By Karen Louise Boothe
Sunday, November 30, 2003
The theme of World AIDS Day on Dec. 1 is that discrimination and stigma are fueling the disease. Evidence of that abounds in Kyrgyzstan, a front line for the disease where women are at higher risk and health workers struggle for funding.
BISHKEK, Kyrgyzstan (WOMENSENEWS)--Dr. Valentina Kirichenko is glad organizers of World AIDS Day on Dec. 1 chose the stigma surrounding HIV/AIDS as the theme for this year. In Kyrgyzstan, she says, the disease is spreading quickly and the general response is to isolate those who contract it.
A 2002 report by UNICEF warned that HIV is moving--virtually unchecked--into a number ofcountries, such as Kyrgyzstan, in the Commonwealth of Independent States, an allianceof 12 of the 15 former Republics of the Soviet Union.
That's why Kirichenko, director of the National AIDS Center in the capital Bishkek, believes more needs to be done to persuade high-risk Kyrgyz citizens to get tested for HIV.
Kirichenko says that about 700 people come to her center each month to get tested. "But most of them know they are at low-risk," she says. "They just want the necessary health papers so they can get travel visas to countries that require them. We need to get the word to those at high-risk--drug addicts--of contracting HIV to come and get tested too."
Kyrgyzstan was once confident it was immune from HIV. Today, the drug trade from Afghanistan continues to pose a serious threat. In fact, United Nations officials say one-half of all drugs trafficked from Afghanistan pass through Central Asian countries such as Kyrgyzstan. The drug route has led to a large population of drug addicts in Kyrgyzstan--50,000 according to 2001 government statistics but known to actually be many times that number--who are hooked on opium and heroin. The lack of clean needles and treatment programs, couple with the intense aversion to testing, is said to be why the number of HIV-infected drug addicts keeps rising.
"Those who are already infected, or are at high-risk of contracting HIV, are too afraid to get tested out of fear of the heavy social stigma infected persons suffer," Kirichenko says. "And even worse, many people are afraid to educate themselves and protect themselves out of fear of being associated with HIV/AIDS."
Moreover, some men are unwilling to buy, or accept free condoms, out of fear of being associated with AIDS, she adds.
As for treatment options, those suffering from HIV/AIDS are likely never properly diagnosed. And, those who are properly diagnosed must rely on a health care system that is lacking in drugs for treatment. There are no health care centers or programs catering solely to treating those with HIV/AIDS and care still falls with the family.
Government statistics show that while more men than women are infected, infection is increasing at a slightly faster rate among women than men. In November, there were 467 officially registered HIV-infected persons nationwide. Forty of them--or 10 percent--were women, but local health workers think those numbers are in fact far higher.
According to a survey of about 400 women by Building Potential, a women's HIV/AIDS education project in Bishkek, Kyrgyz women are increasingly at risk of contracting HIV because of intense economic, social and cultural pressures that infringe on women's rights.
According to the survey backed by the United Nations Development Fund for Women, or UNIFEM, women are still taught it is their duty and responsibility to their husbands to be sexually compliant. It found that men in most Kyrgyz families, especially in rural communities, initiate and display sexuality while women's preferences are disregarded. A woman cannot refuse sex or assert the use of condoms without risking a violent reaction.
"And 80 percent of women who are HIV positive were infected by their husbands," Nurgul Jamankulova, manager of Building Potential.
Jamankulova also blames poverty. Not only do women fear asserting themselves in the home because of their economic dependence on their husbands, many impoverished female teen-agers leave their rural communities, move to Bishkek and begin work as prostitutes.
"There are no means for them to protect themselves against infection," Kirichenko says. "And they, in turn, infect more men because here in Kyrgyzstan, extramarital sex--often with prostitutes--is commonly tolerated."
However, the month that begins with World's Aids Day, is particularly worrisome for Jamankulova and her HIV/AIDS education project for women. December, she says, offers precious little time if she's going to educate even one more woman about the risks of HIV infection. "Right now, my biggest problem is lack of money in a few weeks," she says.
Building Potential has been funded this year with a $50,000 grant by UNIFEM, but the money runs out Dec. 31. Regional UNIFEM leaders are still scrambling to find a new donor if the project is to remain viable next year.
"It is possible our doors will close in a few weeks," Jamankulova says.
Health care professionals don't foresee any government funding. Despite pledging to contribute money to HIV/AIDS prevention efforts, Jamankulova says, the Kyrgyz government has not come forth. Further, while officials acknowledge the problem, they have yet to formulate a strategic prevention plan.
UN data indicates that HIV/AIDS is spreading faster in parts of the former Soviet Union than anywhere else in the world. Causes include increased drug use, sexual activity at an earlier age and growing numbers of sex workers. HIV infection rates in the region are estimated to have increased five-fold between 1998 and 2001.
"Eighty-three percent of those infected are drug users who have used contaminated needles and 17 percent have been infected via sexual activity," Jamankulova says. "But unless we get continued funding our educational outreach is going to cease, and I am especially afraid for women living in rural areas. No other organization is as focused on educating women as we are."
Kirichenko, at the National AIDS Center in Bishkek, is all too aware of the stress the funding crisis poses for Jamankulova and her organization. She herself squeezes what she can from a depleted budget.
Neither Jamankulova nor Kirichenko are waiting for government-funded programs to continue their work. They're doing what they can to piece together foreign donor funds to build a plan for local and national civic action.
To protect themselves, women need the confidence to assert their rights to sexual and reproductive health, equal access to information and education, economic independence and equality at home.
Also, they say, health workers should intensify rural education to raise awareness about HIV/AIDS, including addressing themselves to men, because only with the men's understanding and support will women be able to negotiate safe sex to protect themselves.
They also urge school administrators to incorporate sexual and reproductive health and life skills into their curricula and national policymakers to redress prevailing gender stereotypes that make women vulnerable to HIV/AIDS infection.
Lastly, they intend to encourage the mass media to carry out a more widespread information campaign to help eliminate some social customs that restrict the rights and opportunities of g