VZCZCXRO4965
RR RUEHAG RUEHAST RUEHBI RUEHCI RUEHDF RUEHIK RUEHLH RUEHLN RUEHLZ
RUEHPW RUEHROV RUEHVK RUEHYG
DE RUEHAH #0380/01 0861212
ZNR UUUUU ZZH
R 261212Z MAR 08
FM AMEMBASSY ASHGABAT
TO RUEHC/SECSTATE WASHDC 0495
INFO RUCNCIS/CIS COLLECTIVE
RUCNMEM/EU MEMBER STATES COLLECTIVE
RUCNCLS/ALL SOUTH AND CENTRAL ASIA COLLECTIVE
RUEHAK/AMEMBASSY ANKARA 3550
RUEHBJ/AMEMBASSY BEIJING 1368
RUEHKO/AMEMBASSY TOKYO 1235
RUEHIT/AMCONSUL ISTANBUL 1804
RUEHVEN/USMISSION USOSCE 2352
RHMFIUU/CDR USCENTCOM MACDILL AFB FL
RHEHNSC/NSC WASHDC
RUEAIIA/CIA WASHDC
RHEFDIA/DIA WASHDC
RUEKJCS/JOINT STAFF WASHDC
RUEKJCS/SECDEF WASHDC

UNCLAS SECTION 01 OF 03 ASHGABAT 000380 
 
SIPDIS 
 
SIPDIS 
 
SENSITIVE 
 
STATE FOR SCA/CEN, EUR/ACE 
AID/W FOR EE/AA 
 
E.O. 12958: N/A 
TAGS: PGOV EAID SOCI KHIV TX
SUBJECT:  TURKMENISTAN:  COMMERCIAL SEX WORKERS SHOW SIGNIFICANT 
LACK OF KNOWLEDGE ABOUT HIV/AIDS 
 
¶1.  (U) Sensitive but unclassified.  Not for public Internet. 
 
¶2.  (SBU) SUMMARY:  An unpublished report on "Knowledge, Attitude, 
and Practice Survey on HIV/AIDS and Drug Use Among Sex Workers in 
Turkmenistan" prepared in 2007 by the UN Development Program (UNDP) 
with the support of the Ministry of Health and Medical Industry 
(MOHMI) uncovered a glaring lack of knowledge about HIV/AIDS among 
commercial sex workers in Turkmenistan.  Approximately 61% of 
respondents were aware of HIV transmission via sexual intercourse 
but less than half knew that it could be transmitted through blood 
or shared syringes.  Almost three quarters of respondents 
acknowledged using recreational drugs, and slightly over one-third 
of total respondents believed that recreational drugs provide 
protection from HIV and sexually transmitted infections (STIs). 
Less than 40% reported using condoms regularly, although another 47% 
said condoms were used "sometimes".  Collectively, these findings 
highlight the considerable risk that Turkmenistan already faces 
HIV/AIDS rates similar to its Central Asian neighbors, even as it 
continues to deny the problem.  END SUMMARY 
 
HEADS IN THE SAND - FOR NOW? 
 
¶3.  (SBU) Turkmenistan has reported officially only two HIV-positive 
cases since 1993. These two patients died in 1993 and 1996. Due to 
unwillingness at the highest levels of government to directly 
confront the issue, the real rate of HIV/AIDS cases remains unknown. 
 Signs are emerging, however, that the government may slowly be 
willing to confront what may be a significant problem.  At a 
UNODC-organized conference in Tashkent, Uzbekistan, November 29-30, 
2007, Turkmenistan's representatives announced that the country's 
officially registered number of drug users was 33,361, of which 
9,112 are intravenous drug users (IDUs).  One potential estimate of 
the scale of the HIV positive population is 10% of the acknowledged 
IDUs. 
 
¶4.  (SBU) Turkmenistan's National HIV/AIDS/STIs Prevention program 
for 2005-2010 broadly corresponds to international standards, but is 
aimed at prevention only.  In 2006, Turkmenistan applied to the 
Global Fund to Fight TB, HIV/AIDS and Malaria for a grant to support 
its prevention programs, but the application was rated "Category 3 
-- Not recommended for approval in its present form but encouraged 
to resubmit following major revision."  In 2008, Turkmenistan 
decided not to apply for a Global Fund grant on HIV/AIDS because the 
government remained reluctant to announce the actual number of 
HIV/AIDS cases. 
 
SURVEY A STEP IN THE RIGHT DIRECTION - BUT NOT ENOUGH 
 
¶5.  (SBU) Beginning in summer 2007, UNDP undertook a "Knowledge, 
Attitude, and Practice Survey on HIV/AIDS and Drug Use Among Sex 
Workers in Turkmenistan" with the support of the MOHMI.  This is one 
of the few surveys that has been undertaken in Turkmenistan to 
assess the HIV/AIDS situation.  The survey was based on individual 
interviews with a representative sample of 238 sex workers from 
different provinces of Turkmenistan.  The report's release, however, 
was not approved by the Turkmen government, so the findings are not 
considered official and are not publicly acknowledged by health 
officials.  USAID recently obtained a copy of the report, however, 
and its major findings are detailed below. 
 
