Two news articles on increased HIV in Central Asia this week: first, in Tajikistan, IWPR writes that HIV treatment and incidence is not well known by medical practitioners in Central Asia. HIV treatment was made available for the first time ever in Tajikistan last year. In the meantime, many patients have already died from the ravages of the disease.
Today, RFE/RL reports from Kyrgyzstan that another nine cases of HIV transmitted by medical professionals to patients has been discovered, bringing the total up to 22 patients. Seventeen of these are children, and at least ten of them are under two years old. The news articles are about higher incidence of HIV infection, much of it transmitted from medical professionals to patients.
To this we can add the cases in Kazakhstan in the Shymkent area, where approximately 132 children and 16 adults have been infected with the deadly virus and several have already died.
And perhaps the most fearful and disastrous, we don't have much news from Turkmenistan and Uzbekistan to go on about incidence of the disease inside these states.
The challenge of public health:
First of all, these cases echo similar events in Europe and the U.S. twenty years ago before principles of medical practice changed in these “first-world” countries. And there were many barriers to fixing the structure of medical practice and getting the information out to the public. The challenge of public health through the ages has always been to find the sources and vectors of a disease and then get that information out; to challenge old structures of medical practice, from getting doctors to wash their hands (Semmelweis) to screening blood for HIV virus. The larger challenge continues on the front of intangible goods: confronting the moral hesitance of society at large to deal with societal issues that are unspoken or less-spoken, and calming the panic that surrounds epidemics without inducing lethargy.
Returning to Central Asia:
So this is also the challenge for Central Asia, with HIV. And there is no aspect of this fight that cannot be identified with by people in other states, even those further along in their understanding and treatment of HIV/AIDS:
1. Getting information to medical practitioners about how they do or do not get the disease.
2. Getting absolute medical rituals in place, such as clean/unused needles and surgical equipment, the use of gloves and glasses when working with the possibility of blood.
3. Funding the practice of these rituals through a. education and b. supplying the tools needed to make those rituals occur. This requires less corruption and more transparency.
4. Inspecting clinics and testing clinicians for adequate equipment and evidence of its use 100% of the time.
5. Getting the word out to the public on the importance of these medical rituals, and safe and unsafe practices in their own lives.
6. Getting word out to the public on how the disease spreads, so that people do not shun HIV+ persons but are careful in specific situations, i.e., injuries, medical settings, and other exchanges.
All of these challenges are made more difficult by a lack of infrastructure in these states, particularly in outlying areas; by the ingrained acceptance of authority by the people (hard to argue with a doctor, isn't it?) and by a lack of free press.
We need to work on this one. We need to work on this one awfully soon.
Talk to us:
I hope those out there fighting the good fight will share their knowledge with us and the help that they need. Anything you leave in comments I will research, expand upon, and post anew. I promise you.
Further Reading on Global Public Health:
RFE/RL: WHO warns about global epidemics
RFE/RL: Tatarstan HIV clinic on the vanguard
May 2006, interview with the head of UNAIDS on CIS countries
FPA Central Asia on Medical/Institutional Failure & HIV
Great Reading on Public Health: anything by Laurie Garrett. The Coming Plague is a great start on understanding many contemporary public health issues.
Here are two articles by Ms. Garrett:
The Challenge of Global (Public) Health (on giving health care providers the ability to work no matter what disease comes forward)
The Next Pandemic? (on H5N1 virus)
About HIV in the “First World”: The Band Played On by Randy Shilts. There is a review of the work at Wikipedia.
