SHYMKENT, 6 March (IRIN) - As the trial continues in Kazakhstan of former health sector staff accused of infecting scores of toddlers with HIV, there are signs that the government is tackling the fight against HIV/AIDS with renewed vigour. Its challenges include rooting out corruption in the healthcare system and combating the stigma against people living with HIV in this Central Asian state.

The crisis that saw 94 children infected with HIV during medical treatment in the southern city of Shymkent has forced the government to take the fight against the disease seriously, said Dr Alexander Kossukhin, Kazakhstan's United Nations AIDS country officer.

"Now Kazakhstan has become very committed, and I think it has happened largely due to the outbreak in Shymkent," he told IRIN after an HIV/AIDS symposium in Shymkent on 1 March.

A city court is currently trying 21 former senior doctors and public health officials. They are accused of negligence and corruption, which led to the infection of the children, eight of whom have died. Thirteen mothers were also infected after receiving blood transfusions in Shymkent. The accused deny the charges.

An investigation into the HIV outbreak among the children uncovered serious irregularities in the blood donor system. Prosecutors allege that medical staff traded in blood for profit. Bribery was reportedly rife and disposable syringes were re-used to cover up alleged theft.

Corruption

Isidora Yerasilova, former head of the National AIDS Centre and whose contract was not renewed after the Shymkent scandal, agrees that corruption is endemic within the medical system, but points to low salaries as the cause. Some junior doctors in Kazakhstan earn little more than US $100 per month while auxiliary staff earn about $50 per month.

"A lot of people extort money," she said. "Of course it's a crime, but the one thing generates the other."

The outbreak led to the firing of the health minister and regional governor, and the government began sweeping inspections of medical institutions nationwide in addition to tests for health workers. They revealed shortcomings across the board in the healthcare system and led to large-scale sackings of doctors. Thousands of medical staff are to receive refresher training.

Deputy health minister Anatoliy Belonog acknowledged in February that there were still widespread infringements in the blood donor system.

Strict rules are now in force at the Regional Children's Hospital, one of the major sources of the HIV outbreak in Shymkent. "Blood transfusion is now strictly by the book, "said deputy chief physician Anzhelika Pak.

National strategy

In December, the government adopted a national strategy on HIV/AIDS to 2010. The goals include the government paying a greater share of the costs of combating HIV/AIDS – it will take on 30 per cent of the costs against five per cent previously, rising to 50 per cent in 2008.

Kossukhin of UNAIDS said there are two crucial issues that need to be addressed. "The first issue is prevention, the second is providing proper treatment and support to people living with HIV," he said.

Twenty-six of the children infected in Shymkent hospitals are receiving antiretroviral drugs, but many HIV positive people in Kazakhstan do not have access to the therapy; UNAIDS figures say just 15 per cent of those living with HIV receive antiretroviral drugs in Kazakhstan.

Knowing the precise number of people living with HIV/AIDS could help Kazakhstan and other Central Asian states tackle the HIV/AIDS issue, said Tilek Meimanaliev, director of the Central Asia AIDS Project (CAAP). The project has US $27m million-worth of funding from the World Bank and UK Department for International Development to combat HIV/AIDS in Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan.

According to registered figures, AIDS cases in Kazakhstan rose 30 percent year-on-year to total 131 at the end of 2006, while in 2006 the total number of HIV positive people grew by 80 percent year-on-year to total 1,741. Intravenous drug injection is currently the main driving force of infection, UNAIDS said.

Stigma

Those working to respond to HIV/AIDS agree that sufferers are stigmatised by society.

"Most people think HIV infection happens somewhere else, to third-class people, that this would never happen to them, that prostitutes, homosexuals and drug addicts get it and that they deserve it," said Tatyana Rodina, director of I Believe, an AIDS prevention NGO in Shymkent.

Asked by IRIN to identify how HIV is transmitted, students at the Kazakhstan Institute of Management, Economics and Strategic Research (KIMEP) in the commercial capital, Almaty, made reference to drug users and commercial sex workers.

The more stigma risk groups suffer, the harder it is to reach them, said Rodina. "The men who have sex with men [category] is dangerous simply because the mentality of our region – a southern region – makes it a very closed group... They are ostracised."

Outside big cities and in more conservative regions such as southern Kazakhstan, the problem is more pronounced, said Kossukhin. "In southern Kazakhstan [stigma] is rather serious. Unfortunately, the general public cannot understand that it is not dangerous to communicate with people living with HIV."

As part of public awareness-raising efforts, CAAP works with Muslim leaders in Central Asia, whom Meimanaliev described as "proactive" in the fight against AIDS. The organisation plans to hold an inter-faith conference this year to bring other religious leaders on board.

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