The region which brought you the Black Death, communism and all-pervasive kleptocracy now presents: AIDS. The process of enlargement to the east may, unwittingly, open the European Union's doors to the two scourges of inordinately brutal organized crime and exceptionally lethal disease. As Newsweek noted, the threat is greater and nearer than any hysterically conjured act of terrorism.
The effective measure of quarantining the HIV-positive inhabitants of the blighted region to prevent a calamity of medieval proportions is proscribed by the latest vintage of politically correct liberalism. The West can only help them improve detection and treatment. But this is a tall order.
East European medicine harbors fantastic pretensions to west European standards of quality and service. But it is encumbered with African financing, German bureaucracy and Vietnamese infrastructure. Since the implosion of communism in 1989, deteriorating incomes, widespread unemployment and social disintegration plunged people into abject poverty, making it impossible to maintain a healthy lifestyle.
A report published in September by the European regional office of the World Health Organization (WHO) pegs at 46 the percentage of the general population in the countries of the former communist bloc living on less than $4 a day - close to 170 million people. Crumbling and desperately underfunded healthcare systems, ridden by corruption and cronyism, ceased to provide even the appearance of rudimentary health services.
The number of women who die at - ever rarer - childbirth skyrocketed. Transition has trimmed Russian life expectancy by well over a decade to 59, lower than in India. People lead brutish and nasty lives only to expire in their prime, often inebriated. In the republics of former Yugoslavia, respiratory and digestive tract diseases run amok. Stress and pollution conspire to reap a grim harvest throughout the wastelands of eastern Europe. The rate of Tuberculosis in Romania exceeds that of sub-Saharan Africa.
UNAIDS and WHO have just published their AIDS Epidemic Update. It states unequivocally: "In Eastern Europe and Central Asia, the number of people living with Human Immunodeficiency Virus - HIV - in 2002 stood at 1.2 million. HIV/AIDS is expanding rapidly in the Baltic States, the Russian Federation and several Central Asian republics."
The figures are grossly understated - and distorting. The epidemic in eastern Europe and central Asia - virtually on the European Union's doorstep - is accelerating and its growth rate has surpassed sub-Saharan Africa's. One fifth of all people in this region infected by HIV contracted the virus in the preceding 12 months. UNAIDS says: "The unfortunate distinction of having the world’s fastest-growing HIV/AIDS epidemic still belongs to Eastern Europe and Central Asia."
In the past eight years, AIDS has been suddenly "discovered" in 30 large Russian cities and in 86 of its 89 regions. Four fifth of all infections in the Commonwealth of Independent States - the debris left by the collapse of the USSR - are among people younger than 29. By July this year, new HIV cases surged to 200,000 - up from 11,000 in December 1998.
In St. Petersburg, their numbers multiplied a staggering 250-fold since 1996 to 10,000 new instances diagnosed in 2001. Most of these cases are attributed to intravenous drug use. But, according to Radio Free Europe/Radio Liberty, 400 infected women gave birth in a single hospital in St. Petersburg in the first nine months of 2002 - compared to 149 throughout last year. About one third of the neonates test HIV-positive within 24 months. The disease has broken loose.
How misleading even these dire data are is revealed by an in-depth study of a single city in Russia, Togliatti. Fully 56 percent of all drug users proved to be HIV-positive, most of them infected in the last 2 years. Three quarters of them were unaware of their predicament. One quarter of all prostitutes did not require their customers to use condoms. Two fifths of all "female sex workers" then proceeded to have unsafe intercourse with their mates, husbands, or partners. Studies conducted in Donetsk, Moscow and St. Petersburg found that one seventh of all prostitutes are already infected.
An evidently shocked compiler of the results states: "The study lends further credence to concerns that the HIV/AIDS epidemic in Russian cities could be considerably more severe than the already-high official statistics indicate." The region's governments claim that 1 percent of the population of countries in transition - still a hefty 4 million people - use drugs. But this, too, is a wild underestimate. UNAIDS itself cites a study that concluded that "among Moscow secondary-school students... 4% had injected drugs".
Quoted in Pravda.ru, The Director of the Federal Scientific Center for AIDS at Russia's Ministry of Health, Vadim Pokrovsky, warns that Russia is likely to follow the "African model" with up to an 80 percent infection rate in some parts. Kaliningrad, with a 4 percent prevalence of the syndrome, he muses, can serve as a blueprint for the short-term development of the AIDS epidemic in Russia.
Or, take Uzbekistan. New infections registered in the first six months of 2002 surpassed the entire caseload of the previous decade. Following the war in Afghanistan, heroin routes have shifted to central Asia, spreading its abuse among the destitute and despondent populations of Azerbaijan, Kazakhstan, Georgia, Kyrgyzstan, Tajikistan and Uzbekistan. In many of these countries and, to some extent, in Russia and Ukraine, some grades of heroine are cheaper than vodka.
Ominously, reports the European enter for the Epidemiological Monitoring of AIDS, as HIV cases among drug users decline, they increase exponentially among heterosexuals. This, for instance, is the case in Belarus and Ukraine. The prevalence of HIV among all Ukrainians is 1 percent.
Even relative prosperity and good governance can no longer stem the tide. Estonia's infection rate is 50 percent higher than Russia's, even if the AIDS cesspool that is the exclave of Kaliningrad is included in the statistics. Latvia is not far behind. One of every seven prisoners in Lithuania has fallen prey to the virus. All three countries will accede to the European Union in 2004. Pursuant to an agreement signed recently between Russia and the EU, Kaliningrad's denizens will travel to all European destinations unencumbered by a visa regime.
Very little is done to confront the looming plague. One third of young women in Azerbaijan and Uzbekistan never heard of AIDS. Over-crowded prisons provide no clean needles or condoms to their inmates. There are no early warning "sentinel" programs anywhere. Needle exchanges are unheard of. UNICEF warns, in its report titled "Social Monitor 2002", that HIV/AIDS imperils both future generations and the social order.
The political class is unmoved. President Vladimir Putin never as much as mentions AIDS in his litany of speeches. Even Macedonia's western-minded and western-propped president, Boris Trajkovski, dealt with the subject for the first time only yesterday. Belarus did not bother to apply to the United Nation's Global Fund to Fight AIDS, Tuberculosis, and Malaria or to draw approved resources from the World Bank's anti-TB/HIV/AIDS project.
In many backward, tribal countries - especially in the Balkan and in central Asia - the subjects of procreation, let alone contraception, are taboo. Vehicles belonging to Medecins du Monde, a French NGO running a pioneer needle exchange program in Russia, were torched. The Orthodox Church has strongly objected to cinema ads promoting safer sex. Sexual education is rare.
Even when education is on offer - like last year's media campaign in Ukraine - it rarely mitigates or alters high-risk conduct. According to Radio Free Europe/Radio Liberty, the St. Petersburg AIDS Center carried out a survey of 2000 people who came to be tested there and were consequently exposed to AIDS prevention training. "Neither the men nor the women had changed their high-risk behavior", is the unsettling conclusion.
Ignorance is compounded by a dismal level personal hygiene, not the least due to chronically malfunctioning water, sanitation and electricity grids and to the prohibitive costs of cleansing agents and medicines. Sexually transmitted diseases - the gateways to the virus - are rampant. Close to half a million new cases of syphilis are diagnosed annually only in Russia.
The first step in confronting the epidemic is proper diagnosis and acknowledgement of the magnitude of the problem. Macedonia, with 2 million citizens, implausibly claims to harbor only 18 carriers and 5 AIDS patients. A national strategy to confront the syndrome is not due until June next year. Though AIDS medication is theoretically provided free of charge to all patients, the country's health insurance fund, looted by its management, is unable to afford to import them.
In a year of buoyant tax revenues, the Russian government reduced spending on AIDS-related issues from $6 million to $5 million. By comparison, the U.S. Agency for International Development (USAID) alone allocated $4 million to Russia's HIV/AIDS activities last year. Another $1.5 were given to Ukraine. Russia blocked last year a $150 million World Bank loan for the treatment of tuberculosis and AIDS.
Money is a cardinal issue, though. Christof Ruehl, the World Bank's chief economist in Russia and Murray Feshbach, a senior scholar at the Woodrow Wilson International Center for Scholars in Washington, put the number of infected people in the Russian Federation at 1-1.2 million. Even this figure - five times the official guesstimate - may be irrationally exuberant. A report by the US National Intelligence Council forecasts 5-8 million HIV-positives in Russia by the end of the decade. Already one third of conscripts are deemed unfit for service due to HIV and hepatitis.
Medicines are scarce. Only 100 of St. Petersburg's 17,000 registered HIV carriers receive retroviral care of any kind. Most of them will die if not given access to free treatment. Yet, even a locally manufactured, generic version, of an annual dose of the least potent antiretroviral cocktail would cost hundreds of dollars - about half a year's wages. At market prices, free medicines for all AIDS sufferers in this vast country would amount to as much as four fifths of the entire federal budget, says Ruehl.
Some pharmaceutical multinationals - spearheaded by Merck - have offered the more impoverished countries of the region, such as Romania, AIDS prescriptions at 10 percent of the retail price in the United States. But this is still an unaffordable $1100 per year per patient. To this should be added the cost of repeated laboratory tests and antibiotics - c. $10,000 annually, according to the New York Times. The average monthly salary in Romania is $100, in Macedonia $160, in Ukraine $60. It is cheaper to die than to be treated for AIDS.
Indeed, society would rather let the tainted expire. People diagnosed with AIDS in eastern Europe are superstitiously shunned, sacked from their jobs and mistreated by health and law enforcement authorities. Municipal bureaucracies scuttle even the little initiative shown by reluctant governments. These self-defeating attitudes have changed only in central Europe, notably in Poland where an outbreak of AIDS was contained successfully.
And, thus, the bleak picture is unlikely to improve soon. UNAIDS, UNICEF and WHO publish country-specific "Epidemiological Factsheets on HIV/AIDS and Sexually Transmitted Infections". The latest edition, released this year, is disheartening. Under-reporting, shoddy, intermittent testing, increasing transmission through heterosexual contact, a rising number of infected children. This is part of the dowry east Europe brings to its long-delayed marriage with a commitment-phobic European Union.
About the Author
Sam Vaknin ( http://samvak.tripod.com ) is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He served as a columnist for Central Europe Review, PopMatters, and eBookWeb , and Bellaonline, and as a United Press International (UPI) Senior Business Correspondent. He is the the editor of mental health and Central East Europe categories in The Open Directory and Suite101.