Potential for Spread of the Epidemic

Indications are that the epidemic continues to grow. Some pointers for the potential spread of the epidemic are:

• High levels of drug injection among the youth, as well as frequent sharing of needlesin some countries, pose a growing risk for spread of the disease. In Ukraine, for example, 75 percent of HIV infections are related to increasing drug use. Moreover, drug users are more likely to be involved in the sex industry, increasing the chances of the virus spreading to the wider community.

• The proportion of sexually transmitted HIV/AIDS infections is increasing.More people (mostly women) appear to be contracting HIV through sexual transmission, and more pregnant women are testing positive for HIV—suggesting a shift of the epidemic into the wider population.

• Young people in several countries are becoming sexually active at an earlier age and premarital sex is on the rise. In Romania, a steady rise in premarital sex is being observed among adolescent girls aged between 15–19 years. Reported premarital sexual relations more than doubled to 22 percent in 1999 from 9 percent in 1993. In Ukraine a 2000 report revealed that some 51percent of women aged 15–24 had experienced a premarital sexual relationship.

• Awareness of the disease and methods of prevention remain low in many places. In some Central Asian republics, awareness of HIV/AIDS is very low among vulnerable groups. A mere 10 percent of teenage girls in Tajikistan had heard of HIV/AIDS. In Azerbaijan and Uzbekistan, in 2001, less than 60 percent were aware of the disease. In Ukraine, which has the highest prevalence rate in Europe, only 9 percent of adolescent girls were aware of HIV prevention methods. Although improving in some places, levels of condom use remain low.

• The very high rates of sexually transmitted infections increase the chances of HIV transmission through unprotected sex. In 2000, newly reported cases of syphilis in the Russian Federation stood at 157 per 100 000 persons, dramatically higher than the 4.2 per 100 000 persons in 1987. Similar general trends are visible in the other countries of the Commonwealth of Independent States, the Baltic States and Romania.

• The political, social, and economic upheaval in the region, has created fertile ground for the spread of the disease. Across the region, young people are trying to find their place in a rapidly changing and challenging environment. Their high mobility, along with growing rates of unemployment and limited opportunities for the future, lead to greater risk-taking behaviors, making them more vulnerable to HIV. The psychological and socioeconomic aftermath of conflicts in the region has also increased the vulnerability of the youth to the disease.