has been undercut by the growing menace of AIDS.

"The world celebrated with us when the Berlin Wall fell and then left us alone to deal with the consequences," she said. "AIDS and drug use are the issues that will define whether or not we reverse the tide of economic and social disruption in this generation," she said.

"If the world is unable or unwilling to turn its attention to this region and offer help, . . . the consequences will be horrific."

Current estimates are that 1 percent of the population of the Commonwealth of Independent States, which includes most of the former Soviet Union, uses injection drugs.

"More than 90 percent of new HIV cases in Moscow are related to injection drug use," said Ilona van de Braak of the AIDS Foundation East-West. Young people in Moscow are experimenting with drugs, and there is little aversion to injecting drugs because Russian medicine has often favored the syringe over the pill, she said.

"Drug use started with the Soviet Union collapse," said Lily Hyde of the International HIV/AIDS Alliance, a British group that helps communities in other nations cope with the epidemic. In Ukraine, the drugs are mainly homemade, processed from opium poppies that grow in the countryside, she said. "It's a lower quality of heroin, so it requires injection six or seven times a day," she said. "It is cheaper than alcohol in some of the villages."

While drugs are driving the AIDS epidemic in Eastern Europe, heroin is leaving a trail of HIV infections throughout Asia. Drug-related epidemics are turning up along the heroin trade routes from Afghanistan to Burma. Already, at least 4 million are believed infected in India.

In China, home to 1.3 billion people, pockets of drug-driven outbreaks have turned up in seven provinces, with infection rates among heroin users approaching 70 percent. The Chinese HIV problem first appeared in Yunnan province, along the border with Burma, which is perhaps the world's largest supplier of opium.

Indonesia, which had seemed remarkably immune to the AIDS epidemic, is now seeing high rates of HIV in urban areas where drug use thrives. HIV rates at a Jakarta drug treatment center rose from 15 percent to 40 percent within 18 months.

Evidence of the gravity of the problem is turning up in isolated studies that show extremely dangerous practices, such as needle sharing by drug users, linked with unprotected sex among their partners.

Vietnamese AIDS researcher Dr. Dao Quang Vinh told of a study of 30 drug users who shoot up in isolated alleys of two districts of Hanoi. More than half of the group shared needles -- a practice widely considered to pose the highest risk of transmitting HIV -- and 7 out of 8 reported their peers did it "very often."

Unlike outbreaks of HIV among gay men, where sexual relations tend to be confined to a relatively isolated network, injection drug epidemics can quickly carry over into heterosexuals because most drug users are heterosexual themselves and can pass the virus to their sex partners. But outbreaks of drug- driven HIV do not always result in a widespread epidemic.

When the AIDS virus surfaced in San Francisco 20 years ago, epidemiologists quickly identified injection drug users as a high-risk group. After isolation of the virus, San Francisco was among the first cities to institute programs to clean needles with bleach and, later, a needle exchange program. The infection rate among San Francisco drug users peaked at about 15 percent. It is now half that rate.

E-mail Sabin Russell at srussell@sfchronicle.com
020711
SC020711

Always watch for outdated information. This article first appeared in 2002. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2002. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .