DRUG USE BEGETTING AIDS IN CENTRAL ASIA

TEMIRTAU, Kazakhstan -- The five nations of Central Asia may be at the
brink of an explosive growth in AIDS, medical experts and government
officials say.

"There is a growing drug trade, declining standards of living and
social chaos," said Jay Dobkin, director of the AIDS program at
Columbia-Presbyterian Medical Center in New York, who has visited the
region three times in recent months. "It's hard to know if there is
going to be an explosion, but it's smarter not to wait and see."

So far, the official number of people with AIDS or who are H.I.V.
positive is relatively low in most of the countries -- Turkmenistan,
Uzbekistan, Tajikistan, Kyrgyzstan and Kazakhstan -- but experts
believe the figures are underreported.

Two decades after AIDS began taking its toll on the rest of the world,
these isolated nations -- all formerly republics of the Soviet Union --
are still hobbled by taboos, meager resources and authoritarian
bureaucracies. They have been slow to develop programs to counter the
steep rise in drug abuse and to educate people about AIDS.

In Kyrgyzstan the government allots just $26,500 for AIDS prevention
and awareness programs, and throughout the area there are almost no
treatment centers.

In June the United Nations concluded there was a basis for more people
getting AIDS in all five countries. It cited the rapid increase in
drug use, high levels of sexually transmitted diseases, widespread
prostitution and a population with more than half its people under
25.

Oxsana, 27, said she started using drugs seven years ago, at the age
of 20, here in Temirtau. There was nothing to do, she said. "I decided
to try with my friends the first time," she said. "It was easy to buy
drugs."

By the time she started using a mixture of opium and flour in 1994,
there were plenty of abandoned apartments where drug users would
congregate. Nobody had heard of AIDS in Temirtau and, as in the
culture of drugs elsewhere, they shared needles.

The specter of AIDS follows the path of heroin and opium trafficking
from Afghanistan to Kazakhstan and its Central Asian neighbors, all of
which are way stations for drugs headed to Russia and Europe.

As inevitably happens, transit countries have turned into user
countries. Where there were almost no intravenous drug users a decade
ago, today there are an estimated 300,000 among the region's 55
million people.

In Kyrgyzstan and Tajikistan, the most fragile and poorest countries
in the region, a full-blown AIDS crisis could overwhelm medical
resources and cause political and social instability, experts warn.
For now, the crisis is worst in Kazakhstan, a nation of 17 million
people.

The United Nations estimates that 3,500 people here are H.I.V.
positive or have AIDS; the Kazakhstan government puts the figure at
1,700 and unofficial estimates are as high as 10,000. Official figures
put the totals at about 100 people in each of the other four countries
in the region, though those figures are also thought to be low.

Ground zero is Temirtau, a city of 160,000 in central Kazakhstan. It
is a laboratory for the effects of the social and economic woes that
swept across the region like a medieval plague after the
disintegration of the Soviet Union in 1991.

Temirtau was built during World War II, to produce steel using coal
from nearby mines. When the Soviet Union collapsed, so did the city's
economy and the social institutions. Almost overnight, people were
trapped by unemployment, poverty, crime and disillusionment.

Temirtau, near the primary road from Afghanistan to Russia, proved
fertile territory for the drug business. Some people sold drugs to
survive; more used them to cope.

Oxsana's boyfriend, Sasha, a 28- year-old intravenous drug user who
still manages to hold onto his job at a steel plant, said drugs are
easy to find and cheap to buy. After eight years of using opium, he
said he needs about $3 a day to maintain a level mood, more to get
high.

Sasha and Oxsana have watched many friends die from AIDS. There is no
rehabilitation program to help them get off drugs, but they visit a
city-run needle-exchange program to get free syringes and condoms.

The center, in a converted kindergarten, financed by the United
Nations and a local steel company, provides checkups and some
medication for people with AIDS or who are H.I.V. positive. Space and
resources are limited and there is no treatment capacity.

No one is sure how the virus that causes AIDS came to this isolated
town on the steppes.

Abdygaliev Berik, the deputy mayor, and Svetlana Krukovskaya, a
supervisor at the AIDS center, said the prevailing theory is that a
businessman contracted the virus in Moscow and brought it back here.

The first known case in Temirtau was discovered in 1996 when a drug
user was arrested and tested. Since then the number of cases has grown
and the latest figures show that 918 people are H.I.V. positive,
nearly 1 in 1,600, and 106 have died of AIDS- related illnesses.

Experts are convinced AIDS is equally severe elsewhere in Kazakhstan.
Most cases are discovered when drug users and prostitutes are arrested
and tested. Temirtau is the only place where international attention
led to widespread testing of the general population.

"H.I.V. and AIDS in Kazakhstan are not just in Temirtau,
unfortunately," said Valeriya Gourevich, a doctor who runs a public
health program in Almaty, the country's most populous city with 1.2
million people. The program is sponsored by the New York-based Soros
Foundation.

She listed six other cities, from Aktobe in oil-rich western
Kazakhstan to Pavlodar near the Russian border in the northeast and
Shymkent in the south, where heavy drug use indicates widespread AIDS.

In Kazakhstan, 80 percent of those found to be H.I.V. positive are
intravenous drug users, experts say. But data from Temirtau presented
at a United Nations conference in June found an increasing percentage
of cases transmitted by sexual activity. The disclosure alarmed
experts because it indicates drug users are spreading the virus to
spouses and lovers, increasing the potential for an epidemic.

The risk of contracting AIDS is high throughout Central Asia partly
because deeply rooted attitudes prevent appropriate education and
preventive techniques, said Dr. Gourevich. Parents rarely discuss sex
with children and cases sexually transmitted diseases are increasing
sharply.

Evgenia Misurevich, 26, was one of the first people in Temirtau to
find out she was H.I.V. positive. She said she had never heard of the
virus or AIDS before she got it in 1996 from sharing a needle.

Drugs first arrived in Temirtau a decade ago and Ms. Misurevich said
she was eager to try them. "It was a new thing and we thought it was
cool," she said.

She said she got the virus from a cellmate in prison, where drug use
was rampant. Ms. Misurevich was serving a four-year sentence for theft
to support her drug habit.

"I understood something was wrong when the doctor said I needed to go
to a separate cell," she said, waiting for a checkup in the bleak
examining room of the AIDS center.

Ms. Misurevich stopped using drugs after contracting the virus in
prison. But she said she returned to drug use when she was released
last year, though she said she used her own needle. Five months ago,
she entered a rehabilitation program run by the Roman Catholic Church,
one of two religion-based rehabilitation programs in the country of 17
million. She said she is drug-free and feels well.

Despite the highest incidence of AIDS in the region, Kazakhstan has no
government-operated treatment centers.

The situation is the same in Almaty, 600 miles south. Medical
officials said there is no place where people who are H.I.V. positive
or have AIDS can get treatment and few education programs.

Dr. Dobkin of Columbia-Presbyterian said a bureaucracy has grown up
around the issue without taking concrete steps to tackle AIDS yet.
"There are a lot of people with AIDS on their business cards, but I
couldn't find any evidence of anybody getting any treatment," he said.

"We have never figured out what leads to an epidemic in one place and
not others, but there is no time to waste here."