The next plague: HIV/AIDS in Eastern Europe.

Stopping the spread of HIV/AIDS requires not only scientific awareness but also public awareness. More so than any other disease, HIV spreads because of misconception and lack of information; for instance, it is often dismissed as a threat to only sub-Saharan Africa and other parts of the undeveloped world. This false impression masks a distressing increase in the prevalence of HIV infection in Eastern Europe. The nations of this region are at a critical juncture, and widespread government-sponsored education about the disease is necessary to prevent it from becoming an unstoppable epidemic.

The 2006 Eastern Europe AIDS fact sheet--a joint effort of the United Nations and the World Health Organization--pins the number of people in Central Asia and Eastern Europe with the virus at 1.7 million. While this figure is not very large, it represents a twenty-fold regional increase in a span of less than 10 years--one of the fastest increases in infection rates in the world. Of these cases, 90 percent are located in Russia and Ukraine. To date, the health response has been inadequate; fewer than 24,000 people have the benefit of antiretroviral therapy. There is also a worrying shift in the form of HIV transmission. Two thirds of the region's HIV infections are the result of intravenous drug use. The disease, however, is starting to spread from injection drug users, who are relatively marginalized and usually male, to the general population. In Ukraine, as late as 2003, heterosexual intercourse accounted for 14 percent of new infections; that figure is now over 35 percent. As a result, 1.5 percent of the country's adults are now HIV positive.

The above statistics may not seem startling, especially when compared to figures from African countries. But what these conservative estimates fail to convey is that Eastern Europe is at a critical point of departure: the explosion of HIV may yet be contained by rapid action. Otherwise, HIV will likely have devastating economic and social effects and surge across the rest of Europe. According to Kalman Mizsei, UN Development Programme (UNDP) Assistant Administrator, "All experts concur that delays are disastrous when dealing with HIV/AIDS. Just as in some CIS countries today, only twelve years ago South Africa too saw less than 1 percent of its adult population infected; now that rate is 20 times higher." A small HIV rate can quickly explode into a pandemic. Eastern European governments must act quickly to prevent this from occurring.

Numerous solutions have been proposed, including increasing spending on antiretroviral therapy, initiating prison reform, and creating needle exchange programs for drug users. All of these measures are certainly worthwhile, but they are aimed at the isolated populations that already have HIV. The reality is that none of these measures will be 100 percent effective in stopping the spread of the disease. It is not enough to compartmentalize the problem; the general public needs information on the disease, awareness of its prevalence, and knowledge of prevention techniques.

There is one strategy that is currently underused in the region yet uniquely effective in reaching the general population--education. Indeed, the universal mass education systems and complete adult literacy rates already present in Eastern Europe will facilitate the implementation of this strategy. Education, especially at the secondary and college level, is vital for two reasons. First, education uniquely targets the younger members of society who account for the vast majority of new infections. In Russia, 80 percent of those infected are in the 15-30 age bracket, the most mobile and most sexually active segment of the population. Education oriented at adults may come too late. Research has shown that four percent of Moscow secondary-school students have injected drugs. Because many youth are at serious risk of contracting HIV, there is great and urgent need for education.

Second, it can dispel misconceptions about the disease and thus deter its spread. The tendency in Eastern Europe among politicians, health workers, and citizens alike is to dismiss HIV as a problem of moral decay in marginalized groups. But as the above statistics reveal, the HIV epidemic is spreading beyond prisoners, homosexuals, prostitutes, and hard drug users. Though concentrated in these demographics, stigma and denial serve only to accelerate the spread of infection through the general population. Misconceptions about the disease abound. One Russian ad campaign felt compelled to proclaim, "HIV is NOT transmitted through playing sports." This is a troubling indicator that far too many people lack basic knowledge about the disease.

Campaigns such as the Russian ad above, however, are not enough; people need not just slogans but also an understanding of how the disease spreads and how to stay safe. The content must include general information on the disease, encourage practices that lower the risk of contraction, and point to facilities for testing and counseling. According to the UNDP's HIV/AIDS report for the region, "Youth-friendly services that are conveniently located have been found to be especially effective." Such a campaign would require coordinating the efforts of several levels of government, local NGOs, and international organizations with experience in fighting HIV.

A mass education campaign will be expensive and difficult to execute, yet it makes sense even in the stark terms of cost-benefit analysis. Unchecked HIV will reduce the region's GDP over the next decade by four percent and will strain existing social welfare services. But Eastern Europe's governments should not have to undertake this task entirely on their own. Positive developments can be accelerated if international donors and politicians, particularly those in Europe, offer additional resources and inducements for effective anti-HIV education.

Most HIV efforts--such as research and distribution of drugs for treatment--look backward, aiming to limit the effects of the disease once it has been contracted. But an effective policy on HIV must look in both directions. Eastern European governments must look forward, and with effective education aimed at prevention, this future may be bright instead of gloomy.

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senior editor

MICHAEL JASKIW