The Changing Face of Disease: Implications for Society

Robin Goodwin

As the HIV/AIDS epidemic sweeps the world, and the number of adults and children infected by the HIV virus tops 34 million (Joint United Nations Programme on HIV/AIDS, 2000a) the spread of the epidemic in Central and particularly Eastern Europe has received relatively little attention (Barnett et al., 2000). Whilst the HIV/ AIDS epidemic is a relatively recent phenomenon in Eastern Europe, only beginning in the early 1990s, WHO AIDS surveillance figures indicate a rapid growth in both HIV and AIDS in Eastern Europe over the past five years, with Central and Eastern Europe now showing the world's steepest HIV curve (European Centre for Epidemiological Monitoring of AIDS in Europe, 1999; Joint United Nations Programme on HIV/AIDS, 2000b). In the towns and cities surrounding Moscow, HIV infection increased five times in the first nine months of 1999 (Joint United Nations Programme on HIV/AIDS, 2000a) and new infections during the year 2000 were higher than in all previous years of the epidemic combined (Joint United Nations Programme on HIV/AIDS, 2000b). Meanwhile the geographical location of other, less-infected nations in the former Soviet Bloc on drug routes, and the high rates of population movement across this region, raise the prospect of a rapid increase in the spread of the epidemic (Dehne et al., 1999).

A number of social and structural factors have been suggested to explain the rapid rise of HIV infection in these countries. Such explanations include the growth of temporary sexual partnerships as a means of economic survival or as a response to coping with a stressful environment (Kalichman, 1998) and the continuing acceptance of sexual violence in many of these societies, a factor contributing to high infection risk (Kalichman et al., 2000). At the same time, a widespread belief that HIV is an 'outsiders' problem associated with the 'decadent West' has led to controversial legislation which reflects the political sensitivity of the epidemic. A

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