HIV in Focus

by Joshua Foust on 9/19/2006 · 8 comments

It is very glamorous to talk about HIV in Africa, but the disease’s impact elsewhere, like India, Russia, or Central Asia, is almost never talked about. Recent news of the infection of fifty-five children in a hospital in Shymkent therefore gets barely a mention from the BBC, despite the shocking negligence displayed: what kind of screening procedure would allow 17 infected people to donate blood? Are there no other safeguards in place?

The question isn’t as daft as it sounds: Shymkent ranks only behind Almaty and Karaganda in terms of population, and it fairly developed by Kazakh standards. The problem is, in fact, endemic to the country and the region as a whole. Back in 2000, the UN sponsored a study of HIV in Kazakhstan that offered a rather chilling statistic.

If compared with other regions, Kazakhstan belongs to the countries with a low HIV infection prevalence level: just slightly above 1,000 cases were registered by the end of 1999. At the same time, experts believe that the real number of HIV cases exceeds the above mentioned figure at least tenfold. The reason for that is low technical equipment for diagnostic procedures at the so-called “Aids Centers” – the network of official establishments entitled to engage in all issues concerning the AIDS/HIV prevention and treatment in the country. It is noteworthy that 833 cases of the HIV infection out of the total (83 %) are accounted for by Temirtau, a factory town in Central Kazakhstan with the population of 150,000.

When I was teaching in Karaganda, I had several students from Temirtau, and one told me at length of what she called “the illness.” It took me little time to realize she was talking about HIV. Most of it came from heroin addiction, conveniently supplied by nearby Afghanistan.

It’s interesting that Kazakhstan is one of those weird countries that require an HIV test, but only for registered non-CIS visitors who plan on staying longer than three months. I would think that any visitor is a potential carrier of the virus; if you are to go to the trouble of requiring an HIV test to stay in country, shouldn’t one be required to visit? Ahh, but that would annoy the western tourists and oil men. Far better to have an ineffective, token test for the teachers and non-citizens.

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This post was written by...

– author of 1848 posts on 17_PersonNotFound.

Joshua Foust is a Fellow at the American Security Project and the author of Afghanistan Journal: Selections from His research focuses primarily on Central and South Asia. Joshua is a correspondent for The Atlantic and a columnist for PBS Need to Know. Joshua appears regularly on the BBC World News, Aljazeera, and international public radio. Joshua's writing has appeared in the Columbia Journalism Review, Foreign Policy’s AfPak Channel, the New York Times, Reuters, and the Christian Science Monitor. Follow him on twitter: @joshuafoust

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Nick September 19, 2006 at 12:54 pm

Good post, Joshua. The growing HIV/AIDS eipidemic in Central Asia deserves a much higher profile, the better for educating and warning people. Loyalty requires me to big-up the group-posting on HIV/AIDS at neweurasia from earlier in the year.

Josh September 19, 2006 at 3:15 pm

Nick, no shame. I actually missed that post, but it is, from what I can see a really wonderful resource on the topic. Thanks!

Dolkun September 19, 2006 at 9:19 pm

Any medicos reading this?

Two questions:

Are donors in Kazakhstan paid? If so, adverse selection may lead to drug users being more likely than the general populace to give blood. And if the collector then sells the blood to hospitals, it will have an economic incentive to be lax in testing.

Second, what’s with all the transfusions? If 55 kids got infected, how many in total get transfusions? Is this the latest trend in Soviet pediatrics?

KZblog September 20, 2006 at 1:38 am

Dolkum has hit one key point: Presumably these kids were already sick in some way.

Also, the regional head of health is the sister of the akim of Almaty, and calls for her resignation are therefore meeting with resistance.

JC September 20, 2006 at 9:29 am

There are alot of factors that contribute to this particular scandal and the health system in Kazakhstan is in dire need of an overhaul, including of the education system that trains health professionals. There are many questions that need to be asked regarding the state of the health care system: are there any screening procedures for donated blood? Are sterilized needles used or reused? What are the qualifications for the medical staff? How is training performed? Are medical degrees easy to purchase? What is the state of the hospital facilities? And so forth…

I taught in a high school in a village outside Shymkent and visited a local hospital with a colleague from my school a couple of times. The first time, my colleague needed to get a blood test done and the medical professional used an old, used needle to withdraw blood and inserted my colleague’s blood sample into a broken test tube that had dried blood on the bottom. Then, after releasing the blood into the test tube, the medical professional dipped the needle into a glass of water, injected the water and released it to clean the needle. On another occasion, I witnessed a young nurse try to withdraw blood from another patient. The nurse jabbed the patient in several areas on the patient’s arm in order to find a vein and finally used a vein on the top of her hand to withdraw blood from. On another occassion, I went with a colleague and her young son to a hospital in Shymkent because her son had broken his leg. The nurses wanted a bribe before my colleague could see a doctor.

No doubt there are qualified professionals but the system needs MAJOR reform and those folks who are leeching off the patients need to be held accountable. Many people will tell you that it is customary to pay extra money to nurses and doctors so that their family members get “proper care.”
This is one case that somehow made to the public’s attention…and what about other cases?

Michael Hancock September 20, 2006 at 10:06 am

This just in – the Akim of South Kazakhstan Oblast has been sacked by word given on high by Nazarbaev himself, supposedly in response to this scandal hitting the media. It’s actually the media’s attention to it that has really stirred this up, as this isn’t very recent news. Also, it’s clear that fifty-odd unfortunates are just those that were positively infected, while it’s clear that the accident may have effected everyone else these specific nurses have seen recently, which could mean hundreds to thousands of new HIV-carriers in the Oblast’.

Sorry I don’t have a news link for you – but I couldn’t find independent confirmation. My closest friend here in Kazakhstan’s wife works for the Drug Rehab center in Shymkent, and she said it’s way worse than anyone is admitting. Poor Kazakhstanis.

JC – feel free to contact me, as I am your Peace Corps followup in Sayram. Ulugbek says hi. I guess from your initials that you could/should be who I think you are.

KZblog September 20, 2006 at 10:50 pm

My bad, the regional representative of the Ministry of Health (who stepped down to avoid being fired) is the sister of the akim of Astana.

Also, word on the street is that a lot of well trained doctors and administrators get frustrated trying to introduce “innovations” like AIDS testing for donors because there is always resistance to change. It’s a complicated situation and like governments everywhere, it often takes a crisis to introduce change.

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