IHRD Director Discusses HIV/AIDS in Eastern Europe on NPR

In an interview with Bob Edwards, the host of National Public Radio's "Morning Edition" program, Kasia Malinowska-Sempruch, the director of OSI's International Harm Reduction Development program (IHRD), spoke frankly about the social and economic realities behind the surging number of HIV infections in Eastern Europe and the former Soviet Union. The rate of infection in that region, largely due to injecting drug use, is currently the fastest in the world—and the majority of the newly infected are younger than 25.

Below is an edited transcript of the interview, which aired on September 26, 2002.

BOB EDWARDS:
HIV and AIDS are spreading faster in Eastern Europe and the former Soviet Union than anywhere else in the world, according to a new report from UNICEF [United Nations Children's Fund]. The study estimates there are one million HIV and AIDS cases in the region. Hardest hit are Russia and Ukraine. Kasia Malinowska-Sempruch heads the international AIDS prevention efforts for the non-profit Open Society Institute. She says some familiar problems are contributing to the spread of the disease.

KASIA MALINOWSKA-SEMPRUCH:
The reasons, as anywhere else in the world, are quite complex, but one of the major ones is the epidemic of injecting drug use that followed the economic changes and political changes in the region. In fact, it's this epidemic of injecting drug use that's causing a very rapid spread of HIV.

EDWARDS:
Maybe the question is, why the greater use of drugs?

MALINOWSKA-SEMPRUCH:
Well, there are many reasons. The economic dislocation for many, the lack of hope for young people leaving schools, the drug trafficking routes from Afghanistan that are running right through that region. I mean, these are the complexities that come together to make the region very vulnerable to drug use.

EDWARDS:
And are young people more affected than older people?

MALINOWSKA-SEMPRUCH:
Yes, definitely. If you look at the numbers and the ages of those who are infected, these are mostly people between 17 and 25 years old. These are the folks who started injecting at a relatively early age and once the epidemic of HIV arrived, they started getting infected very, very rapidly. So it's really a very striking aspect of the HIV epidemic in our region.

EDWARDS:
Well, they're, of course, probably more sexually active, too.

MALINOWSKA-SEMPRUCH:
Sure. Exactly so. I think this clearly is a concern about where the HIV epidemic is going to spread. The fact is that they're also young people who are not what we would stereotypically consider drug users. They're in schools. They're living in their homes. They're very often supported by their parents. They have very active social lives. They clearly have sexual partners. So this is a very different epidemic of drug use than we have seen in United States, for example, where people tend to be more marginalized. [In Eastern Europe and the former Soviet Union] the social networks are very broad and open and the spread of HIV through sexual transmission is clearly going to follow.

EDWARDS:
What are governments and public health agencies in the region doing?

MALINOWSKA-SEMPRUCH:
It varies from country to country. What governments are doing mostly is allowing international organizations to come in and do some preventive work. It very rarely happens that the governments themselves take responsibility and fund those activities.

EDWARDS:
Well, what does UNICEF recommend the governments do?

MALINOWSKA-SEMPRUCH:
UNICEF is taking on the recommendations of UNAIDS, the UN program that deals with HIV, which is providing vulnerable young people with information and preventive services that are, in fact, effective. Those would, obviously, include HIV education as well as condom distribution and needle exchange.