This this the fourth in a multipart series of articles by United Press International on the status of the global AIDS epidemic.
WEST PALM BEACH, Fla. (UPI) -- Dr. Scott Hammer bit his lip and thought about how to describe the what is happening with AIDS in Eastern Europe and the regions that made up the former Soviet Union.
"Explosive," said the professor of infectious diseases at Columbia University in New York City. "Explosive."
Hammer is not the only one who has characterized the epidemic in that term. Almost all researchers who are studying infections with the human immunodeficiency virus -- the organism that causes AIDS -- in places such as Belarus, the Ukraine, Russia, Uzbekistan, and use the same word.
The epidemic is roaring through populations of injecting-drug users and is evident among people with other sexually transmitted diseases. In the region, 1.2-million people already are infected.
The 28 states that make up the region are strapped for cash to run prevention campaigns and treatment programs. More tragic, in general the governments of the region have managed not to have learned anything from the mistakes made in the West and in Africa, where the epidemic is more mature.
Take, for example, industrial Togliatti, a city with a population of about 750,000 located on the Volga River, about 700 miles south of Moscow. Among Togliatti's injecting drug users, about 56 percent are HIV-infected, said Ali Judd, a researcher at the Imperial College Faculty of Medicine in London. In the year before, the figure was 41 percent. More ominous, about four out of 10 of the injecting-drug-abusing population are sex workers.
"We know from past experience," Hammer told United Press International, "that once HIV is in the injecting-drug population and among sex workers, the virus most likely is already widespread."
In certain cities in the United States, the spread of HIV among injecting-drug users has been slowed by controversial needle exchange programs. In Togliatti, if police catch a person with drug paraphernalia, that person is arrested. So instead of carrying their own needles and syringes, Judd told UPI, the many users rely on needles from others. Sharing needles is one of the primary ways HIV/AIDS is spread among injecting-drug populations.
Outbreaks such as the one in Togliatti are occurring throughout the region, said Dr. Alex Wodak, director of the alcohol and drug treatment service at St. Vincent's Hospital in Sydney. He said attempts to control injecting-drug use through law-enforcement procedures has resulted in users avoiding syringe exchange programs and engaging in risky drug use patterns.
The Joint United Nations Programme on HIV/AIDS reports that in Uzbekistan, the number of HIV cases in 2002 exceeded the total number of cases in the previous decade.
UNAIDS also ticked off more disturbing findings:
--About 80 percent of new HIV infections in the Commonwealth of Independent Nations between 1997 and 2002 were among people younger than age 29.
--In the Russian Federation, at the end of 1998, a total of 10,993 HIV cases were reported. By the end of 2002, that number had exploded to more than 225,000.
--The epidemic has passed the 1 percent mark of the adult population in Ukraine, making it the most affected nation in the region -- in fact, it is the most affected nation in all of Europe.
--In Ukraine, UNAIDS estimates show that of all the new infections in 2002, about 28 percent occurred through heterosexual contact. The year before, 15 percent of new infections originated through heterosexual contact. The data show that once the epidemic becomes rife among injecting-drug users and commercial sex workers, the disease can spread rapidly through the rest of society.
--Belarus is showing the same pattern. In 2001, about 27 percent of the new infections occurred due to heterosexual contact -- usually the partners of injecting-drug users.
Despite the expanding nature of the epidemic, researchers are troubled by lack of awareness and knowledge of HIV/AIDS among the most vulnerable populations -- young, sexually active people engaging in premarital sex. A survey found in Azerbaijan and Uzbekistan, one-third of women ages 15 to 24 have never even heard of AIDS.
The epidemic in Eastern Europe and Central Asia had caught the attention of economists as well as epidemiologists. Shigeo Katsu, World Bank vice president for the Europe and Central Asia region, suggested if the HIV epidemic becomes generalized among economically active age groups, annual economic growth rates could decline by 0.5 to 1.0 percent.
In addition, health expenditures could increase by 1 percent to 3 percent, straining social protection systems, in particular in countries such as Belarus, Moldova and Russia, where fertility rates have been dropping.
"By acting now and mobilizing greater political commitment at the country level, governments and development partners could stave off major crises that would damage health as well as economic growth, the labor force and the welfare of households," said Katsu.
"Countries are paying more attention to the problem, but most of the current efforts to curb HIV/AIDS in the region are too small to have an effect on the course of the epidemic," said Olusoji Adeyi the World Bank's senior health specialist for Europe.
"Large-scale programs for HIV/AIDS prevention and care will require that funding from all sources increase from about $300 million in 2001 to about $1.5 billion by 2007, Adeyi told UPI. "But money alone is not the issue. It is crucial to improve the local information base for programs, to support what works against HIV/AIDS, and to break down the barriers to effective actions in the region."
The World Bank is a cosponsor of UNAIDS. Its report pays particular attention to actions that can help prevent new HIV infections: improving blood product safety and reducing infection spread among injecting-drug users, sex workers and their clients, and prison inmates and ex-inmates, who are among the hardest-hit in the region.
Though the situation in Eastern Europe is grim and worrisome, the wealthier states of Western Europe are beginning to experience their own potential nightmare scenario: As many as 10 percent of people diagnosed with HIV infection are carrying mutant versions of the virus that render at least one class of drugs used to treat the disease impotent.
"Transmission of resistant virus occurs," Dr. David van de Vijver, an epidemiologist at the University Medical Center in Utrecht, the Netherlands, told UPI.
Meanwhile, an estimated 570,000 people are living with HIV/AIDS in Western Europe. Though most of those countries have stable rates of overall infection, there still are pockets of alarming increases in new infection rates -- notably in cities in Portugal and Italy.
"We were used to thinking that the epidemic in Western Europe was stable," Lucas Wiessing, a researcher with the European Monitoring Centre for Drugs and Drug Addiction in Lisbon, Portugal, told UPI. "But we have found that despite prevention measures, HIV transmission continues at high rates among subgroups of injecting-drug users in some countries. The situation in Portugal is scary, very scary."
Explosive. Scary. Such terms should result in action. So far, however, the action has consisted largely of mere words -- in a few countries -- and very little in deeds.