KAZAKHSTAN: TEMIRTAU IS "AIDS CAPITAL OF KAZAKHSTAN"

UNCLAS SECTION 01 OF 03 ASTANA 001547 SIPDIS STATE FOR SCA/CEN, S/GAC, OES/PCI (PHUDAK) E.O. 12958: N/A TAGS: PGOV ECON SOCI SNAR KHIV KZ SUBJECT: KAZAKHSTAN: TEMIRTAU IS "AIDS CAPITAL OF KAZAKHSTAN" ASTANA 00001547 001.2 OF 003 ¶1. SUMMARY: Home to AcelorMittal, Kazakhstan's giant steel plant, Temirtau is known as the "AIDS capital of Kazakhstan." An "explosion" of new HIV/AIDS cases peaked in 1997, then dropped, and has since held steady. The local AIDS Center believes that financial difficulties and layoffs following Kazakhstan's independence, a young migrant population without social restraints, and the fact that drugs are cheaper than vodka led to the city's high rate. While no reliable drug-use data exists, the Center estimates that two-thirds of HIV/AIDS cases are drug users or their sexual partners. Many of those who seek counseling and treatment do not work, cannot adapt to societal norms, and need help obtaining government assistance. END SUMMARY. AIDS IN TEMIRTAU ¶2. ArcelorMittal, Kazakhstan's massive steel plant that employs 45-50 percent of the people living in the "company" town of Temirtau, attracts many outsiders to Termirtau looking for work. Temirtau has the highest incidence of HIV/AIDS in Kazakhstan, with 1767 new cases registered since 1990 when the city registered its first case. An ongoing "explosion" of HIV/AIDS cases in the city accompanied AcelorMittal's 1996 resurgence. This "explosion" peaked in 1997 with 386 new registered cases, then tapered off until 2001 when only 76 new cases of HIV/AIDS were registered. The rate of new cases each year held steady until 2006, at approximately 70 new registered cases each year, but then increased again to its current level of over 130 new cases per year. POSSIBLE CAUSES OF HIV/AIDS "EXPLOSION" IN TEMIRTAU ¶3. Speculating on the reasons for such a high rate of HIV/AIDS cases in Temirtau, the Head Doctor-Epidemiologist of the city's AIDS Center, Sholpan Baimurznina, linked the situation to the history of ArcelorMittal, which employs almost half the city's population. After Kazakhstan's independence, ArcelorMittal's financial difficulties forced it to lay off many workers. The resulting economic destabilization profoundly affected the emotional well-being of this company town with only one real source of jobs. Temirtau is right in the middle of a major narcotics route, and drug use is widespread among the young and the unemployed. Drugs are very cheap; a hypodermic needle filled with drugs costs less than a shot of vodka. Because most of those with HIV/AIDS also use drugs, Baimurznina attributes much of the spread of HIV/AIDS to contaminated needles. With many young men out of work, going to bars, and having loose, unprotected sex, it should not be surprising that many discovered, to their astonishment, that they had contracted HIV/AIDS. Many who initially left the city in search of work, returned when the plant resumed production with various problems, including drug addiction and HIV/AIDS. According to Baimurznina, the U.S. Centers for Disease Control (CDC) conducted a gene type identification test on the cases of HIV/AIDS in Temirtau and determined that many of the viruses were genetically similar to viruses circulating in Europe. While the AIDS Center wants to use this data to conclude that people were bringing HIV/AIDS with them to Temirtau, CDC cautioned REO against drawing any conclusions from that fact, since there could be many different routes of transmission. ¶4. 2005-2006 saw a large influx of youth looking for work. Mostly students who had just graduated from college, they lived without restraints, free for the first time, and partook in Temirtau's night life. Baimurznina believes these factors contributed to the second "jump" in cases. Baimurznina complained that it is difficult to change how people think about using condoms. Kazakhstan is stuck in "old" ways of thinking, she said, different than the West. ¶5. Baimurznina said that, unfortunately, no adequate data exists on the extent of drug use in Temirtau and the Karaganda region. 5500 people voluntarily have sought help with their addiction, but many more are not registered because they have not come forward. She believes, but cannot confirm due to statistical deficiencies, there is a strong connection between the growth of drug use and the increase in the incidence of HIV/AIDS. She estimated that two-thirds of HIV/AIDS cases are drug users or their sexual partners. Temirtau was also one of the Soviet Union's prison ASTANA 00001547 002.2 OF 003 centers, and many of the exiles sent to the region had a high incidence of drug usage, according to Baimurznina. LOCAL AND INTERNATIONAL RESPONSES ¶6. In 1990 following the official registration of the first HIV/AIDS case in the city, the Ministry of Health designated Temirtau a zone of concern and established its AIDS Center. At that time, Almaty hosted the only other