Wake up call

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Health experts are warning that unless urgent action is taken, Eastern Europe and Central Asia will face an AIDS epidemic to equal that currently gripping Africa.

Why then, asks Kemal Ulker, do we hear so little about it?

Eastern Europe and Central Asia are experiencing one of the world’s fastest-growing HIV/AIDS epidemics. UNAIDS’ global report for 2006 puts the number of people infected with HIV in these areas at around 1.5 million in 2005. This means that in the space of just 10 years, prevalence in the region has increased 20-fold.

The report pinpoints Ukraine in particular, where it says the annual number of new HIV diagnoses keeps rising, and the Russian Federation, which has the biggest AIDS epidemic in Europe.

Kazakhstan, Tajikistan and Uzbekistan are all also experiencing epidemics according to the report, which highlights a steeply rising annual rate of infections in each of these countries.

The countries of South Eastern Europe are relatively less affected, but some are indicating vulnerability to new HIV outbreaks due to their levels of injecting drug use and sexual risk behaviour.

"Unprecedented numbers of young people are not finishing secondary school, and with jobs in short supply, many are at risk of joining the vulnerable groups of injecting drug users and sex workers"

This is not the first time the spotlight has pointed to Eastern Europe, whose growing prevalence has been monitored for a number of years now and where, as in most regions, transport workers have been identified as a particular risk group.

Two World Bank surveys in 2003, which explored the practice of casual sex among truck drivers and commercial sex workers in the border areas of Poland and Lithuania, demonstrate how big the threat is for truck drivers and their families and partners.

The surveys show that, just as in other regions, increased international trade and cross-border flows across countries in Eastern and Central Europe and the Baltics provide a channel for spreading HIV in a way that can escalate very quickly if timely action is not taken.

Neo-liberalism and HIV

Average life expectancy in the countries of the former Eastern Bloc and Soviet Union has plummeted as a result of social and economic changes following the end of communism and the opening up of markets.

Based on data from 27 countries in the region, a 2003 study in the medical journal The Lancet concluded: “The profound social and economic upheaval which took place in the former Soviet Union in the 1990s has resulted in a sharp increase in the incidence of substance abuse, prostitution, HIV, and other sexually transmitted infections.

“Rapidly declining socio-economic conditions and increasing inequity bring a sense of despair and hopelessness that is fertile ground for HIV transmission through inc-reased risk behaviour, including prostitution and drug use; a struggling economy means fewer resources for prevention and care.”

The World Bank report also confirms this: “Large-scale unemployment and economic insecurity, coupled with liberalisation of social and cultural norms, has made the region fertile for an HIV epidemic. Unprec-edented numbers of young people are not finishing secondary school, and with jobs in short supply, many are at a risk of joining the vulnerable groups of injecting drug users and regular or occasional sex workers.”

The growing HIV/AIDS crisis in this region has received relatively little public attention either at the international level or even within the countries concerned. It seems that HIV/AIDS has been thriving in the region amid a culture of silence and denial.

Early warnings ignored

In December 2000 when the total number of people living with HIV in Eastern Europe was 700,000, the World Health Organi-zation issued a message in the wake of alarming new data that pointed to an exploding HIV epidemic. It stated:

 “We have a unique chance to contain the epidemic through early, carefully targeted and well coordinated national action, strongly backed by international agencies. The present generation of children and young people in Eastern Europe is a generation in jeopardy. Africa once had 400, 000 HIV-infected people. It now has nearly four million. Our window of opportunity is not yet closed. We must act now.”

Sadly, in light of UNAIDS’ latest figures, it would appear that the warning has fallen on deaf ears.

A critical and fundamental challenge for government structures, society and transport unions in this region is now to find ways to overcome the syndrome of denial, which encourages vulnerable groups such as transport workers to continue their behaviours in ignorance of the dangers involved.

Trade unions in the region have many other problems to contend with and are generally disinclined to prioritise HIV/AIDS, which is still often perceived as a problem only for drug users. This has proved a challenge for the International Labour Organi-zation, which has prevention and support projects ongoing in the region, mainly in Russia and Ukraine.

It is clear that the epidemic has now found additional momentum among sex workers and their clients, and transport workers are a substantial subset of these clients. It is less clear whether transport unions in the region are intensifying their HIV and AIDS work in response.

Cristina Tilling of the ITF’s European region, the ETF, explains: “These unions have been confronted in the last decade and a half with an accelerated reform of their sector and therefore their efforts and resources have been focused on fighting for jobs and working conditions in a fully liberalised transport sector.”

However, they may soon find themselves compelled by their members to step up their responses, as Tilling acknowledges: “The spread of disease may present an even greater risk as Europe develops long-distance transport corridors and where enlargement fosters transport without borders in an enlarged European Union.”

Survey findings

The World Bank surveys were conducted at four border crossings in Poland and at a work station in Vilnius in Lithuania. In the course of the surveys, 901 truck drivers were sequentially selected at the waiting lines, and interviews were conducted by trained interviewers.  

The Poland survey, by far the bigger and more detailed, showed that the strong link established in other regions between long absences from home and high risk behaviour applies also in this part of the world.

Virtually all the truckers questioned travelled abroad regularly – 72.8 per cent at least two or three times a month – and 80 per cent reported spending four months or more per year away from home. In the last month, over a quarter of the sample had spent 15 to 21 days away from home. Over 95 per cent reported spending their nights at parking places while on the road.

Of the 42.3 per cent of drivers who admitted engaging in casual sex while travelling, 18.4 stated that they never used condoms, while 15 per cent claimed to use condoms sometimes. Almost 62 per cent of all those surveyed reported that they never used condoms at home.

A clear majority of the respondents (72 per cent) did not feel that they were in any danger of contracting HIV/AIDS. Only 16 per cent of all respondents felt they were at risk, the remaining 12 per cent being uncertain.

Along with the International Road Transport Union, the ETF is at the forefront of campaigning for a European Union policy on safe and decent rest places for drivers, which they hope will help stem the rate of infection among drivers across Europe.

The ETF is keen to progress the debate on HIV/AIDS with European trade unions, not only to foster recognition of the scale of the problem, in Central and Eastern Europe in particular, but also to ensure it is given proper context.

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