Uzbekistan is facing a public health time bomb, experts are warning. Authorities contend they are making gains in the battle to contain the spread of HIV/AIDS, but independent specialists say such claims are built on twisted figures and deceptive methodology.
At a late-November speech to mark World AIDS Day, the director of Uzbekistan’s National AIDS Center, Nurmat Atabekov, said Tashkent is making progress in its fight against HIV/AIDS and that the number of new infections in the country is falling, local media reported.
In 2011, Atabekov said, Uzbekistan saw an 11 percent decline in the number of new infections compared with the previous year; that followed a 5.5 percent decline in 2010. This year, the country should see another drop. The total number of infected people continues to rise – to 24,539 as of November 1 – but the number of new infections per year peaked in 2009, he said.
"We now test over 2 million people a year and the rate of occurrence [this year] is 0.19 cases per 100,000 people," Atabekov said. "For comparison, it was 0.43 in 2008."
That sounds like very good news. But independent experts say Atabekov and his office came up with the rosy numbers by design. Of course, it would not be the first time an Uzbek official has massaged statistics. Since the Soviet days when Uzbek planners reported inflated cotton harvests to Moscow, Tashkent has often distributed misleading numbers.
The US State Department regularly cautions that Uzbek government statistics on everything from economic growth to domestic violence are “not consistently reliable [5].” In some cases, authorities go to great lengths to conceal facts. For example, from 2007-10, officials tried to cover up a hospital scandal involving the spread of HIV that left 147 children infected in the eastern city of Namangan.
EurasiaNet.org tried to follow up with Atabekov, but he would not take our calls and his staff would not share a copy of his presentation. But his deputy, Gulyam Radjabov, did speak with us briefly and confirmed that though Uzbekistan is testing more people each year, “less and less cases of infected people are being found.”
The key to the decrease, on paper, seems not to be that 2 million people were screened last year (out of a population of roughly 30 million), but rather who was screened. Several HIV experts familiar with Uzbekistan said the infection rate is dropping because officials are testing people who are at low risk of contracting the virus.
For example, the number of Uzbeks tested has more than doubled since 2009, when HIV testing for pregnant women became mandatory. Couples require a test to obtain a marriage certificate, too. While that is a good practice, HIV experts say, these are low-risk populations and screening them allows Tashkent to trumpet a drop in the overall infection rate.
But are vulnerable groups – specifically injecting drug users and gay men – getting tested? Experts worry that official statistics underestimate the absolute number of infections by as much as a factor of three because Uzbekistan’s conservative society (where homosexuality is illegal) stigmatizes [6] these most vulnerable populations, and thus they eschew testing.
Getting HIV data for Uzbekistan is a chore. UNAIDS does not publish basic epidemiological statistics for the country, and the World Health Organization's latest online data for Uzbekistan, which is full of holes, was published in 2008.
Because of the sensitivity of the issue in Uzbekistan – where most western NGOs have been forced to close by the government, foreigners are routinely denied visas, and a local activist was jailed [7] in 2009 for passing out literature on how to prevent HIV – knowledgeable regional experts would speak only on the strictest terms of anonymity.
Several suggested that authorities are deliberately hiding new infections in order to report numbers that will burnish Uzbekistan’s image. Just a few years ago new infection rates were exploding. Between 2001 and 2005, when international organizations were helping to introduce testing, annual newly registered cases grew by 300 percent.
Atabekov pointed to migrant workers as a particular problem. On this point, experts concur. An estimated three million Uzbeks work in Russia, where the virus is out of control. As in Uzbekistan, social stigma among high-risk populations in Russia discourages testing.
Migrants traveling to Russia from Uzbekistan routinely pay for sex (one 2009 study found 93 percent had) and show little knowledge of how to prevent HIV. In 2010, the Central Asia AIDS Control Project found that only 12.9 percent of Uzbek migrants knew that a condom could prevent the virus. Men seem to be traveling to Russia, picking up HIV from prostitutes, and later passing the virus onto their wives at home.
But there the consensus ends. A Western HIV expert with years of Central Asia experience flagged two additional concerns with the Uzbek National AIDS Center’s statistics.
For one, tests are coming back with false negatives, she said, because samples are not properly refrigerated, especially in rural areas.
If sending HIV-positive people back into the population convinced they are not carriers is not worrying enough, the expert expressed concern that officials deliberately fix infection numbers to show a decline: “The government is artificially keeping [low] the rate of infections by freezing the blood at the point when the [nationwide] infection level reaches a certain [quota] and testing that blood the following year. So if you look at the statistics for each year, most of the infections will be recorded in the first quarter. And the show goes on,” she said.