The HIV/AIDS epidemic has taken firm hold in parts of the former Soviet Union, particularly in Russia and Ukraine. The prospects for stemming the spread of the disease are best in the central Asian republics, where there are still relatively few cases. In the Baltic states, there is concern about the rapid rate of transmission. In addition, people infected with HIV are more vulnerable to tuberculosis, which is emerging in increasingly drug-resistant stains across the region.
Russia has the largest HIV/AIDS epidemic in Europe, according to the World Health Organization, with an estimated 860,000 people infected, although officials say the number could be more than one million.
Intravenous drug use, especially among young people, is the prime vehicle for the spread of the disease in Russia. An estimated 80 percent of officially reported cases were among injecting drug users, and a similar percentage are under the age of 30. The majority of cases are concentrated in a few urban areas, including Moscow and St. Petersburg.
The trend is much the same in neighboring Ukraine, where the number of newly reported cases has nearly doubled in each of the first three years of this century.
The five Republics of Central Asia are in what is described as beginning stages of the epidemic, but could face similar problems soon, without urgent intervention. And in the Baltic nations of Latvia, Lithuania and Estonia, the overall number of infections is extremely low, but those numbers are increasing rapidly.
Robyn Montgomery of Russia's independent Aids Foundation East-West says, increasingly, the virus is spreading through sexual transmission to the general population.
"What we are seeing is epidemiological trends pointing to [the] fact that bridging populations, such as sex workers, or partners of injecting drug users, or partners or clients of sex workers, are having an increasing role to play in terms of the transfer of [HIV] AIDS in the region," she said. "Other factors - poverty [for example] - fuels [the] drug trade, and fuels sex work in most cases, and that is running rampant, especially Central Asia and up into Russia and Ukraine and over to the West."
But governments across the region have been slow to react. Ms. Montgomery says one of the first steps is for leaders to confront the magnitude of the problem, and then apply the resources to match. Aside from money, Ms. Montgomery says, grass-roots involvement is also needed.
"Only people affected and infected can really shape the agenda, and really know where the interventions are needed, where assistance is needed," she said.
But she says widespread discrimination and stigma have prevented such action. Thus, those who are in need of treatment with anti-retroviral drugs, do not get it, even though Russian law assures free and universal access to the drugs, known as ARV.
"Unfortunately, those who are in greatest need are not receiving the medicines they need, mainly because they are injecting drug users, and because the state believes injecting drug users are untreatable, or lead chaotic lifestyles that would only help spread resistance to ARV," said Ms. Montgomery.
Ms. Montgomery says other forms of discrimination include having confidential test results communicated to employers and a general lack of confidentiality and consent, all of which she says push HIV/AIDS patients underground and further out of reach of critical care.
Experts say, if there is a bright spot in the region, it is Central Asia, where many agree HIV/AIDS treatment and prevention programs still have a chance to make a difference. Aids Foundation East-West launched an HIV/AIDS prevention project in March in Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan to train medical workers and others.
"We will work with NGOs [and], with medical workers," said Saltanat Sutayeva, the program manager for Kazakhstan, the richest of the five Central Asian Republics. "We will direct our activities on three target groups sex workers, IDUs [injecting drug users], and prisoners. In Kazakhstan, we will train more than 60 medical workers, also prison staff, more than 40 staff people and also representatives from non-governmental organizations.
It is the first such pilot-project of its kind in the region, and Ms. Sutayeva, and AIDS Foundation East-West hope that, after three years, it will serve as a prevention model for governments across the region.
People with HIV are also more susceptible to contracting tuberculosis, which is evolving into increasingly drug-resistant forms. Tuberculosis is the leading cause of death in Ukraine, and the World Health Organization lists six of the former Soviet republics among 10 of the world's "hot spots" for drug-resistant strains of TB.
Dr. Wieslaw Jakubowiak heads the World Health Organization's TB program in the Russia. He says, while TB is still a cause for concern, there are signs progress is being made.
"We have a continuous supply of anti-TB Drugs, which is the most important factor, because in the 90s, when we observed such a big increase in TB, we had no continuous supply of TB drugs," he said.
He also commends the Russian government, which he says spends more than $50 million each year on TB control, although, he says multi-drug resistant strains of TB remain a problem.
The World Health Organization says international assistance is available to treat and control both TB and the HIV/AIDS in the region, but much more needs to be done by local governments to ensure effective treatment and prevention.