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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Scenes from  Barakholka Market

A Kazakh woman in her early 20s starts things off: “A lot of the guys I’m approaching don’t understand the whole confidentiality thing.” El-Bassel suggests a game of role-playing, in which the researchers demonstrate their recruitment pitches. After observing one another, they decide they need to communicate more clearly to potential subjects that participation is anonymous. “Be extremely direct on this point,” says El-Bassel. “Say to them, ‘This is all secret,’ and ‘Nobody will know who you are.’”

This work has been arduous from the start. The local researchers employed by GHRCCA are all college-educated, but few of them have studied in the West. So El-Bassel and her senior staff members, most of whom are Columbia alumni, have taught them modern research methods from scratch.

“Our subjects, meanwhile, have absolutely no concept of what research is,” El-Bassel tells me later. “We need to explain all the basics — for example, that we’re generating knowledge that will benefit their community. It’s not unlike working in a traditional culture.”

Lately, the work has become increasingly difficult. The trouble started in April, when an uprising in nearby Kyrgyzstan triggered violence between ethnic Kyrgyz and Uzbeks in that country. Soon there were news reports that Kazakhstani police were rounding up and deporting Kyrgyz immigrants, apparently for fear that the fighting would spill over the border into Kazakhstan. Since then, market workers have been reluctant to talk. “Many of them are undocumented immigrants,” says El-Bassel, a Palestinian who grew up in Tel Aviv. “They’re afraid we’re police or immigration officials.”

The researchers themselves have been caught in the security crackdown. In May, four GHRCCA researchers, with clipboards and questionnaires in hand, were arrested by police while recruiting in the market. They were interrogated in a market jailhouse for four hours before GHRCCA senior staff were able to secure their release. “The police asked about their relationship to political opposition parties inside Kazakhstan,” says Primbetova, who helped get her colleagues out of jail. “I think they worried that we’re trying to stir up political unrest.”

So today, El-Bassel and GHRCCA deputy director Louisa Gilbert’83BC, ’09SW, an associate research scientist at the Columbia University School of Social Work, have invited 10 entrepreneurs who manage Barakholka’s administrative affairs to meet with their staff. El-Bassel and Gilbert want to patch up their relationships with these market bosses. “Things got strained after the arrests,” says El-Bassel. The bosses have since promised El-Bassel that police who patrol the market won’t bother her team again; the Columbia researchers now want to ask the bosses to reassure their workers that it’s safe to participate in their study.

When the market bosses arrive, Assel Terlikbayeva ’03SW, a native Kazakh who directs GHRCCA’s local staff, gives them an overview of the team’s preliminary findings. Then she explains that controlling disease in Barakholka will be good for business. The bosses listen attentively and nod, needing no convincing.

When Terlikbayeva opens the floor to questions, however, it quickly becomes apparent how difficult it’s going to be to create a comfortable atmosphere for the workers. First to speak is a middle-aged Russian woman, with heavy makeup and dyed-blond hair, who represents the market’s 1300 shoe vendors. “Forget about this study being voluntary,” she says. “We should make the workers take part.”

Terlikbayeva shoots a sidelong glance at El-Bassel, composes herself, and calmly explains: “It has to be voluntary,” she says. “We don’t force anybody. This is a standard that other people established a long time ago, and it is a good standard.”

A man raises his hand: “If people have AIDS, they won’t want everybody else to know,” he says. “They’ll never take part.”

Terlikbayeva reassures him that the results will stay confidential. “If a subject needs medical treatment, we refer him to a clinic,” she says. “But we do it discreetly.”

After a few more questions, the bosses seem satisfied. They agree, as a next step, to hold a health fair where workers will be educated about the Columbia project. “I think this could be good,” says one of the bosses. “Good for everybody.”

Leaving the meeting, Terlikbayeva looks tired. “We have to be very patient,” she says. “We’re not simply doing research; we’re trying to change a culture.”

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