The number of new HIV infections in countries of the former Soviet Union has jumped more than 10 fold since the mid 1990s, to nearly 100,000 in 2001. That's according to a recent report in the British medical journal, The Lancet.
Report author Francoise Hamers says one factor in particular is contributing to the increase. "In Eastern Europe, the epidemic of HIV spread very quickly due to a concurrent epidemic of injecting drug use," she explained.
Ms. Hamers' report says injecting drug use was responsible for more than half of the new cases in former Soviet countries in 2001, up from just three percent in 1994.
Kathleen Cravero, deputy executive director of the United Nations AIDS program, says when HIV takes hold among those injecting drug, it usually doesn't stop there. "People who inject drugs sleep with other people. And they don't always sleep with other people who inject drugs. In other words, their interaction with the rest of the community is vast," she said.
The report says the epidemic is at or near the point where it will spread beyond intravenous drug users into the general population. And, sexually transmitted diseases may facilitate that spread.
People with diseases such as syphilis may spread HIV through skin contact and Ms. Hamers says the combination of syphilis and injecting drugs could mean trouble for Eastern Europe. "Because there is also a big syphilis epidemic, and there are large numbers of infected injecting drug users, there is a threat that we may also face a major epidemic linked to sexual transmission of HIV," she said.
Ms. Hamers' report says heterosexual sex is currently a relatively small factor in the spread of HIV, but it's on the rise. In Ukraine and Belarus, however, heterosexual sex already accounted for more than a quarter of the new cases in 2001.
Although the epidemic is hitting drug users and prostitutes particularly hard, Kathleen Cravaro, from UNAIDS, says it's a mistake to think it will not spread beyond the margins of society. "We know from other situations from the way the epidemic has progressed in other countries that is absolutely not the case, and that will not be the case in Eastern Europe," she said. "So that's the alarm bell we're trying to ring."
The HIV epidemic, she says, is much more severe in countries of the former Soviet Union than in erstwhile satellite countries of Central Europe.
Ms. Hamers says the reasons for the difference are complex. But she says a declining economy in countries of the former Soviet Union, may be contributing to increases in drug use and prostitution that spread the disease. "Where there is no job, when people are desperate, when the economy goes down, when there is a lack of hope for the future, I think all these are determinants for high-risk behaviors," she said.
While high risk behavior is spreading the AIDS virus, cases of actual AIDS in the former Soviet Union are still relatively low. That's because it takes several years for an HIV infection to become full blown AIDS. Ms. Hamers predicts major problems when that happens. "Very soon there will be an epidemic of AIDS, so very sick people in need for care," she said. "Of course, the social, the health system has basically collapsed. There is no drugs, and especially no anti-retrovirals."
And, her report says, the struggling economies in countries of the former Soviet Union can not provide the resources to care for those future AIDS patients.
Ms. Cravaro from UNAIDS says she is especially worried because most drug users in those countries are young: between 15 and 24 years old. She says governments in the region need to step up their AIDS prevention efforts to benefit the next generation.