VANCOUVER, Canada – As a conference where discussions of southern and eastern countries told of tipping points, with numbers of people on HIV treatment greater than numbers of new HIV infections, drew toward its close Wednesday, Dr. Michel Kazatchkine painted a contrasting picture of the epidemic in Eastern Europe and Central Asia.
In this region where new infections have climbed by 51 percent and AIDS deaths by 21 percent, about 50 percent of cases in the region are still linked to unsafe drug injection and drug users, Kazatchkine, United Nations Special Envoy for HIV/AIDS for Eastern Europe and Central Asia, said. Criminalized populations in nations with low access to prevention and treatment services and no or limited harm reduction services, they face high levels of stigma and marginalization, and have strong distrust for government agencies. With one of the two largest epidemics in the region, the Russian Federation provides treatment to only 14 percent of drug users with HIV, and Ukraine, with the other, has treatment coverage of only 12 percent among drug users with HIV, Kazatchkine said. The Russian Federation bans methadone, while access to methadone in Ukraine has dramatically diminished following the Russian incursion on the country. Thanks to criminalization and neglect, the late-starting concentrated epidemic in these nations now exists alongside a heterosexual epidemic with closely linked epidemics of hepatitis C and drug-resistant tuberculosis.
Despite few structured civil society organizations, “remarkable examples of strongly engaged individuals and activists,” take on these challenges, Kazatchkine said.
What funding is available for services to prevent and treat HIV in drug users comes from international sources, primarily from the Global Fund to Fight AIDS, Tuberculosis and Malaria, and that funding has been reduced and will be reduced further. Speaking both as an advocate for affected populations in Eastern Europe and Central Asia, and as the former chief executive of the Global Fund, Kazatchkine was critical of the international organization’s planned retreat from investing in middle income countries where, he noted, “governments have little willingness to pay for programs aimed at vulnerable groups.” Medicines are already procured at much higher prices in this region than in countries with similar income levels, and funding transitions “mean procurement disruption,” Kazatchkine said. He called for ramping up investment, getting serious about HIV prevention, expanding treatment access, finding “new paths to strengthen human rights.” “We must retain our faith in the people of the region.”
To read about how conflict has made a bad situation even worse, see this op-ed by Dr. Kazatchkine in the New York Times.