AIDS THERAPY

In the near future, Azerbaijan will adopt a law "On AIDS" which has already been discussed by the parliamentary committee on social policy. According to many HIV experts in the country, the adoption of the new law is an urgent necessity, since many provisions of the existing law, adopted in 1996, have lost their relevance and are now obsolete.

New law - alternative prevention

Of course, it's not just that in the 21st century attitudes towards AIDS have changed around the world, and hence also in Azerbaijan; many legal and medical aspects of this disease need to be adjusted. It is important that our country is poised for a radical review of measures to prevent and treat this disease by so-called substitution therapy, using the drug methadone. It is worth noting right at the start that this method of preventing and treating AIDS has earlier caused mixed reactions in society, because it was believed that drug addicts were being given one drug instead of another, even though one was legitimate and synthetic, prescribed by a doctor. But experts are convinced that this innovation, now widely used by progressive medicine, will halt the spread of AIDS and hepatitis among drug addicts, save hundreds of thousands of lives and make it possible to treat drug addicts with HIV or hepatitis B and C, especially as 65 per cent of AIDS carriers in Azerbaijan are intravenous drug users. Substitution therapy is used on this category of patients around the world.

Thus, according to Hadi Racabli, head of the parliamentary committee on social policy, the undoubted pluses of substitution therapy are a return to socially useful life and a reduction of crime. Addicts begin to make significantly less use of illicit opioids and, as a result, stop using them. This means that a drug addict will not have to resort to criminal acts to obtain drugs. In essence, the state gains control of the addict - patients will be registered and receive regular individual doses of methadone, but since this is not a potent drug, it is understood that, ultimately, with a gradual reduction of dosage, the patient will no longer be dependent on drugs. Moreover, unlike other drugs, this one does not cause euphoria; it reduces pain and can be taken in pill form. It has been proved that transition by drug addicts to methadone significantly reduces the spread of AIDS.

Another important aspect of the new bill is that it emphasizes the inadmissibility of any discrimination against AIDS patients - all their constitutional rights as citizens of Azerbaijan will be recognized. The document also includes measures relating to immigrants and migrant workers - citizens of Azerbaijan with AIDS. Treatment and preventive measures for them will most likely be regulated by the State Migration Service. AIDS treatment and prevention programmes will be carried out in prisons. Their extent is currently limited by a lack of enabling legislation. The document will indicate that the examination and treatment of AIDS will be conducted strictly on a voluntary basis. Treatment will only be enforced on the basis of a court order against those who knowingly infect others.

The adoption of the new law means that the phobia of an incurable and lethal disease, the way that AIDS was previously perceived, not only by people in the street, but also by specialists, has been overcome. Today HIV carriers are equal members of society and should be protected by the law. To be fair, it should be noted that the spread of AIDS is no faster than that of other diseases. Advanced practices in the prevention and treatment of AIDS have converted it from the "angel of death" into a certain lifestyle. Henceforth, patients can live long lives and maintain their ability to work. Hence, attitudes towards them have become much more humane. And Azerbaijan cannot be isolated from these processes.

International assistance

Azerbaijan has relatively low rates of HIV infection. According to the National AIDS Centre of the Ministry of Health, the first case of HIV infection in Azerbaijan was recorded in 1987. The Baku office of the Joint UN Programme on HIV/AIDS (UNAIDS) notes that here the infection is spread mainly through drug use and sexual relations, as is characteristic of Eastern Europe and Central Asia. Thus the difficulties and achievements in the fight against AIDS in our country are identical to those in neighbouring countries. However, UNAIDS stresses, intensive infection by HIV in Azerbaijan is limited by timely actions of the authorities and by two legislative documents - the laws on HIV infection and on drug use. Therefore, according to an official of the Baku office of UNAIDS, Camila Carrahova, when adopting a new law "On AIDS", we must take into account the positive experience of those two bills.

But, the specialist stressed, the new law is necessary precisely because in Azerbaijan, as in many other countries, there is still palpable discrimination against people living with HIV/AIDS, and this severely limits programmes to prevent and treat the disease. Thus, taking this aspect into account, UNAIDS drafted a global structure of tasks in 2009 to prevent the spread of AIDS; this will involve ten co-sponsors - the UN agencies that make up UNAIDS. These priorities are reviewed every 5-6 years, depending on the situations existing in different countries. Thus, nine priority areas have been outlined until 2011, and 3 or 4 of them are selected for each country. In coordination with UNAIDS headquarters in Geneva, four objectives have been selected for Azerbaijan for 2010-11: support for patients in treatment, prevention of the spread of HIV between intravenous drug users, prevention of sexual transmission of HIV and combating discrimination against AIDS patients and HIV-infected individuals. UNAIDS is planning to spend $200,000 within two years to carry out these tasks in Azerbaijan.

In addition, in 2010 the Global Fund (GF) to Fight AIDS, Tuberculosis and Malaria will allocate a grant to Azerbaijan to combat the spread of AIDS, allowing the Ministry of Health to launch a large-scale campaign in the regions. The Global Fund has allocated $6 million to Azerbaijan over five years for a programme to reduce the effects of AIDS, which includes syringe exchange projects, antiretroviral therapy (ARV therapy), the provision of education based on essential knowledge, information support and funding for a reproductive centre where doctors are taught to assist patients infected by the AIDS virus in childbirth. It is still not clear how much money the Global Fund will allocate to Azerbaijan in 2010. However, we know that since the beginning of its activities in Azerbaijan, the Baku office of the Global Fund has done a great deal for the ARV treatment of 150 patients with AIDS. The Baku office of the Global Fund also implements programmes for the treatment of TB patients in prisons.

At state level

The fight against AIDS is an important issue not only for the world, but also for Azerbaijan, said Haqiqat Qadirli, director of the National AIDS Centre, in an interview with R+. In 2009 alone, the country's state budget allocated more than 1 million manats to the centre. "Treatment of HIV-infected people in Azerbaijan has been carried out since 2006. There are 12 laboratories in the country. We are taking all measures necessary to reduce the level and spread of the disease. As a result, Azerbaijan is one of the countries least affected by HIV infection: among the countries of the South Caucasus, it has the second highest number of AIDS cases after Georgia. A dramatic decline in AIDS deaths has been observed since 2007 and, since the start of ARV therapy in 2006, 310 people have been provided with free treatment in Azerbaijan," said the expert.

ARV therapy is also given to prisoners with AIDS. In the prison service, such treatment has been provided since the end of 2007 and now 46 prisoners are involved. Nine inmates are infected with both HIV and tuberculosis and are undergoing treatment for both diseases in institutions for the treatment of patients with tuberculosis. HIV testing is conducted when a prisoner enters a detention centre. Risk group prisoners (drug addicts, people with tuberculosis) periodically undergo various examinations in institutions, and these examinations are kept confidential. Despite the holding of educational programmes among inmates to reduce the damage done by these diseases, the law does not allow syringes or other protective equipment to be given to them. To do this, changes are needed to the laws and internal regulations, as mentioned above. Of the total number of AIDS cases in Azerbaijan, 34.3 per cent are prisoners, most of whom were infected by intravenous drug use.