Pubdate: Tue, 21 Nov 2000
Source: Christian Science Monitor (US)
Copyright: 2000 The Christian Science Publishing Society.
Contact:  One Norway Street, Boston, MA 02115
Fax: (617) 450-2031
Website: http://www.csmonitor.com/
Forum: http://www.csmonitor.com/atcsmonitor/vox/p-vox.html
Author: Scott Peterson

BISHKEK'S UNLIKELY AIDS BATTLE

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

[BISHKEK, KYRGYZSTAN] 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.
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