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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To understand why Kazakhstan isn’t doing a better job combatting AIDS, it’s helpful to speak to Maksut K. Kulzhanov, the head of the Kazakhstan School of Public Health. Kulzhanov has been a vocal supporter of Columbia’s GHRCCA since its founding in 2007, and he is now a member of the center’s scientific advisory board. His school, which is operated by the country’s ministry of health, is located on the outskirts of Almaty. To get there, you rumble down a long, pothole-strewn driveway. The building that eventually appears behind a copse of unpruned apple trees has large pieces of concrete missing from its façade. Inside, corridors are dimly lit and walls are veined with cracks.

Kulzhanov, a neatly dressed man, greets visitors with a two-handed shake. Once seated at an oak table, he explains that Kazakhstan has a long history of shortchanging public-health research, which means that health officials often lack the information they would need to respond effectively to new problems. “Under the Soviets, our government had little interest in promoting an open spirit of inquiry on this kind of thing,” Kulzhanov says. “Health-policy decisions, like all policy decisions, were made in a top-down manner.”

Assel Terlikbayeva ’03SW, professor Nabila El-Bassel ’87SW, and  Louisa Gilbert ’83BC, ’09SW, in Republic Square, Almaty, Kazakhstan

Kazakhstan created its school of public health, the nation’s first, in 1997, and the government plans to soon open a second in the capital city of Astana. But the country still has too few people trained to conduct health research, Kulzhanov says. This has crippled the nation’s response not only to AIDS but also to tuberculosis and hepatitis C, which are threatening to become epidemic. The lack of research is a particular liability in the fight against AIDS, Kulzhanov says, because there are powerful cultural forces in Kazakhstan that resist funding AIDS programs. Most citizens of this country are Muslim, he points out. Also, in Kazakhstan there is intense prejudice that lingers from Soviet culture against drug addiction, homosexuality, and other behaviors regarded as antisocial. If health officials are to secure adequate funds for HIV-prevention programs, Kulzhanov says, they’ll need to give lawmakers political cover by providing them very specific answers to questions such as: How will you reach out to these marginalized people? What messages will they find persuasive? Whom will you target first?

“But even the best-intentioned health professionals in my country,” he says, “can’t really answer these questions.”

Hearts and minds

A dozen GHRCCA researchers are packed into their tiny, run-down field office in the attic of a restaurant in Barakholka Market. The mood is tense. It’s a Thursday afternoon in late June, and the team is about to expand its study to include some 2000 additional market workers, but recruitment is down.

El-Bassel, 54, is at the meeting. As the principal investigator for GHRCCA’s studies, she visits Kazakhstan several times a year and holds daily videoconferences with her Kazakh staff when she’s back in her New York City office. She is a warm and unassuming person, almost bashful, and she has a teacher’s knack for drawing out the contributions of her colleagues, preferring the role of arbiter to orator.

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