By Sam Vaknin
Author of "Malignant Self Love - Narcissism Revisited"

(continued from part I: http://www.newsback.com/forums/showcontent.php?t=142 )

Even relative prosperity and good governance can no longer stem the tide. Estonia's infection rate is 50 percent higher than Russia's, even if the AIDS cesspool that is the exclave of Kaliningrad is included in the statistics. Latvia is not far behind. One of every seven prisoners in Lithuania has fallen prey to the virus. All three countries acceded to the European Union in May 2004. Pursuant to an agreement signed recently between Russia and the EU, Kaliningrad's denizens will travel to all European destinations unencumbered by a visa regime.

Very little is done to confront the looming plague. One third of young women in Azerbaijan and Uzbekistan never heard of AIDS. Over-crowded prisons provide no clean needles or condoms to their inmates. There are no early warning "sentinel" programs anywhere. Needle exchanges are unheard of. UNICEF warns, in its report titled "Social Monitor 2002", that HIV/AIDS imperils both future generations and the social order.

The political class is unmoved. President Vladimir Putin never as much as mentions AIDS in his litany of speeches. Even Macedonia's western-minded and western-propped late president, Boris Trajkovski, dealt with the subject for the first time in December 2002. Belarus did not bother to apply to the United Nation's Global Fund to Fight AIDS, Tuberculosis, and Malaria or to draw approved resources from the World Bank's anti-TB/HIV/AIDS project.

In many backward, tribal countries - especially in the Balkans and in central Asia - the subjects of procreation, let alone contraception, are taboo. Vehicles belonging to Medecins du Monde, a French NGO running a pioneer needle exchange program in Russia, were torched. The Orthodox Church has strongly objected to cinema ads promoting safer sex. Sexual education is rare.

Even when education is on offer - like last year's media campaign in Ukraine - it rarely mitigates or alters high-risk conduct. According to Radio Free Europe/Radio Liberty, the St. Petersburg AIDS Center carried out a survey of 2000 people who came to be tested there and were consequently exposed to AIDS prevention training. "Neither the men nor the women had changed their high-risk behavior", is the unsettling conclusion.

Ignorance is compounded by a dismal level personal hygiene, not the least due to chronically malfunctioning water, sanitation and electricity grids and to the prohibitive costs of cleansing agents and medicines. Sexually transmitted diseases - the gateways to the virus - are rampant. Close to half a million new cases of syphilis are diagnosed annually only in Russia.

The first step in confronting the epidemic is proper diagnosis and acknowledgement of the magnitude of the problem. Macedonia, with 2 million citizens, implausibly claims to harbor only 18 carriers and 5 AIDS patients. A national strategy to confront the syndrome is not due until June next year. Though AIDS medication is theoretically provided free of charge to all patients, the country's health insurance fund, looted by its management, is unable to afford to import them.

In a year of buoyant tax revenues, the Russian government reduced spending on AIDS-related issues from $6 million to $5 million. By comparison, the U.S. Agency for International Development (USAID) alone allocated $4 million to Russia's HIV/AIDS activities in 2001. Another $1.5 were given to Ukraine. Russia blocked last year a $150 million World Bank loan for the treatment of tuberculosis and AIDS.

Money is a cardinal issue, though. Christof Ruehl, the World Bank's then chief economist in Russia and Murray Feshbach, a senior scholar at the Woodrow Wilson International Center for Scholars in Washington, put the number of infected people in the Russian Federation at 1-1.2 million. Even this figure - five times the official guesstimate - may be irrationally exuberant. A report by the US National Intelligence Council forecasts 5-8 million HIV-positives in Russia by the end of the decade. Already one third of conscripts are deemed unfit for service due to HIV and hepatitis.

Medicines are scarce. Only 100 of St. Petersburg's 17,000 registered HIV carriers receive retroviral care of any kind. Most of them will die if not given access to free treatment. Yet, even a locally manufactured, generic version, of an annual dose of the least potent antiretroviral cocktail would cost hundreds of dollars - about half a year's wages. At market prices, free medicines for all AIDS sufferers in this vast country would amount to as much as four fifths of the entire federal budget, says Ruehl.

Some pharmaceutical multinationals - spearheaded by Merck - have offered the more impoverished countries of the region, such as Romania, AIDS prescriptions at 10 percent of the retail price in the United States. But this is still an unaffordable $1100 per year per patient. To this should be added the cost of repeated laboratory tests and antibiotics - c. $10,000 annually, according to the New York Times. The average monthly salary in Romania is $100, in Macedonia $160, in Ukraine $60. It is cheaper to die than to be treated for AIDS.

Indeed, society would rather let the tainted expire. People diagnosed with AIDS in eastern Europe are superstitiously shunned, sacked from their jobs and mistreated by health and law enforcement authorities. Municipal bureaucracies scuttle even the little initiative shown by reluctant governments. These self-defeating attitudes have changed only in central Europe, notably in Poland where an outbreak of AIDS was contained successfully.

And, thus, the bleak picture is unlikely to improve soon. UNAIDS, UNICEF and WHO publish country-specific "Epidemiological Factsheets on HIV/AIDS and Sexually Transmitted Infections". The latest edition, released this year, is disheartening. Under-reporting, shoddy, intermittent testing, increasing transmission through heterosexual contact, a rising number of infected children. This is part of the dowry east Europe brings to its long-delayed marriage with a commitment-phobic European Union.