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South Kazakhstan Outbreak Led to Anti-HIV ProgramsDardane Arifaj, who has provided technical assistance to the health sectors of Kazakhstan and other countries, speaks at UCLA on the Shymkent HIV outbreak of 2006. (Photo by Margaretta Soehendro)

South Kazakhstan Outbreak Led to Anti-HIV Programs

The Shymkent outbreak of 2006 affected more than 130 children but also energized Kazakh officials to implement programs for HIV/AIDS prevention and treatment.

By Margaretta Soehendro
Staff Writer

They are pouring millions in South Kazakhstan Oblast [province] because it has become such a big political issue.

IN FEBRUARY 2006, the southern Kazakh city of Shymkent experienced a sudden outbreak of HIV among children under the age of three. More than 130 children had contracted the virus, which causes AIDS, through tainted blood transfusions while hospitalized for other ailments.

"Getting blood transfusions is part of the old belief that the blood transfusion may boost immunity and clean the organism," said Dardane Arifaj, who worked in Kazakhstan to evaluate the national response to the Shymkent outbreak. Arifaj has provided technical support in the health sectors of developing countries for the World Health Organization and UNICEF. She discussed the Shymkent outbreak on Oct. 16, 2008, at a talk sponsored by the UCLA Center for European and Eurasian Studies.

Kazakh officials initially assumed that the cause of the children's infections was mother-to-child transmission and were unwilling to accept other explanations, according to Arifaj. Later, the numbers of cases continued to rise and tests showed the parents were HIV-negative.

Further investigation revealed that underfunded hospitals had exacerbated the problem of tainted blood by using the same blood dosage for multiple children, reusing syringes and even failing to sterilize them properly, and performing unnecessary blood transfusions. When the healthcare system was removed from state control, unscrupulous doctors began making up for lost income from the government by prescribing the unnecessary transfusions, according to Arifaj.

The nosocomial outbreak in South Kazakhstan province was no isolated incident, however. Lying behind it was a rapidly spreading disease driven by a slew of risk factors, but principally intravenous drug use (IDU) and unsafe needle-sharing. IDU accounts for 80 percent of new HIV infections in Kazakhstan, which sits on a crossroads of the drug trade between Afghanistan and Russia, Arifaj said. The spread of AIDS in Central Asia also owes to poverty and unemployment, the dismantling of state-supported health systems after the fall of the Soviet Union, low rates of condom use, and stigma associated with the disease. In 2006, medical services were unprepared to screen blood for HIV, and medical staff still had little experience in diagnosing and treating the disease.

"Until now, in central Asia you would get paid if you donate blood, and that was basically an incentive for poor people and drug users who were desperate [for] money," Arifaj said.

Although it took time to respond to the outbreak, the Kazakh government eventually invited international organizations to help and also held a number of its own officials accountable. The discovery that children had been infected while under medical care led to the resignation or dismissal of officials as high as the minister of health. Twenty-one people were found guilty for crimes connected to the outbreak, with 17 receiving jail sentences.

Included in the international support was psychosocial assistance for the affected children and families. Out of fear and ignorance, some parents had abandoned HIV-infected children, and neighbors isolated neighbors.

Medical staff began to receive training on how to prevent and treat the disease and how to counsel those affected by it. Meanwhile, journalists were educated on writing about HIV/AIDS issues with sensitivity. When the Shymkent outbreak occurred, newspapers published the names of families with infected children, causing a panic.

The government also amended its national blood safety legislation and built an infrastructure to fight HIV/AIDS that includes nongovernmental organizations. Under a five-year national program, a semi-autonomous group called Republican AIDS Center sets standards and connects with provincial HIV centers.

"This unfortunate event has energized the government officials to really tackle this issue more seriously," Arifaj said.

Given the huge oil discoveries in the country, Kazakhstan has no difficulty funding national HIV/AIDS programs and localized ones for Shymkent and South Kazakhstan province alike.

"They are pouring millions in South Kazakhstan Oblast because it has become such a big political issue," Arifaj said.

If anything, the government may have overreached in addressing the outbreak, by setting aside a new Shymkent hospital entirely for HIV-infected children, with 60 beds and 164 permanent staff members.

The hospital "'is underutilized, but who cares?' That's the answer you got from government officials," Arifaj said. "'It's there because we needed to do something. We feel guilty that we didn't protect these children, and we don't care about the efficiency.'"

Center for European and Eurasian Studies