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«CONTENTS Summary HIV/AIDS OTHER INFECTIOUS DISEASES INJECTION DRUG USE LAW AND LAW ENFORCEMENT PRACTICES PUBLIC HEALTH INTERVENTIONS ECONOMIC AND ...»

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DRUG POLICY AND HEALTH IN KAZAKHSTAN

A Profile Prepared by the Drug Law and Health Policy Resource Network

24 January 2002

CONTENTS

Summary

HIV/AIDS

OTHER INFECTIOUS DISEASES

INJECTION DRUG USE

LAW AND LAW ENFORCEMENT PRACTICES

PUBLIC HEALTH INTERVENTIONS

ECONOMIC AND SOCIAL INDICATORS

Full Report

INTRODUCTION

HIV/AIDS

OTHER INFECTIOUS DISEASES

INJECTION DRUG USE

LAWS AND LAW ENFORCEMENT PRACTICES

PUBLIC HEALTH INTERVENTIONS

SOCIOPOLITICAL ENVIRONMENT

RESOURCES

REFERENCES

Kazakhstan – 24 January 2002 - 1 Summary I. HIV/AIDS Although data are incomplete, Kazakhstan is apparently experiencing a dramatic but locally concentrated increase in HIV cases, with the majority attributable directly or indirectly to injection drug use. The epicenter of the epidemic is the town of Temirtau, Karaganda Oblast.

AIDS Cases By Mode of Transmission, 1994-1999 8% 16% Hetero 12% 1% Homo/Bi IDU Perinatal Other 60% Source: http://www.unaids.org/hivaidsinfo/statistics/fact_sheets/pdfs/Kazakhstan_en.pdf New HIV Infections per Million Population 30 25 20 15 10 5 0 1993 1994 1995 1996 1997 1998 Source: The European Center for the Epidemiological Monitoring of AIDS (11) Misinformation and stigma concerning HIV are reportedly high. One source reports that suicide is a significant cause of death among people with HIV/AIDS. (6) Kazakhstan – 24 January 2002 - 2

II. OTHER INFECTIOUS DISEASES

Cases per 100,000 Population 300 250 200 Syphilis 150 TB 100 50 0 90 92 94 96 98 19 19 19 19

–  –  –

Trend data on Hepatitis are not available, but eighty-five percent of all drug users in the Karaganda Oblast are estimated to be infected with Hepatitis C. (9)

III. INJECTION DRUG USE

Drug Use. Drug use is increasing, particularly among women. A study commissioned by the United Nations Office of Drug Control and Crime Prevention (UNODCCP) estimated that at least 170,000 Kazakhs regularly use drugs, with two thirds using opium or heroin. The majority of the users are young people under 35. One of the main drivers of the increase has been the permeability of borders and the country’s proximity to Afghanistan, the regions largest drug producer. (6) The effect on supply of the U.S. war with Afghanistan is not yet known, though UNODCCP reports substantial increases in exports from Afghanistan since September 11, 2001. (1) Risk Behavior Information. A rapid assessment by UNAIDS in 1998 was conducted in the country’s two largest cities, Almaty and Shymkent. It found that 80% of both male and female IDUs shared syringes or solutions. A significant proportion of IDU women earned the money for purchasing drugs by prostitution. (6) There have also been reports of the practice of adding blood to drugs during preparation. Drug overdose appears to be a significant problem, with as many as 4,000 annual cases. (9) Social Attitudes. Social attitudes towards drug use and drug users are reportedly negative, with widespread support for repressive measures. At the same time, the population is resigned to people’s use of alcohol and illicit drugs to relieve pain and suffering and as a mechanism for coping. (9)

Kazakhstan – 24 January 2002 - 3IV. LAW AND LAW ENFORCEMENT PRACTICES

Drug use is treated as a criminal matter. Users are subject to arrest, compulsory detoxification and imprisonment. Though access to syringes is not legally prohibited, a climate of fear may discourage IDUs from obtaining syringes, HIV education or other forms of assistance to reduce the spread of disease and other harms of drug use.

