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HIV/AIDS: Eastern Europe

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Science  09 Jul 2010:
Vol. 329, Issue 5988, pp. 159
DOI: 10.1126/science.329.5988.159

“Why is AIDS almost nonexistent in the Soviet Union?” asked a 1991 news story in Science, headlined the “Russian AIDS Puzzle.” The story (13 September 1991, p. 1214) offered no good explanation for why the epidemic, then a decade old, had spared Eastern Europe and Central Asia but speculated that the dissolution of the Soviet Union might pave the way for HIV. It did. Today, the region is home to an estimated 1.5 million HIV-infected people, and the rate of spread remains dauntingly high.

From 18 to 23 July 2010, more than 20,000 HIV/AIDS researchers will gather in Vienna, Austria—the “gateway” to Eastern Europe—for the 18th International AIDS Conference to try to bridge the gap between scientists and policymakers in East and West. In this issue, Science looks closely at the factors that in the mid-1990s led to the rapid spread of HIV in Russia and Ukraine, which account for more than 90% of the infections in the region.

With a travel grant from the Open Society Institute's Public Health Program, correspondent Jon Cohen and photographer Malcolm Linton visited researchers, clinicians, advocates, and affected communities in both countries. The package of stories that begins on p. 160 examines how public health officials, health-care workers, researchers, and members of civil society in different regions have responded to the epidemic, as well as the criticisms that the governments have done too little to slow the spread of the virus. The central dilemma is that HIV in the region has been mainly transmitted by injecting drug users sharing needles, and the “harm reduction” strategies successfully used in Western Europe and elsewhere, such as needle exchange or opiate-substitution treatment, have not taken root in the more conservative climate of the East. Critics charge that stigma and discrimination against drug users by government officials, law enforcement, and the medical community have fueled the problem. A slideshow published online further captures some of the challenges in the region and how they are being addressed. Building a strong response to HIV/AIDS takes several years in almost every country. But Russia, Ukraine, and their neighbors have an advantage: They can learn from the many other countries that began confronting the virus more than a decade before it hit Eastern Europe.

The News package is followed by Policy Forums and original research about the field's most pressing topics, which will take center stage at the upcoming conference. Girard and colleagues (p. 147) advocate for the importance of a renewed commitment to universal access to prevention, treatment, and care. Jewkes (p. 145) discusses the continuing contribution of gender inequities to the prevalence of HIV/AIDS in women, especially in South Africa. A Review by Trono et al. (p. 174) focuses on the latent viral reservoir that persists in HIV-infected people, describing the underlying biology and potential interventions that may lead to a cure. A report by Wu et al. (Science Express) describes a trio of new broadly neutralizing antibodies isolated from an HIV-infected person that attach to the CD4 binding site of the virus and can potently neutralize a broad range of viral strains.

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