In 2005 UNAIDS reported that Uzbekistan had more than 5,600 officially recognised HIV cases (pdf). It said:

“Among the Central Asian republics, Uzbekistan is experiencing the most dynamic epidemic. In 1999, just 28 HIV diagnoses were reported there; last year there were 2016 new HIV infections, bringing to more than 5600 the total number of HIV cases (EuroHIV, 2005). Injecting drug use is the driving force in this epidemic, which has its epicentre in the capital Tashkent and surrounding districts. Fuelling the epidemic is an overlap between injecting drug use and commercial sex. HIV prevalence of 10% was found among female sex workers in Tashkent in a recent study, and among women who traded drugs for sex, 28% were HIV-infected (Todd et al., 2005).”

The conclusions reached by UNAIDS are presaged by two reports from 2003: one from the International Aids Society (pdf), one from the Lancet (pdf). In both reports, which cover the area of the former Soviet Union, drug use and the sex industry were identified as key vectors in the transmission of HIV/AIDS, with particular local factors, e.g. heroin smuggling from Afghanistan and illegal traffic in sex workers, playing a key role. The International Aids Society said:

“In conclusion, the recent rapid increase in new HIV infections in central Asia is alarming. As the epidemic is very recent, with most new infections occurring among vulnerable groups including IDU and sex workers, prevention efforts should target these groups and aim to achieve high coverage. Such a strategy supported by prevention efforts for young people have the potential to avoid a much larger epidemic in this region.”

On drug use, the authors of the Lancet report said:

“The spread of HIV in the East region is closely linked with a rise in injecting drug use that developed after the collapse of the Soviet Union during the 1990s in the midst of a severe socioeconomic crisis and at the time when Afghanistan became the world’s largest opium producer. This increase in opium production was paralleled by a diversification of trafficking routes through Central Asia and eastern Europe, an increase in overall trafficking of heroin from Afghanistan and surrounding countries to Europe, and a considerable rise in drug consumption. The extent of drug use is hard to assess because of the illicit nature of drug use and the hidden nature of target populations, but all available indicators suggest that abuse continues to rise rapidly. Even fewer data are available on behaviours of drug users, but sharing of injecting materials appears to be widespread, sexual promiscuity is common, and HIV prevention is rarely a priority.”

This makes pretty grim reading. The actual number of reported cases (my italics) in Uzbekistan is quite low, but the rate of infection is alarming. It’s also difficult to tell whether all those most at risk (intravenous drug users, sex workers) are being tested - it seems unlikely. Indeed, UNAIDS itself reckons that the actual number or cases may be five to six times higher that the officially reported figure of 5,612.

Clearly, the Uzbek government has work to do, but effective action against the threat of HIV/AIDS extends beyond the realm of health education and medical treatment, and touches upon the pernicious nature of drugs smuggling and the sex industry.