Information on the state of the criminal justice system is not available.

–  –  –

V. PUBLIC HEALTH INTERVENTIONS

Harm Reduction Programs Generally. The government takes no position on and provides no funding for harm reduction programs. Drug use and HIV initiatives depend upon the international donor community, primarily UNAIDS and the Open Society Institute. Harm reduction programs in the region reach about 5% of drug users. A project covering 18 prisons includes needle exchange and distribution of condoms. (9) Drug Treatment. Drug treatment other than detoxification is expensive and difficult to obtain. There is no organization consisting of and led by drug users. Most of the government’s HIV/AIDS funding is devoted to testing. There has been no significant government effort to prevent the spread of HIV among IDUs.

VI. ECONOMIC AND SOCIAL INDICATORS

The Transparency Corruption Perceptions Index (CPI) ranks countries in terms of the degree to which corruption is perceived to exist among public officials and

–  –  –





The Human Development Index value is a composite index measuring average achievement in three basic dimensions of human development-a long and healthy life, knowledge and a decent standard of living. In 1999 Kazakhstan ranked 76 of the 174 countries measured.

The GINI index measures the extent to which the distribution of income (or in some cases consumption expenditures) among individuals or households within an economy deviates from a perfectly equal distribution. The GINI index of zero equals perfect equality, while and index of 100 implies perfect inequality. The GINI index for the most recent reported year for Kazakhstan was 35.4 in 1996.

Unemployment refers to the share of the labor force without work but available for and seeking employment. Definitions of labor force and unemployment differ by country. Kazakhstan’s unemployment rate saw a sharp rise from 1996 at 4.1% to 13.7% in 1998.

The Gross Domestic Product (GDP) is the total of all economic activity in one country, regardless of who owns the productive assets. There has been a precipitous decline in GDP in Kazakhstan during the past decade. In 1990 the GDP was $40,304 Million (US) and in 1999 it declined to $15,842. The average annual growth of the economy from 1990 to 1999 was –5.9%.

–  –  –

I. INTRODUCTION The Drug Law and Health Policy Resource Network is an international research collaboration designed to improve data collection and policy analysis on drug policy and health in the countries of Eastern Europe and the Former Soviet Union. The information in this report was gathered by staff at Temple University’s Beasley School of Law and the University of Connecticut Health Sciences Center. It will be augmented by further research in 2002 by network collaborators in the study region.

This Report presents available information in six domains: HIV/AIDS, other infectious diseases, injection drug use, law and law enforcement practices, public health interventions, and economic and social indicators. It concludes that Kazakhstan is in the early stages of a serious HIV epidemic driven primarily by injection drug use. With sufficient external support and dramatic internal changes in drug policy and law enforcement practice, a public health effort against HIV and other blood-borne diseases could be successful.

II. HIV/AIDS

Accurate and complete data on HIV in Kazakhstan are not available. The data presented here are from a variety of sources and may not entirely agree. These data generally do not represent HIV incidence, and depend heavily upon patterns of HIV testing and reporting that remain very incomplete in the most severely affected countries.

HIV infection is defined as an individual with HIV infection confirmed by a laboratory according to country definitions and requirements. AIDS cases are reported according to a uniform AIDS case definition originally published in 1982 and revised in 1985, 1987 and for adults and adolescents (age 13) in 1993. The 1993 European AIDS surveillance case definition differs from that used in the United States in that it does not include CD4 lymphocyte criteria.

Overall Data. The government reported 1,403 new cases of AIDS between January 2000 and February 2001, (5) with an estimated 2500 - 4500 adults and children living with HIV/AIDS at the end of 1999. (8) The actual numbers of cases is believed to be ten times higher (6) Of 815 reported cases of HIV/AIDS in 1998, 86% were injection drug users (IDU’s) (8). Eighty percent of registered people with HIV are males. (6)

–  –  –

Regional Distribution. The epidemic is not evenly spread across the country.

