Target 7: Have halted by 2015 and Begun to reverse, the spread of HIV/AIDS
Target 8: Have halted by 2015 and Begun to reverse, the Incidence of Tuberculosis and Malaria

Scale of the HIV/AIDS Prevalence

HIV/AIDS - is a complex and fatal disease that arises from the destroyed immune system of the body. It can be slowed down by a medicine called antiretroviral therapy, but it cannot be cured. The medicine is still too expensive for the majority of affected people. As a result, the majority of those affected by AIDS die.

Uzbekistan faces the threat of HIV/AIDS, which has emerged in late 20th century as a global menace to health, socio-economic development and security. The accumulative number of registered HIV/AIDS cases in Uzbekistan is the highest recorded in Central Asia. 2,028 new HIV cases were officially registered in 2004, thus bringing the total accumulated number to 5,612 registered HIV/AIDS cases. In 2004 the greatest number of HIV cases was noted in Tashkent city (39.7%) and in Tashkent province outside the city (27.3%).
The first incidence of HIV was registered in the country in 1987. Until 1999, reported HIV cases were mainly among adults and there was yet no strong association with drug abuse. The main cause was unprotected sex, responsible for 50 to 60% of the registered cases. Since 2000, intravenous drug abusers have started to emerge as the principal victims.

• According to official statistics, sexual activity among young people begins at the age of 20 for females and 18 for males.
• This may put them at a high risk from HIV/AIDS, due to their lack of knowledge and information.
• Official statistics state that 54 per cent of HIV cases in 2005 were among injecting drug users, many of whom are young people between the ages of 16-23.
• During the period 1999-2003, the TB mortality rate in Karakalpakstan increased by 34 per cent and in 2004 it was twice the national average.
• During the period 1999-2004, the malaria rate in Surkhandarya region has steadily declined from 66 cases in 2000 to 30 cases in 2004. Surkhandarya region has the highest prevalence of malaria cases in the country.  

Situation analysis on HIV/AIDS prevalence identify the following vulnerable groups of the population:

1. injecting drug users;
2. sex workers;
3. men having sex with men;
4. prisoners.

Increasing mother to child transmission has appeared in the last few years. The first case of HIV-positive pregnant woman was registered in Namangan city, in 1999, and by the end of 2004, the total number of HIV-positive pregnant women reached 69, with 13 new cases in 2004.

There is a lack of access to affordable, effective and appropriate services, accurate information, clean injecting equipment, condoms, voluntary, confidential counseling and testing, effective treatment of sexually transmitted infections and drug abuse related problems. Comprehensive services are not widely available and cover no more than 1% of the most vulnerable groups.

What is Being Done to Fight HIV/AIDS?

In 1999, a law was passed to protect people living with HIV/AIDS from discrimination; the right to equal access to education, employment and social protection is guaranteed by this legislation, as is the right to free care from government health organizations.
The Strategic Program on Counteracting the HIV/AIDS Epidemic (2003-2006) was adopted by the Government in 2003. It outlines the priority areas, roles and responsibilities of line ministries in managing the country's collective response.
A number of multilateral and bilateral organizations currently assist HIV/AIDS prevention in Uzbekistan. Several UN organizations provide assistance with specific interventions through both Government and NGOs and under the overall coordination of the UN Expanded Theme Group on HIV/AIDS. World Bank, DFID, USAID and JICA are implementing a number of HIV prevention projects.

TB Trends and Prevalence

2003 WHO Global Report on TB Control indicates that Uzbekistan has 20,700 cases. That is equal to 79 cases per 100,000 population, which is nearly twice that reported in 1995. Ministry of Health reports a death rate from TB of 12.3 per 100,000 in 2002 - an increase of 45% since 1995. Moreover, there is evidence of a significant spread of the drug resistance tuberculosis variety, a factor that greatly increases the likelihood of fatalities. A survey in Karakalpakstan found that 27% of tested cases were multi-drug resistant tuberculosis, among the highest rates in the world.

Main Challenges and Causes

Unlike many other countries, tuberculosis in Uzbekistan has specific features targeting mostly teenagers, young people and women of fertile age group. The morbidity rate in these groups has increased during 1999-2003 by 23%.The Aral Sea region, characterized by an ecological calamity, has the highest TB incidence. Also cotton growing regions suffer particularly because immunity of the local people was adversely affected by unlimited application of pesticides. Risk factors for tuberculosis include the following: HIV infection, low socioeconomic status, alcoholism, homelessness, crowded living conditions, diseases that weaken the immune system and migration. During 1999-2003, the TB mortality rate in Karakalpakstan increased by 34% and in 2004 it was twice the national average.

Malaria Trends and Prevalence

Malaria Trends and Prevalence Malaria in Uzbekistan was widespread until the middle of the 20th century. The disease has been under control since the late 1950s due to improved sanitation, health promotion, medicinal treatment, drying up of stagnant water reservoirs, chemical and biological eradication of mosquitoes. There are a few cases registered every year, mostly at the southern territories, bordering with Tajikistan, Afghanistan and Kyrgyzstan - Ferghana Valley, Surkhandarya and Tashkent viloyats. However, after 1995, there is clear trend of increase in the number of registered cases due to insufficient malaria control measures.

Main Challenges and Causes

Taking into account the present malaria situation in neighboring Afghanistan and Tajikistan, and the high risk of resurgence of local transmission, the MOH in Uzbekistan has intensified malaria surveillance. According to the Global Malaria Report 2005, from mid-1990's, the number of imported malaria cases continued to increase: from 21 cases in 1994 to 80 cases in 2000. In 2001, 225 cases were registered, 53 of which were the result of local transmission.33 With further exacerbation of the situation in Kyrgyzstan, there is a real threat that malaria could become a problem in Uzbekistan.

What is Being Done to Reduce TB and Malaria?

• Strategic Program on Prevention and Reduction of Tuberculosis (2004-2008).
• Law «On Protection of the Population from TB» (2001).
• Strategic Program on Prevention and Eradication of Malaria (2004-2008).
• Global Fund grants on HIV/AIDS, TB and Malaria.
• UN joint efforts to implement projects on TB and malaria prevention.