KAZAKHSTANI GOVERNMENT REACTS TO HIV/AIDS SCANDAL

UNCLAS ASTANA 000563 SIPDIS STATE FOR S/GAC KRAPPOSELLI USAID FOR E&E/DGST PHOLMES, E&E BWALLIN; GH/HIDN/ID CVINCENT CDC FOR SBLOUNT, EMCCRAY AND PSIMONE TASHKENT FOR EPUTNAM SIPDIS E.O. 12958: N/A TAGS: SENV KHIV KZ SUBJECT: KAZAKHSTANI GOVERNMENT REACTS TO HIV/AIDS SCANDAL REF: A. ASTANA 353, B. ASTANA 251 ¶1. Summary: The HIV/AIDS scandal in Shymkent continues to receive high-level attention. On October 9, President Nazarbayev instructed Umurzak Shukeyev, the new Akim of the Southern Kazakhstan Oblast (SKO),to provide all necessary treatment to the 78 children infected with HIV as a result of contaminated blood transfusions and unsafe injection practices. On October 10, Minister of Health Anatoliy Dernovoy announced that the HIV outbreak in SKO has been contained. President Nazarbayev visited Shymkent on October 25, where he demanded that those responsible for the outbreak be identified and punished. End summary ¶2. On October 10 Health Minister Anatoliy Dernovoy announced that the HIV/AIDS outbreak in Southern Kazakhstan (SKO) has been contained. Seventy-eight children have been infected due to the reuse of disposable medical instruments, improper infection control practices in the hospital setting, or through contaminated blood transfusions. ¶3. Minister Dernovoy visited the Southern Kazakhstan Oblast on October 15-16. He stated that the quality of medical services in SKO is the worst in the country. The equipment at the blood donor center in Shymkent, the largest city in SKO, is outdated and incapable of meeting all necessary safety requirements, said Dernovoy. He added that most hospitals lack basic necessities, from hot water to linens. Dernovoy noted that many medical personnel are poorly qualified. ¶4. The Minister also condemned bribery in the regional hospitals and the misuse of budgetary funds. Patients have to pay for everything - medical preparations, blood transfusions and treatment, said Dernovoy, and he asked where the twenty billion tenge ($156.6 million) allocated annually for the oblast had been spent. ¶5. Dernovoy called for better blood safety in Kazakhstan. He stated that the government has allocated 65 million tenge ($500,000) to repair the existing blood center in Shymkent and 120 million tenge ($940,000) to purchase disposable medical instruments and new equipment. The GOK has also allocated 1.4 billion tenge ($10.9 million) to build a new blood center in Shymkent. ¶6. In his introductory meetings as new Akim of the Southern Kazakhstan Oblast, Umirzak Shukeyev learned that most hospitals are legally categorized as communal facilities, which permits them to require payment for services even in cases where free medical services are guaranteed by the state. Shukeyev recommended that all children's hospitals and maternity clinics be registered as state organizations, thus ensuring that all services will be free. (Comment: This reaction reflects an unfortunate shift away from USG-supported health finance reforms in Kazakhstan, and disregards the fact that informal and under-the-table payments always have occurred in the inefficient Soviet system. End comment.) ¶7. In reaction to the HIV outbreak in Shymkent, Kazakhstani authorities have examined blood centers throughout the country. Activities at blood centers in Zhezkazgan, Temirtau and Balkhash were suspended because of equipment degradation. The Akmola Procurator has also recommended the suspension of activities at blood centers in Stepnogorsk and Atbasar, after discovering that the centers were using outdated equipment, including refrigerators manufactured 40 years ago. ¶8. President Nazarbayev arrived in Shymkent on October 25 to discuss the HIV outbreak with oblast officials. Nazarbayev declared that urgent measures must be taken to revitalize the health care sector of the oblast. He also urged procurators to quickly complete their investigation and to punish those guilty for the HIV outbreak. Kazakhstani authorities have already charged 17 doctors with negligence and investigators are now attempting to identify who recommended and performed the faulty blood transfusions and injections. ¶9. Comment: The USG continues to assist the Ministry of Health with the reforms required above and beyond replacing old refrigerators. USAID and the U.S. Centers for Disease Control and Prevention continue to provide technical assistance in Shymkent and input to the draft National Blood Safety Program, which should clarify roles and responsibilities of stakeholders, including the quality monitoring of blood bank services. Many of the deeper flaws revealed by the Shymkent tragedy, however, will take years of continued health sector reforms to address. End comment