Introduction

The first case of HIV/AIDS in Kazakhstan was detected in 1987. Today, there are about 5,440 people reported to live with the virus, including about 313 with full-blown AIDS. Other data estimates the number of people infected as high as 16,500. This makes Kazakhstan the most severely affected Central Asian country. The spread of HIV/AIDS was until recently mostly limited to intravenous drug users. An ILO report from 2002 stated that:

The most common HIV transmission route is parenteral, i.e. 87 per cent of all cases of virus transmission are through injecting drug use, with 6.4 per cent for the sexual route. 6.3 per cent were unaccountable. Thus, based on the infection incidence structure, one may state that, so far, HIV spread in the country has depended by over 90 per cent on unsafe injecting drug use and sexual contacts. The shares of virus transmission routes have changed little since the HIV outbreak in Temirtau.

According to a WHO report, HIV/AIDS in Kazakhstan disproportionately affects young men (about 70% of affected persons are between the ages of 15 and 29, and about 80% are male), although women are increasingly affected as well.

The Tragedy of Temirtau

The outbreak in Temirtau is the bleakest chapter in Kazakhstan’s history of HIV/AIDS. In 1997, it was said that 85% of all reported cases of HIV?AIDS in the entire republic came from that city - and it was dubbed “Central Asia’s Ground Zero” with regards to HIV/Aids. Temirtau’s plight is symbolic for Central Asia’s Aids problem:

The worsening socio-economic situation in Temirtau, inflated by the down-sizing of its main employer the steel-producing combinat, and the virtual collapse of the former Soviet welfare state, is being tragically aggravated by a relatively cheap and well organised supply of illicit narcotics.

(If you read German, I recommend you to give this article on Temirtau a closer look.)

New Forms of Transmission

However, nowadays, this has changed, and the virus is spreading to groups that have previously been relatively safe from contact with HIV-positive individuals. The virus is now being sexually transmitted by prostitutes, and is no longer exclusively a by-product of the country’s huge problem with intravenous drug users (of which there are said to be as many as 200,000 in Kazakhstan alone, and 500,000 in Central Asia).

The World Health Organization in one of their reports (PDF) states that:

More than 25% of newly registered infections in 2004 have been attributed to unprotected sex. Most of the infected people are men, but the proportion of women infected is reported to be increasing.

A BBC special on the topic interviews Kazakh prostitutes, revealing that there is very little public understanding of the disease, or how it is spread. While the prostitutes were aware of HIV/AIDS and concerned about it, they reported wide misconceptions about its transmission.

“Everyone says it is possible to get AIDS through talking to someone. You never know in which bed you are lying, you might get AIDS just from dirty bed or something.”

The BBC also explored Kazakhstan’s small, stigmatized homosexual population by venturing to a gay club. According to their interviews, about half of all gay men still don’t even know about HIV, and because the community is so small and secretive, it is nearly impossible to get information to them.

Solutions to an Increasing Danger

2005 saw a significant rise in reported HIV cases - 960 new cases, increasing from 740 the year before.

While the Kazakh government does recognize the problem, the United Nations is concerned about how it is choosing to handle it.

The state sees the spread of AIDS/HIV, first of all, not as a social, but as a medical problem, the ways of whose resolution lie in the regulatory and administrative dimensions. The inefficiency of such an approach was already revealed in connection with the sharp growth of STI morbidity.

However, the government seems to be changing its stance, and is pursuing new strategies.

The government’s program aims to prevent HIV transmission through behavior change and harm reduction strategies targeting high-risk groups, including injection drug users, commercial sex workers and men who have sex with men.

Finally, NGOs are joining the fight to combat HIV in Kazakhstan. The Clinton Foundation has added Kazakhstan to the Procurement Consortium, allowing the country to receive drugs and diagnostic equipment at reduced prices. Additionaly, Open Society Institute’s International Harm Reduction Development (IHRD) program supports a Street Kids International (SKI) program to “bring at-risk youth and social workers together before the spread of HIV/ AIDS and drug use gets out of control.”

Conclusion

While HIV/AIDS infection rates seem to be on the rise in Kazakhstan, the country still does not face an epidemic of the magnitude many other countries face. Assuming smart government policies and outside funding, Kazakhstan faces a manageable situation that should not be allowed to get out of control.

Both James and Ben contributed to this post.