The majority of reported case have occurred in Temirtau, a factory town of 150,000 with 3,000 IDU’s (6) The number of HIV-positive individuals in northern Kazakhstan's Pavlodar Region has increased 200 % since the beginning of 2001. Half of Pavlodar's 364 infected residents are IDUs. Three thousand of the region's 300,000 residents use drugs.

Based upon estimations that the region's number of HIV positive individuals may reach 1400 in 2002, the center of AIDS Prevention is planning to open a medical center focused on treating drug problems. (17) During the first six months of 2001, a total of 31 HIV positive people were reported in Kazakhstan's Aktyubinsk region, with 3 additional infected individuals identified in August. All of these 34 individuals are IDUs. (18)

Stigma and Social Attitudes towards HIV/AIDS. One investigator reported:

“More than 90 % of the young population of the country (UNAIDS, 1999) are informed about existence of the STIs, mainly syphilis and gonorrhea. In the opinion of 95 % of the respondents, unprotected sex (without a condom) results in a high risk of the STI infection. It is of special importance that half of the surveyed students believe that the risk also exists in sharing plates and glasses, towels and the toilet with an STI-infected person. Thus, the erroneous opinion that the STIs are transferred not only through sexual contact is widely spread. As a matter of fact, girls are more susceptible to this error and are afraid of imaginary dangers more than young men. The consequence of such delusions is that, as compared with men, only 41 % of the surveyed women would agree to look after an HIV-infected relative at home, while among the men the corresponding figure is 64 %. The high level of stigmatization of the HIV-infected and their relatives is reflected in actual cases. In Pavlodar, a mother of a convicted HIV-infected woman could not find people to look after her child even for pay. Suicide has become the leading mortality cause among the HIV-infected people.” (6)

Kazakhstan – 24 January 2002 - 7III. OTHER INFECTIOUS DISEASES

The spread of HIV is related in important ways to the incidence of other infectious diseases. Unsterile injection drug use is a risk factor not only for HIV, but also Hepatitis. Incarceration in many countries in this region is a risk factor for tuberculosis.

Sexually transmitted diseases may increase the likelihood of HIV transmission during sex.

Kazakhstan appears to be in the midst of seriously growing epidemics of TB and syphilis.

–  –  –

1993 - - 12 - - Ninety percent of HIV infected individuals and 85% of all drug users in the Karaganda Oblast are infected with Hepatitis C. (9) Incarceration appears to be an important source of TB.

IV. INJECTION DRUG USE

This section reports available information about drug use levels, trends and risk behaviors, as well as social attitudes about drug use and information about the problem of Kazakhstan – 24 January 2002 - 8 drug overdose. Drug treatment and other interventions to reduce the morbidity and mortality of drug use are discussed in section V, below. Data about drug use come primarily from unofficial sources, including more or less rigorous rapid assessments, consultant reports and the news media.

Drug use is increasing, particularly among women. A study commissioned by the UN OODCP estimated that at least 170,000 Kazakhs regularly use drugs, with two thirds using opium or heroin.

Trends in Drug Use. There has been an overall increase in drug use. Injection drug use is approximately five times higher in men than in women, although in women it is increasing faster. (6) The majority of drug users are age 35 and under. Marijuana and heroin are the most often abused substances. The drug of choice in the north is opium, in the south heroin, and cannabis in the Chui Valley. Many users are switching from smoking to injecting, primarily because it is illegal to possess, but not use, drugs. Use of synthetic drugs (e.g., Ecstasy) along with LSD and ephedrine is on the rise especially in nightclubs. Youths are also inhaling “Tolol,” a toxic chemical similar to glue sniffing but more dangerous. (1) (6) (9) Risk Behavior. IDUs in Kazakhstan are engaging in high-risk injection behavior, for reasons including lack of basic information about the disease threat. A 2000 paper for

the UN reported:

The express analysis of the situation (UNAIDS, 1998) in the two largest cities of Kazakhstan -- Almaty and Shymkent -- has shown that among injection drug

users (IDUs) the behavior connected with the HIV infection risk is widely spread:



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