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UNCLAS SECTION 01 OF 03 ASTANA 001547 
 
SIPDIS 
 
STATE FOR SCA/CEN, S/GAC, OES/PCI (PHUDAK) 
 
E.O. 12958: N/A 
TAGS: PGOV ECON SOCI SNAR KHIV KZ
SUBJECT:  KAZAKHSTAN:  TEMIRTAU IS "AIDS CAPITAL OF KAZAKHSTAN" 
 
ASTANA 00001547  001.2 OF 003 
 
 
¶1.  SUMMARY: Home to AcelorMittal, Kazakhstan's giant steel plant, 
Temirtau is known as the "AIDS capital of Kazakhstan."   An 
"explosion" of new HIV/AIDS cases peaked in 1997, then dropped, and 
has since held steady.  The local AIDS Center believes that 
financial difficulties and layoffs following Kazakhstan's 
independence, a young migrant population without social restraints, 
and the fact that drugs are cheaper than vodka led to the city's 
high rate.  While no reliable drug-use data exists, the Center 
estimates that two-thirds of HIV/AIDS cases are drug users or their 
sexual partners.   Many of those who seek counseling and treatment 
do not work, cannot adapt to societal norms, and need help obtaining 
government assistance.  END SUMMARY. 
 
AIDS IN TEMIRTAU 
 
¶2.  ArcelorMittal, Kazakhstan's massive steel plant that employs 
45-50 percent of the people living in the "company" town of 
Temirtau, attracts many outsiders to Termirtau looking for work. 
Temirtau has the highest incidence of HIV/AIDS in Kazakhstan, with 
1767 new cases registered since 1990 when the city registered its 
first case.  An ongoing "explosion" of HIV/AIDS cases in the city 
accompanied AcelorMittal's 1996 resurgence.  This "explosion" peaked 
in 1997 with 386 new registered cases, then tapered off until 2001 
when only 76 new cases of HIV/AIDS were registered.  The rate of new 
cases each year held steady until 2006, at approximately 70 new 
registered cases each year, but then increased again to its current 
level of over 130 new cases per year. 
 
POSSIBLE CAUSES OF HIV/AIDS "EXPLOSION" IN TEMIRTAU 
 
¶3.  Speculating on the reasons for such a high rate of HIV/AIDS 
cases in Temirtau, the Head Doctor-Epidemiologist of the city's AIDS 
Center, Sholpan Baimurznina, linked the situation to the history of 
ArcelorMittal, which employs almost half the city's population. 
After Kazakhstan's independence, ArcelorMittal's financial 
difficulties forced it to lay off many workers.  The resulting 
economic destabilization profoundly affected the emotional 
well-being of this company town with only one real source of jobs. 
Temirtau is right in the middle of a major narcotics route, and drug 
use is widespread among the young and the unemployed.  Drugs are 
very cheap; a hypodermic needle filled with drugs costs less than a 
shot of vodka.  Because most of those with HIV/AIDS also use drugs, 
Baimurznina attributes much of the spread of HIV/AIDS to 
contaminated needles.  With many young men out of work, going to 
bars, and having loose, unprotected sex, it should not be surprising 
that many discovered, to their astonishment, that they had 
contracted HIV/AIDS.  Many who initially left the city in search of 
work, returned when the plant resumed production with various 
problems, including drug addiction and HIV/AIDS.  According to 
Baimurznina, the U.S. Centers for Disease Control (CDC) conducted a 
gene type identification test on the cases of HIV/AIDS in Temirtau 
and determined that many of the viruses were genetically similar to 
viruses circulating in Europe.  While the AIDS Center wants to use 
this data to conclude that people were bringing HIV/AIDS with them 
to Temirtau, CDC cautioned REO against drawing any conclusions from 
that fact, since there could be many different routes of 
transmission. 
 
¶4.  2005-2006 saw a large influx of youth looking for work.  Mostly 
students who had just graduated from college, they lived without 
restraints, free for the first time, and partook in Temirtau's night 
life.  Baimurznina believes these factors contributed to the second 
"jump" in cases.  Baimurznina complained that it is difficult to 
change how people think about using condoms.  Kazakhstan is stuck in 
"old" ways of thinking, she said, different than the West. 
 
¶5.  Baimurznina said that, unfortunately, no adequate data exists on 
the extent of drug use in Temirtau and the Karaganda region.  5500 
people voluntarily have sought help with their addiction, but many 
more are not registered because they have not come forward.  She 
believes, but cannot confirm due to statistical deficiencies, there 
is a strong connection between the growth of drug use and the 
increase in the incidence of HIV/AIDS.  She estimated that 
two-thirds of HIV/AIDS cases are drug users or their sexual 
partners.  Temirtau was also one of the Soviet Union's prison 
 
ASTANA 00001547  002.2 OF 003 
 
 
centers, and many of the exiles sent to the region had a high 
incidence of drug usage, according to Baimurznina. 
 
