COVER STORY

Surveyors on the New Silk Road

Columbia social workers are pulling back the curtain on AIDS in Central Asia, where the epidemic is spreading faster than anywhere else in the world.

by David J. Craig Published Fall 2010
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Unfortunately, that’s not what the researchers are finding. So far, they’ve conducted in-depth, private interviews with 422 migrant workers. Few of them inject drugs. But more than a quarter admit to having had sex with prostitutes recently, nearly half say they have multiple sex partners, and only a small number use protection. Furthermore, they know practically nothing about AIDS. They’d be hard-pressed to learn, since there are no HIV-prevention clinics anywhere near the market. A condom, it seems, is one thing that’s difficult to find in Barakholka.

“A bad situation,” says Columbia social work professor Nabila El-Bassel ’87SW, who directs the GHRCCA and oversees this research. “The potential for AIDS to spread here is definitely frightening.”

Sholpan Primbetova ’09SW interviews a worker in Barakholka Market near Almaty, Kazakhstan.

What should be done? Should Kazakhstan's government, perhaps, transfer some of its public-health resources to Barakholka? Until now, it would have been impossible to say if this would be money well spent because no AIDS research has ever been conducted here. In fact, little AIDS research has been conducted among migrant workers anywhere in Central Asia.

“This is remarkable,” says El-Bassel, “considering that AIDS is on the verge of becoming pandemic in the region and there are millions of migrant workers in Kazakhstan alone.”

By conducting studies in Barakholka Market and elsewhere in Central Asia, El-Bassel hopes to produce a clearer picture of how AIDS is spreading and might be controlled. In the process, she’s helping to train a new generation of health researchers here. Most of the fieldwork that GHRCCA conducts is done by a group of 25 Kazakhs, who El-Bassel says will be able to do this work on their own eventually. Several of these young researchers, such as Primbetova, attended Columbia’s School of Social Work; others received short-term training from the school’s faculty both in New York City and in Kazakhstan. To do this work, they’ve also given up careers in medicine, taken bruises in old-fashioned Soviet politics, and even withstood arrests and police interrogations.

In the dark

Over the past 15 years, AIDS has spread at an alarming rate throughout Central Asia and Eastern Europe. In Kazakhstan, the number of new HIV cases has doubled every two years. The epidemic is fueled, experts believe, by a breakdown in social conditions in former Soviet republics. While the transition from communism has improved living standards for many people in this part of the world, it has also introduced the novel problem of unemployment, which, in turn, has led to spikes in drug abuse, prostitution, and migration — all factors that contribute to the spread of AIDS.

In southern Kazakhstan, where El-Bassel’s team is operating, conditions are especially fertile for disease. Not only are poor migrant laborers flocking here, but drug dealers are passing through on their way from Afghanistan to Russia, making heroin cheaply available along the way. (The Columbia researchers have dubbed their work at Barakholka Market the “Silk Road Project,” an allusion both to Almaty’s location along the ancient trade route and to the current migration and drug traffic.) In some towns in southern Kazakhstan, as many as one in seven adults are heroin addicts.

Kazakhstan’s response to AIDS, meanwhile, has been slow. According to a recent United Nations report, very few people in Kazakhstan are aware of the risks of AIDS or have been tested, and condom-distribution and needle-exchange programs are not widely available. This isn’t for a lack of financial resources in the country: Since becoming independent in 1991, Kazakhstan has emerged as the economic powerhouse of Central Asia, with oil and natural-gas industries that attract billions of dollars in Western investment every year. The country has tripled its spending for health care, education, and other public services in the past decade.

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