LOW BASIC KNOWLEDGE OF TRANSMISSION... 
 
¶6.  (SBU) One of the main findings of the report is that commercial 
sex workers, one of the principal high-risk groups for HIV/AIDS 
infection in Turkmenistan, are not adequately informed about methods 
of HIV/AIDS transmission. 
Approximately 61% of respondents were aware of HIV transmission via 
sexual intercourse but less than half knew that it could be 
transmitted through blood or shared syringes.  About one-fourth of 
respondents (27.73%) thought that HIV can be transmitted during 
breast-feeding.  One-fifth thought that use of common toilet seats 
and 13.45% thought that insect bites lead to HIV transmission.  Less 
 
ASHGABAT 00000380  002 OF 003 
 
 
than 30% knew that HIV can be transmitted by all types of sexual 
intercourse.  Almost 60% considered that HIV is transmitted only 
through vaginal sexual intercourse. 
 
...LEADS TO DANGEROUS PRACTICES 
 
¶7.  (SBU) Since a high percentage of respondents were also drug 
users, several questions addressed their behavior and knowledge in 
this area.  Almost three-quarters of those surveyed consume drugs, 
and 56.72% of the total surveyed injects drugs intravenously. 
Almost one-fifth of respondents believed that injecting 10 ml of 
water intravenously was an appropriate response to a drug overdose. 
Slightly over one-third of total respondents believed that 
recreational drugs provide protection from HIV and sexually 
transmitted infections (STIs). 
 
¶8.  (SBU) Additionally, less than 40% reported using condoms 
regularly, although another 47% said they "sometimes" used condoms. 
The most common reason for not using condoms was that clients were 
against condom use. The survey stated that "there is a need for 
full-fledged communication campaign on HIV/AIDS prevention among the 
target audience and also among the population in general. 
Sex-workers' clients are part of population, and it is necessary to 
increase their awareness and motivation to use means of protection 
for sex workers and clients and the community in general." 
 
EXPERTS AGREE ON PROBLEM, NEED FOR MORE OPENNESS 
 
¶9.  (SBU) In the course of the survey, six in-depth interviews were 
carried out with experts from official entities and international 
donors.   The scope of the situation on HIV/AIDS, STIs, and drug-use 
prevalence is unknown, but estimated as "significant."  Almost all 
agreed that, consistent with the survey's results, sex-workers in 
Turkmenistan have low awareness about and motivation for safe-sex 
practices, as well as high levels of drug abuse. 
 
¶10.  (SBU) Some disagreement appeared over the level of detection 
and registration procedures.  While some experts asserted that 
testing was conducted in accordance with international standards 
countrywide, others believed that only testing at the Center for 
HIV/AIDS Prevention in Ashgabat was adequate.  Regarding 
registration, some experts stated that official statistics related 
to HIV-positive cases are concealed by the state, but others said 
that patients were able to access their status as a result of 
testing.  However, all parties agreed that AIDS patients do not 
receive necessary support and infect an unknown number of partners 
due to the unwillingness to officially acknowledge and treat AIDS 
cases. 
 
INTENSIVE COMMUNICATION AND EDUCATION PROGRAM NECESSARY 
 
¶11.  (SBU) The survey demonstrated an insufficient awareness level 
about HIV/AIDS prevention and transmission.  Since the survey also 
identified health workers as the most trusted source of information 
and preferred channel to receive information among respondents, it 
recommended post-graduate training for health workers with an 
intensive communication component aimed at improving their 
counseling skills.  Health workers should learn not only medical 
problems but also understand how to motivate sex workers to change 
their behavior.   Additionally, one-fourth of respondents listed 
"other girls" as preferred source of information, highlighting the 
potential importance of peer education programs. 
 
¶12.  (SBU) COMMENT:  The current HIV/AIDS awareness level among sex 
workers is insufficient.   Due to a lack of knowledge and failure to 
undertake preventive measures and because of dangerous behavior, 
including lack of condoms and intravenous drug use, a clear basis 
for HIV/AIDS and STIs infections to be transmitted to a broader 
segment of the population already exists.  Although all the 
interviewed experts were optimistic about changes towards a more 
open society that tackles hard questions that relate to prevention, 
detection, and registration of HIV-positive individuals, any 
 
ASHGABAT 00000380  003 OF 003 
 
 
positive changes must be accelerated to stop the HIV/AIDS situation 
in Turkmenistan from worsening.  END COMMENT. 
 
HOAGLAND