LOCAL AND INTERNATIONAL RESPONSES 
 
¶6.  In 1990 following the official registration of the first 
HIV/AIDS case in the city, the Ministry of Health designated 
Temirtau a zone of concern and established its AIDS Center.  At that 
time, Almaty hosted the only other AIDS Center in Kazakhstan. 
Currently, the Center's services range from the distribution of 
information about AIDS prevention to the provision of treatments, 
including anti-viral therapy.  The United Nations Development 
Program (UNDP) has helped the Center educate the local population 
about HIV/AIDS and its prevention.  UNDP and the Center have carried 
out a harm reduction project and worked with at-risk groups (drug 
users, prostitutes, transients, prisoners and ex-prisoners, 
unemployed, and others).  The AIDS Center is continuing this work on 
its own while it seeks additional funding to help with this 
program. 
 
SITUATION NOW "UNDER CONTROL"...OR IS IT? 
 
¶7.  In response to the question, "Is the situation under control 
now?" Baimurznina asserted that people will take drugs and engage in 
unprotected sex regardless of information campaigns.  She said 
indicators do not exist to measure the effect of the Center's 
program to encourage prophylactic use.  Even though the Center 
advocates restraint, condoms, and "know your partner," Temirtau's 
incidence of new cases of HIV/AIDS each year remains high.  She used 
a counter-example to illustrate the "mentality" that persists in 
Kazakhstan (and throughout the former Soviet Union): only 1-2 
percent of Temirtau's residents use contraception to restrict birth; 
abortion remains the overwhelming preferred method of birth control. 
 However, she highlighted that 40 percent of those who use abortion 
say they will start using contraception in the future.  Baimurznina 
could not easily say the situation is under control, even though the 
number of new cases each year remains steady. 
 
VOLUNTARY AND MANDATORY HIV/AIDS SCREENING 
 
¶8.  Baimurznina said 10 percent of Temirtau's residents submit to 
voluntary screening for HIV/AIDS each year.  In addition, all 
prisoners and blood and organ donors must undergo a mandatory 
HIV/AIDS test.  She said Temirtau's AIDS Center also serves 
prisoners and noted that 30 percent of all HIV/AIDS cases are 
prisoners in the Karaganda region.  Of these, one-third are from 
Karaganda, and the rest are prisoners transferred from other 
Kazakhstani regions. 
 
SHAPAGAT NGO DIRECTOR AN HIV/AIDS VICTIM, COUNSELOR IS FORMER DRUG 
ADDICT 
 
¶9.  One of Temirtau AIDS Center's implementing partners is the 
HIV/AIDS NGO Shapagat.  Kazakh for "mercy, benefaction, patronage," 
Shapagat carries out education campaigns, gives guidance to victims 
and sex workers, and provides emotional and psychological counseling 
to those with HIV/AIDS and drug users.  Its director, Zoya 
Ruzhnikova, is a lively mid-30s woman who is currently undergoing 
anti-viral therapy and taking medication to treat her own HIV/AIDS. 
She says that this personal tragedy gave her life a new direction. 
Shapagat's counselor, Aida Arapbayeva, is a recovering drug addict 
in her late 20s whose voice has been damaged by drug use.  Studying 
to be a counselor, she works with Shapagat to help current and 
former addicts. 
 
¶10.  Ruzhnikova said Shapagat gets its funding for counseling and 
educational work from Counterpart Consortium, The TIDES Foundation 
(a U.S. philanthropic fund), the Dutch AIDS Foundation East-West 
(AFEW), and the International Red Cross.  In addition, Shapagat has 
worked with legal aid groups to create the "All Kazakhstan Union of 
AIDS" network to help HIV/AIDS victims with questions concerning 
employment, housing, and benefits.  Shapagat recently started a 
pilot project to place an HIV/AIDS treatment clinic inside a 
maternity home to treat sex workers, women with HIV/AIDS, and drug 
users.  It will also provide counseling and advice to those with 
 
ASTANA 00001547  003.2 OF 003 
 
 
psychological and/or emotional problems, give guidance to family 
members, provide support groups, and help with rehabilitation and 
social reintegration.  Ruzhnikova hopes to expand this service to 
other cities in the region. 
 
¶11.  Ruzhnikova said many who seek counseling and treatment do not 
work, cannot adapt to society's norms, and need help obtaining 
government assistance.  (NOTE: In Kazakhstan, citizens must have a 
document called a "propusk" that grants them legal status in a city 
or region.  While many move to work, without a proper "propusk," 
they cannot receive government assistance should they need it.  END 
NOTE.)  Ruzhnikova said most of those seeking counseling have a 
complex of associated problems:  HIV/AIDS, tuberculosis, drug 
addition, homelessness, unemployment, and social intransigence. 
 
¶12.  COMMENT:  Temirtau has the reputation of being the "AIDS 
capital of Kazakhstan" because of its high incidence of cases. 
While it is easier for donor organizations to work with groups and 
centers in Astana and Almaty, Temirtau's experience shows much about 
the spread of HIV/AIDS in Kazakhstan, its likely causes, and the 
effect of economic turmoil, drug use, and transient populations on 
transmission.  As the U.S. Government looks for worthy organizations 
to support, we should not overlook the work by local groups, such as 
those in Temirtau.  END COMMENT.