Bishkek's unlikely AIDS battle

Kyrgyzstan, one of the poorest former Soviet states, takes a proactive approach in prevention.

Victor Logachev's red taxi may look like any other plying the dark streets of this Central Asian capital by night. But when men wave him down and ask to go to the downtown pyatak - the place where prostitutes await clients - they are in for a surprise.

"Have you read this? It will be good for you," Mr. Logachev tells them, pushing into their hands a booklet about condom use and preventing the spread of HIV, the virus that can lead to AIDS.

Invariably, he says, by the time they reach the plaza in front of the colonnaded Opera House and its knot of long-nailed, mini-skirted women, the passenger has asked where he can get condoms. Logachev then reaches into his glove compartment and hands them a few.

"They are very pleased, because they want to avoid these problems," says the taxi driver, a volunteer for a United Nations and government-funded anti-AIDS program. "It's like a present for them."

In a place like Kyrgyzstan, one of the poorest countries of the former Soviet Union, such a public campaign to avert a crisis ahead of time is unexpected.

Throughout Central Asia, prostitution has grown hand in hand with poverty since the 1991 collapse of the Soviet Union. Add a recent surge of intravenous drug use here - including among prostitutes and other high-risk groups such as homosexual men - and there is a new risk of AIDS that has made prevention a top priority, say UN and health officials.

Complicating the picture, Central Asia has become a prime route for drugs - opium and its refined derivative, heroin - going from Afghanistan to Russia and then to Europe. That makes the street value of heroin in Kyrgyzstan very cheap, less than the cost of a bottle of vodka.

But while other Central Asian nations are only beginning to tackle the fast-growing HIV threat, Kyrgyzstan began focusing on AIDS prevention back in 1995.

"Now we can take some serious steps to prevent the spread," says Larisa Bashmakova. Aware of the AIDS problems in Africa and the West, she has been a driving force as head of a joint UN-Kyrgyz government project that began in 1997. The project runs a free clinic, a needle exchange for drug users, as well as a local organization known as Tais-Plus, which enlists prostitutes and taxi drivers in education and condom-distribution programs for Bishkek's estimated 2,500 prostitutes.

"Kyrgyzstan stands out among all other Central Asia countries," says Sergei Gavrilin, who heads the needle-exchange unit. Nearby Kazakhstan, by contrast, has only recently begun to grapple with 1,500 known HIV cases, and "it is getting too late already," Mr. Gavrilin says.

Officially in Kyrgyzstan only one person has died of AIDS, and there are 11 cases of HIV infection on the books. But the real picture is of a race against time: Tests on hundreds of needles that heroin users returned in May found HIV-infection rates of between 18 and 50 percent, he notes.

Kyrgyzstan is the only Central Asian nation to help pay for AIDS prevention. Recognizing that an ounce of prevention is worth a pound of cure, the government plans to earmark $1.2 million over the next two years for various projects. And it wants the UN to extend the joint program, which is due to expire this year. Donors are being asked to fund a five-year, $750,000 project.

Health workers are anxious that infection will spread from prostitutes to their clients, and then to clients' families, as it has in many other countries. Repeat clients often buy sex from many different women - a practice that can quickly spread HIV, health workers say, if precautions aren't taken. Earning between $1 and $16 per hour, prostitutes say they average one to four clients a day. Turnover is as high as 70 percent a year, with more and more women coming from rural areas.

"We know that prostitutes are taking better care of themselves, but now 30 percent of them are using drugs, and 10 percent of those are intravenous users," Dr. Bashmakova says. "Among women, intravenous drug users usually earn money by way of prostitution. Now we expect the [HIV] figures to go up."

The number of drug addicts has blossomed here in the past two years, as it has regionwide from Iran to China. "Now we are getting heroin prostitutes, who pay for their habit with prostitution," agrees Tanya, a prostitute in her 20s who wears a black-and-white fur jacket. "These drug addicts need money, but it is a big risk."

The result is that education has become the front line. "The impact has been big: Two years ago, some girls didn't even know what a condom was," says Irina Rybkina, a prostitute volunteer with Tais-Plus, which has tried to instill a "must use" attitude. "These days, if a client doesn't want to use a condom, we lecture him for 15 minutes about all the problems," she says. "Then he wants one."

The national program also focuses on drug addicts, the military, and other groups. The cover of a pamphlet for troops shows a cartoon of an artillery piece wrapped in a condom, for example, with a soldier proclaiming "We're protected."

Although homosexuality was a criminal offense here until 1998, Kyrgyzstan's national program was designed to include gay men. "There are no [documented] cases of HIV yet [among homosexuals] - and from one side that is good. But it doesn't mean it doesn't exist," says Vladimir Tyupin, head of the Oasis AIDS service, an organization that works with gay men. "When the first case comes, there will be fear," he adds.

Still, there are signs the message is getting out. On a recent frosty night at Bishkek's busiest pyatak, prostitutes wear hats, thick jackets, and knee-high leather boots to ward off the cold. Asked if the the anti-AIDS program has had an impact, one woman replies: "Here it is!" She reaches into her fur jacket pocket and pulls out a pamphlet. Required reading, she says, for any of her clients.

(c) Copyright 2000. The Christian Science Publishing Society

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