Social Problems in Eastern Europe Resulting in Injection Drug Use, Rise in STDs Factors in Region’s AIDS Epidemic, Lancet Review Says

Social and economic upheaval in Eastern Europe and countries of the former Soviet Union has resulted in an increase in injection drug use, prostitution and unprotected sexual activity, all factors that place the region "on the verge of a major sexual epidemic of HIV," according to a review in the March 22 issue of the Lancet, BBC News reports (BBC News, 3/21). Francoise Hamers and Angela Downs of EuroHIV examined World Health Organization and UNAIDS data, unpublished regional and national HIV/AIDS surveillance reports and literature and journal articles about 27 countries in the region to determine the differences between the spread of the epidemic in Eastern and Central Europe. The researchers compared HIV/AIDS rates in the "Eastern Region," including Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Republic of Moldova, Russian Federation, Tajikistan, Turkmenistan, Ukraine and Uzbekistan, and the "Center Region," including Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Hungary, Former Yugoslav Republic of Macedonia, Poland, Romania, Slovakia, Slovenia and Yugoslavia. The study found that in Central Europe, the HIV epidemic, which began in the late 1980s, has remained at "low levels ... and do[es] not seem to be expanding." In contrast, the researchers found that there are an estimated one million HIV-positive people in the Eastern Region as of 2001, compared with only 30,000 cases at the start of 1995, when the first cases were reported.

Injection Drug Use Primary HIV Transmission Mode
The primary mode of transmission in this region is injection drug use. Although little data exist on the behavior of drug users, needle sharing and unprotected sexual activity "appea[r] to be widespread" and "HIV prevention is rarely a priority," according to the study. There has also been a recent increase in the number of reported cases of heterosexually transmitted HIV. Risk factors such as sex work; social repression of homosexual behavior; high rates of sexually transmitted diseases, including syphilis; and risky sexual behavior could contribute to the spread of the disease in the region. The rate of the expansion of the heterosexual epidemic "will depend essentially on the size of so-called bridge population groups that link high-risk groups (in this case, injecting drug users) with the general population," the researchers write. "Improved measures to prevent further HIV spread are urgently needed," including measures that "create the social, legal and ethical environment that is conducive to HIV prevention, care and support," for "key population subgroups," the authors conclude (Hamers/Downs, Lancet, 3/22).

Half of European HIV Cases Heterosexually Transmitted
Researchers from Isis Research, a health care market research agency, on Wednesday said that the percentage of HIV cases in Europe resulting from heterosexual contact has risen from 28% in 1992 to 51% in 2002, Reuters Health reports. The agency reviewed data on 3,000 European HIV patients who were on antiretroviral therapy from July 2002 to October 2002 and found that 308 had been newly diagnosed with HIV earlier that year. In addition, the number of HIV/AIDS cases among women is "quickly catching up with [the number among] men," according to Reuters Health. Amanda Zeffman, HIV analyst for Isis, said that many European heterosexuals do not recognize a significant risk, adding, "Whilst a return to the shock awareness campaigns of the early '90s may not be welcomed, it is clear that there is a great need for a new awareness campaign if the spread of the infection via this route is to be minimized in the coming years" (Woodman, Reuters Health, 3/19).