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Very little is done to confront 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 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 subject for first time only yesterday. Belarus did not bother to apply to United Nation's Global Fund to Fight AIDS, Tuberculosis, and Malaria or to draw approved resources from World Bank's anti-TB/HIV/AIDS project.
In many backward, tribal countries - especially in Balkan and in central Asia - 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, 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 men nor women had changed their high-risk behavior", is unsettling conclusion.
Ignorance is compounded by a dismal level personal hygiene, not least due to chronically malfunctioning water, sanitation and electricity grids and to prohibitive costs of cleansing agents and medicines. Sexually transmitted diseases - gateways to virus - are rampant. Close to half a million new cases of syphilis are diagnosed annually only in Russia.
The first step in confronting epidemic is proper diagnosis and acknowledgement of magnitude of problem. Macedonia, with 2 million citizens, implausibly claims to harbor only 18 carriers and 5 AIDS patients. A national strategy to confront syndrome is not due until June next year. Though AIDS medication is theoretically provided free of charge to all patients, country's health insurance fund, looted by its management, is unable to afford to import them.
In a year of buoyant tax revenues, Russian government reduced spending on AIDS-related issues from $6 million to $5 million. By comparison, 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 treatment of tuberculosis and AIDS.
Money is a cardinal issue, though. Christof Ruehl, World Bank's chief economist in Russia and Murray Feshbach, a senior scholar at Woodrow Wilson International Center for Scholars in Washington, put number of infected people in Russian Federation at 1-1.2 million. Even this figure - five times official guesstimate - may be irrationally exuberant. A report by US National Intelligence Council forecasts 5-8 million HIV-positives in Russia by end of 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 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 entire federal budget, says Ruehl.
Some pharmaceutical multinationals - spearheaded by Merck - have offered more impoverished countries of region, such as Romania, AIDS prescriptions at 10 percent of retail price in United States. But this is still an unaffordable $1100 per year per patient. To this should be added cost of repeated laboratory tests and antibiotics - c. $10,000 annually, according to 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 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 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, 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 dowry east Europe brings to its long-delayed marriage with a commitment-phobic European Union.
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.