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2005-08-27-Soviet ghosts haunt Kazakh Aids policy
As midnight approaches on Sina Street in Almaty, one of Kazakhstan's main cities, groups of young female sex workers stand in the shadows by small hotels, giggling, swigging beer from bottles and smoking.
Every time a car slows down, they push forward into the light from streetlamps in the hope of being chosen by a client.
Some charge as little as $3-4 (￡1.60-2) for an hour.
Some of the young women are from Kazakhstan itself.
Others have travelled here from neighbouring Kyrgyzstan or Uzbekistan.
Although some we spoke to were well informed about HIV and said they always made sure that clients used a condom, others were confused about what HIV was and how it was transmitted.
"I'm very afraid of getting HIV," said one young woman with vivid blonde curls.
"Everyone says it's possible to get Aids from talking to someone.
"Or, you never know, you might get Aids from lying in a dirty bed or something."
In Kazakhstan, more than 5,000 people are formally registered as having HIV-Aids, but officials say the actual total is more than 13,000, in a population of about 15 million.
So far infections have been concentrated in specific groups, including drug users, sex workers and men who have sex with men.
But the fear now is of rapid spread into the general population.
But one of the difficulties in addressing this is that most people in Kazakhstan still have very conservative attitudes to these marginalised groups, a legacy in part of the Soviet era.
These attitudes make these communities more difficult to reach, as Kanat Shakenov, the HIV project manager for the United Nations Development Programme, explained.
"For instance men having sex with men," he told me, "are a really stigmatised and marginalised group of people so they don't reveal themselves to the general public and it's really hard to get access to them."
Late at night, I visited one of the few places in Kazakhstan where gay men can socialise, a gay nightclub.
The sign outside just reads "restaurant."
A guard sits at the locked door, restricting entry, and upstairs all the windows are carefully blacked out.
At the moment there are only two non-governmental groups for gay men.
They hand out condoms and leaflets about HIV in clubs like these.
One of their volunteers, Anatoli, told me that recent surveys suggested about half of all gay men still did not have basic information about HIV, about how to protect themselves from it or even how to use a condom.
"Because it's such a hidden community," he said, "it's hard to get that basic information across to everyone."
Kazakhstan still has few non-governmental organisations (NGOs), especially working with high-risk groups.
HIV programmes - and most of the funding now pouring in - are largely controlled by government ministries.
Linara Akhmedzyanova works for the international non-governmental group, the Aids Foundation East-West.
In neighbouring Kyrgyzstan, she said, NGOs work very closely with the government to reach sex workers, drug users, prison inmates and gay men and women.
But in Kazakhstan it is very difficult to have access to these people, she said.
The main government-funded body dealing with HIV-Aids is the Republican Centre for HIV, which provides a range of educational and support services nationwide.
I visited its headquarters, on a high floor of a Soviet-style block in Almaty.
Its director, Isadora Eraselova, said there were now people officially registered as HIV positive in cities, towns and villages all across Kazakhstan - a country the size of Western Europe.
"This is a big country, and we have to reach all areas," she told me.
"The government just doesn't have the same access to everyone who is affected, the way non-governmental organisations do."
So there are signs the official line is starting to change. Kazakhstan realises its old attitudes do not sit well with this new problem of HIV.
But moving away from a heavy-handed government approach is taking time.
Nurali Amanzholov is the president of a grassroots support group for people with Aids - and is himself HIV positive.
He admitted there were some positive changes.
"The government is turning its face towards people infected with HIV," he said.
"Slowly, but it is turning."
But although officials were trying, he went on, they did not always handle things well.
"Sometimes you can see the government doing something for people who are HIV positive that they don't actually want," he said.
"They try to help but end up making things worse."