Government in Kazakhstan addresses HIV-infection scandal

Joanna Lillis 10/25/06

Kazakhstani President Nursultan Nazarbayev is taking swift action to defuse popular outrage over a scandal, in which at least 78 children have been infected with the HIV virus through the negligence of healthcare workers.

On October 25, Nazarbayev traveled to Shymkent, the capital of the South Kazakhstan Region, and the scene of the mass infections, to be briefed on the crisis by local officials. The first reports of children becoming infected surfaced this spring, but the trend rapidly accelerated in recent weeks. As of mid-October, at least seven of the infected children had died from HIV-related illnesses, the Health Ministry reported. Eight mothers of HIV-positive children are also infected.

The scandal has shed light on corruption within Kazakhstan's healthcare system. It also embarrasses Nazarbayev's administration, which has gone to great lengths this year to tout Kazakhstan as a rapidly modernizing nation that could soon join the ranks of the world's 50 largest economies. [For background see the Eurasia Insight archive].

The children contracted HIV via tainted blood transfusions. Among the sources of the tragedy, Health Minister Anatoly Dernovoi identified three factors: inadequate equipment, unqualified healthcare staff and misappropriation of funds, the Kazinform news agency reported October 25. Other officials have cited the embezzlement of state assets by healthcare workers as playing a major role in the infections.

Nazarbayev's visit to Shymkent was designed to demonstrate his direct involvement in improving care conditions in the region. The president received an update on the HIV situation from the health minister and the regional prosecutor. He also vowed that all those responsible for the infections would be brought to justice, and indicated that additional funds would be allocated to correct existing problems. "The economic situation in the region is not bad," the Kazakhstan Today news agency quoted Nazarbayev as saying. "The only thing that needs to be done is to put right the health situation."

Criminal proceedings are already under way. Eight senior doctors and public health officials face charges of negligence, according to Torekhan Aday, who is leading the ongoing investigation. Aday identified the accused as the former regional health department director, two of her deputies, a former senior doctor at the regional children's hospital along with his deputy and two department heads, and a former senior doctor at the regional blood center. Since those indictments, the investigation has broadened its scope; at least 12 more criminal investigations have been opened. Possible charges arising out of these probes could include bribery, Aday told Kazakhstan Today.

The scandal claimed the political careers of several top officials, with Nazarbayev installing a new health minister, Dernovoi, as well as a new regional governor for South Kazakhstan, Umirzak Shukeyev, the former mayor of the capital Astana. In struggling to contain the spread of HIV infections, authorities have screened roughly 10,000 children and 18,000 pregnant women for the disease.

"This catastrophe has arisen due to the fault of specific people," Shukeyev told a task force set up to tackle the crisis on 26 September. "They must be punished. Society expects that from us; the parents of the victims expect that from us."

Dernovoi was quick to point the finger at his predecessor, Yerbolat Dosayev, who was sacked on September 20. "Obvious medical mistakes have been made which led to the outbreak of HIV infection," Dernovoi said in remarks broadcast on Channel 31. "In this lack of professionalism we see mistakes made by the previous management. The Health Ministry is going to push through all reforms and all measures directly aimed at improving the health service for the public."

The specific origin of the infections has not yet been determined. However, mass media outlets have focused on corrupt practices in the health system. Reports have suggested that graft among hospital managers may have caused equipment shortages, leading to disposable syringes being re-used. The criminal investigation has likewise revealed irregularities in the donor system: blood given for free was re-sold; donors giving their blood for money were underpaid; and one woman remains under investigation for allegedly acting as an intermediary in blood sales.

Reports say that homeless people, prostitutes and drug addicts were routinely giving blood for money, sometimes using fictitious addresses and false IDs. Payments are relatively attractive, ranging from $16 for blood and $32 for plasma. If reports that medical staff pocketed some of that money are accurate, this would indicate both doctors and donors had a financial incentive in the transactions, thereby explaining the lax enforcement of safeguards in Shymkent.

In the wake of the infections, new, stringent standards have been introduced, a doctor at the National Blood Center in Almaty told EurasiaNet. "All laboratories are operating strictly according to the rules now," the deputy head of the center's medical unit, Aliya Mamyrkhanova, said. "Our documentation is all in order; we are strictly checking donors to avoid the transfer of infection.... We are aware of our responsibility for blood transfusion, in making sure infection is not passed on."

To many Kazakhstani citizens, reports of corruption in state-run healthcare facilities do not come as a particular surprise. A payment or gift of some sort, often discretionary, is widely seen as needed to receive attentive care, even though medical services in state-run facilities are supposed to be free. Anecdotal evidence speaks of senior doctors setting targets for junior doctors to bring in a certain sum at the end of each shift.

The families of infected children are to receive financial assistance from the state, including a preliminary payment of approximately $800, and subsidies ranging from $110 to $175 per month while the children are being treated. The children are expected to qualify for a disability allowance of approximately $70 per month until the age of 16.

Medical assistance has arrived from abroad. Two Russian experts are working on the ground, one offering psychological counseling to families and medical staff, another focusing on treatment for the infected children, UNICEF says. More foreign specialists are expected in late October.

The stigma of HIV/AIDS is a further source of trauma for the families, who face rejection by a public ignorant of HIV. Some families of infected children have gone public to report being shunned by acquaintances. UNICEF has launched a publicity campaign to encourage ethical reporting of the crisis and warn of the danger of stigmatizing the infected children. "One main problem is to avoid discrimination against children who are infected," UNICEF communications assistant Torgyn Mukayeva told EurasiaNet. UNICEF conducted a seminar in Shymkent on October 13 to promote awareness that infected people can survive with the virus.

The government is moving to tackle problems in blood transfusion centers. Reports say centers all over Kazakhstan are being inspected. It remains to be seen whether this flurry of activity will translate into real reform of the health system, which is in clear need of an overhaul. As Shukeyev, the new governor of South Kazakhstan, told medical staff in late September: "We may be seeing just the tip of the iceberg."

Editor's Note: Joanna Lillis is a freelance writer who specializes in Central Asian affairs.

Posted October 25, 2006 © Eurasianet