Social Work Matters podcast coverAIDS has spread at an alarming rate over the past couple of decades within Central Asia, a region that is closely tied to the Silk Road, once an important trade route between China and Europe.

The epidemic is fueled, experts believe, by a breakdown in social conditions following the collapse of the Soviet Union.

While the transition from communism has improved living standards, it also introduced the problem of unemployment, which in turn has resulted in more people using drugs. Kazakhstan, Tajikistan, Turkmenistan, and Uzbekistan have all seen spikes in the numbers of HIV infections and deaths from opioid overdose.

In this podcast, we talk to Associate Professor Louisa Gilbert, who co-directs, with Willma and Albert Musher Professor Nabila El-Bassel, the School of Social Work’s Global Health Research Center of Central Asia (GHRCCA). This year marks the 10th anniversary of their efforts to assist regional NGOs in Central Asia with developing solutions to the region’s HIV/STI, hepatitis C and TB epidemics.

Also joining the podcast  is Angela Aifah, a Ph.D. student affiliated with GHRCCA.

SELECTED LINKS FROM THE EPISODE

SHOW NOTES

  • Gilbert recalls that after the fall of the Soviet Union, former Soviet republics faced the need to build their own social services and public health system. Investor and philanthropist George Soros created his Open Society Institute to support those efforts. He also sponsored scholars from Central Asia to earn degrees from leading social work schools in the United States, including CSSW.
  • Ten years ago, one of those students, Assel Terlikbayeva—who was doing research with Professor Nabila El-Bassel’s Social Intervention Group—persuaded the SIG team to try introducing a version of their couples-based HIV intervention, which they had developed for vulnerable U.S. populations, to her home country of Kazakhstan. Gilbert credits Terlikbayeva’s vision, passion and commitment as the original source of inspiration for the decision she and Professor El-Bassel first made to become involved in the region. (Terlikbayeva now serves as the regional director of GHRCCA.)
  • Gilbert points out that the Old Silk Road is the only area in the world where HIV rates have increased in the past ten years: “The old silk road became new trafficking routes for heroine.” As epidemiological maps will show, HIV has spread along those drug trafficking routes, along with the co-occurring conditions of Hepatitis C and tuberculosis. Widespread poverty, mass unemployment, and mass incarceration are the structural drivers of the epidemic, she adds.
  • When El-Bassel and Gilbert first went to Kazakhstan in 2004, they had good results right away with their couples-based therapy. This success made them realize they wanted to do more and they set up their center, GHRCCA, in 2007.
  • Despite some language barriers, the Columbia researchers felt “wide open doors” from the moment they arrived, Gilbert says, from not just leaders of advocacy groups but also government officials. They received their warmest welcomes from members of the younger generation, she added, many of whom shared Terlikbayeva’s enthusiasm for rebuilding their country.
  • GHRCCA’s research has received funding from the National Institute on Drug Abuse (NIDA), the Open Society Foundations, and USAID as well as from local institutions in Kazakhstan. Gilbert says they were happy to get this last kind of funding as it signaled they had buy-in from Kazakhstan itself.
  • GHRCCA does research, training, and education on a wide range of topics having to do with public health. Longer term trainings have sometimes taken place in New York City.
  • Angela Aifah says she had two years of working with the regional GHRCCA from a distance before finally getting a chance to visit their offices last summer. She says she appreciated having the chance to witness the impact the center’s activities are having on people’s lives. Accompanying her on the trip were three Columbia College undergrads, who had received a Minority Health Disparities Research Fellowship. Aifah says she enjoyed watching these students transform into “globally aware people” by the end of their trip.
  • Gilbert concurs that the world needs more individuals who can think globally and locally—who are aware of the roles played by culture, politics and other structural drivers and who can discern the common themes as well as differences among countries that are facing similar problems. Globally aware people, she adds, also perceive that learning takes place in both directions. In the case of GHCCA, for instance, colleagues in Kazakhstan have taught the U.S. team about how to encourage local networking and the creation of self-help groups.
  • Gilbert says that over the years GHRCCA has involved around ten faculty within the School of Social Work in their work in Central Asia. And, as the need arose, they also branched out to faculty within the Schools of Public Health and Medicine, as well as Teachers College.
  • Asked to single out the moment when the group’s efforts in Central Asia of the past ten years have made the most impact, Gilbert says she remains proudest of the way they were able to tweak their very first couples-based HIV study. The initial study achieved success, but when they returned to the data 12 months later, they discovered that five percent of the population had died of drug overdose. With funding from the OSF, they were able to give addicts their own personal supplies of naloxone, a stimulant that counteracts the effects of overdose. This brief, simple, peer -based, 20-minute training made a “huge impact” in terms of saving lives.
  • Gilbert says that during the next ten years, they would like to make the largest “population impact” possible on people at risk of TB, HIV and Hepatitis C, which remain the fastest-growing epidemics. They also foresee moving into areas of chronic-disease management. Kazakhstan, she noted, has one of highest rates of smoking and drinking in the world. And, at the suggestion of staff on the ground, they have engaged faculty from Columbia’s Department of Psychiatry to address the high rate of suicide among teens.
  • Gilbert says she foresees a time when she and Professor El-Bassel will work with the Central Asia team mostly as consultants. And if the Columbia researchers are no longer needed in ten years, “that would be an incredible thing,” she says, “our end game.”

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