AIDS Center in Kazakhstan. Currently, the Center's services range from the distribution of information about AIDS prevention to the provision of treatments, including anti-viral therapy. The United Nations Development Program (UNDP) has helped the Center educate the local population about HIV/AIDS and its prevention. UNDP and the Center have carried out a harm reduction project and worked with at-risk groups (drug users, prostitutes, transients, prisoners and ex-prisoners, unemployed, and others). The AIDS Center is continuing this work on its own while it seeks additional funding to help with this program. SITUATION NOW "UNDER CONTROL"...OR IS IT? ¶7. In response to the question, "Is the situation under control now?" Baimurznina asserted that people will take drugs and engage in unprotected sex regardless of information campaigns. She said indicators do not exist to measure the effect of the Center's program to encourage prophylactic use. Even though the Center advocates restraint, condoms, and "know your partner," Temirtau's incidence of new cases of HIV/AIDS each year remains high. She used a counter-example to illustrate the "mentality" that persists in Kazakhstan (and throughout the former Soviet Union): only 1-2 percent of Temirtau's residents use contraception to restrict birth; abortion remains the overwhelming preferred method of birth control. However, she highlighted that 40 percent of those who use abortion say they will start using contraception in the future. Baimurznina could not easily say the situation is under control, even though the number of new cases each year remains steady. VOLUNTARY AND MANDATORY HIV/AIDS SCREENING ¶8. Baimurznina said 10 percent of Temirtau's residents submit to voluntary screening for HIV/AIDS each year. In addition, all prisoners and blood and organ donors must undergo a mandatory HIV/AIDS test. She said Temirtau's AIDS Center also serves prisoners and noted that 30 percent of all HIV/AIDS cases are prisoners in the Karaganda region. Of these, one-third are from Karaganda, and the rest are prisoners transferred from other Kazakhstani regions. SHAPAGAT NGO DIRECTOR AN HIV/AIDS VICTIM, COUNSELOR IS FORMER DRUG ADDICT ¶9. One of Temirtau AIDS Center's implementing partners is the HIV/AIDS NGO Shapagat. Kazakh for "mercy, benefaction, patronage," Shapagat carries out education campaigns, gives guidance to victims and sex workers, and provides emotional and psychological counseling to those with HIV/AIDS and drug users. Its director, Zoya Ruzhnikova, is a lively mid-30s woman who is currently undergoing anti-viral therapy and taking medication to treat her own HIV/AIDS. She says that this personal tragedy gave her life a new direction. Shapagat's counselor, Aida Arapbayeva, is a recovering drug addict in her late 20s whose voice has been damaged by drug use. Studying to be a counselor, she works with Shapagat to help current and former addicts. ¶10. Ruzhnikova said Shapagat gets its funding for counseling and educational work from Counterpart Consortium, The TIDES Foundation (a U.S. philanthropic fund),the Dutch AIDS Foundation East-West (AFEW),and the International Red Cross. In addition, Shapagat has worked with legal aid groups to create the "All Kazakhstan Union of AIDS" network to help HIV/AIDS victims with questions concerning employment, housing, and benefits. Shapagat recently started a pilot project to place an HIV/AIDS treatment clinic inside a maternity home to treat sex workers, women with HIV/AIDS, and drug users. It will also provide counseling and advice to those with ASTANA 00001547 003.2 OF 003 psychological and/or emotional problems, give guidance to family members, provide support groups, and help with rehabilitation and social reintegration. Ruzhnikova hopes to expand this service to other cities in the region. ¶11. Ruzhnikova said many who seek counseling and treatment do not work, cannot adapt to society's norms, and need help obtaining government assistance. (NOTE: In Kazakhstan, citizens must have a document called a "propusk" that grants them legal status in a city or region. While many move to work, without a proper "propusk," they cannot receive government assistance should they need it. END NOTE.) Ruzhnikova said most of those seeking counseling have a complex of associated problems: HIV/AIDS, tuberculosis, drug addition, homelessness, unemployment, and social intransigence. ¶12. COMMENT: Temirtau has the reputation of being the "AIDS capital of Kazakhstan" because of its high incidence of cases. While it is easier for donor organizations to work with groups and centers in Astana and Almaty, Temirtau's experience shows much about the spread of HIV/AIDS in Kazakhstan, its likely causes, and the effect of economic turmoil, drug use, and transient populations on transmission. As the U.S. Government looks for worthy organizations to support, we should not overlook the work by local groups, such as those in Temirtau. END COMMENT.