Late for the Epidemic: HIV/AIDS in Eastern Europe

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Science  09 Jul 2010:
Vol. 329, Issue 5988, pp. 160-164
DOI: 10.1126/science.329.5988.160

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When the Iron Curtain fell in 1991, Eastern Europe and Central Asia were barely touched by HIV. Today, the Russian Federation and Ukraine alone have twice as many HIV-infected people as all of Western and Central Europe combined. This spring, Science traveled to both countries and met with public health officials, researchers, clinicians, nongovernmental organizations (NGOs), vulnerable groups, and infected people. The countries have responded to the epidemic differently in some key ways: Ukraine, for example, in December 2007 legalized methadone importation (see p. 165). But ultimately, they face many of the same challenges in both treatment and prevention, as they wrestle with antiquated health care systems from the Soviet era, patchy epidemiology, the increasing spread from IDUs to their sex partners, rampant tuberculosis, staggering infection rates in drug-using street youth (see p. 170), corruption, police brutality (see p. 169), isolation from the West, and weak and fractious research communities (see p. 173). Many on the frontlines of combating the epidemic in both countries stress that great strides have been made in preventing mother-to-child transmission and providing anti-HIV drugs for treatment. But they have become deeply frustrated by many other aspects of the response to their epidemics—particularly the limited help available for IDUs, who often are reviled. Next week, the 18th International AIDS Conference will be held in Vienna—"the gateway" to Eastern Europe—in an effort to create a momentum for change that is desperately needed.