Central Asia and Eastern Europe

Subsections:

Page last updated June 9, 2020 by Doug McVay, Editor/Senior Policy Analyst.

1. Central Asian Nations

"Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan comprise the central Asian sub-region, home to nearly 60 million ethnically heterogeneous people, distributed across a geographic area of nearly 4 million km2 (table 1).1–5 These five countries are classified as transitional economies by the World Bank, with Kyrgyzstan, Tajikistan, and Uzbekistan having gross national incomes of less than US$650 per head, less than 20% of their pre-independence levels.6"

Claire Thorne, et al., "Central Asia: Hotspot in the Worldwide HIV Epidemic," The Lancet Infectious Diseases, 2010 Jul;10(7):479-88. doi: 10.1016/S1473-3099(10)70118-3
http://www.ncbi.nlm.nih.gov/pu...
http://www.thelancet.com/journ...

2. Prevalence of Injection Drug Use in Eastern Europe and Central Asia (EECA)

"The EECA region is home to an estimated one quarter of all people who inject drugs worldwide and has the fastest growing HIV epidemic related to unsafe injecting. The United Nations Office on Drugs and Crime (UNODC) estimates the total number of opiate users in EECA is between 3.4 and 3.8 million people19. The UN Reference Group on HIV and Injecting Drug Use also suggests that there are around 3.7 million people who inject drugs in the region, with Eastern Europe having the highest regional prevalence of injecting drug use worldwide20.

"Yet although these challenges and trends have been evident for more than a decade, drug laws and implementation policies have not eased in most countries. Most laws and policies remain punitive and repressive, thereby leading to further stigmatization of and discrimination against people who use drugs as well as increased health harms. Rigid law enforcement and criminalization also have financial consequences, especially for governments. Aggressively pursuing people who use drugs, prosecuting them and imprisoning them is costly. It also has little success in the ultimate goal of reducing drug use in general, let alone among those imprisoned—the vast majority of whom return to using in the absence of comprehensive, evidence-based treatment support such as harm reduction. The health impacts of failing to prioritize policy reform are also costly. The costs of treating people living with HIV and other chronic health conditions are far greater over time than preventing infections in the first place."

Merkinaite, S. "A war against people who use drugs: the costs" (Eurasian Harm Reduction Network (EHRN): Vilnius, Lithuania, 2012), p. 13.
http://www.harm-reduction.org/...

3. Injection Drug Use and HIV in Central Asia

"There have been substantial increases in both trafficking and use of illicit drugs in central Asia, driven by its geographic position along drug-trafficking routes from Afghanistan, domestic opium production in the south of the sub-region, and prevailing socioeconomic conditions.6,14,21,41,42 Although injection of heroin or home-made opiates (eg, so-called khanka) predominates, stimulant injection has also substantially increased, with 69% of IDUs in one Kazakhstan study43 reporting methamphetamine use. Injecting drug use has driven the HIV epidemic in central Asia so far, accounting for 50–70% of cumulative HIV cases. Reported HIV cases among IDUs increased substantially between 2002 and 2006, with increases of 82 cases (482%) in Tajikistan, 323 (130%) in Uzbekistan, 662 (132%) in Kazakhstan, and 39 (30%) in Kyrgyzstan44 and HIV prevalence among IDUs is increasing across the sub-region.31 However, HIV surveillance among IDUs is subject to selection bias, often focusing on registered IDUs who have longer injecting histories or are more likely to be in contact with health services.32 Sentinel surveillance data suggest HIV prevalence of about 7% among IDUs in Kyrgyzstan (ranging from 2% in Bishkek to 13% in the Osh province), 4% in Kazakhstan, and 16% in Uzbekistan and Tajikistan overall,32 but outbreaks of HIV among IDUs in specific cities have recently been reported, resulting in substantially higher prevalence (table 3). For example, in Dushanbe, HIV prevalence among IDUs rose from 3·9%49 in 2001 to 12% in 200444 and 24% in 2006,44 whereas in Karaganda, Kazakhstan, HIV prevalence has reached 19%.31 Rapid and substantial increases in HIV infections have recently been reported in western Siberia, Russia, with increases of up to 700% mostly among IDUs;50 increasing HIV prevalence has also been reported among IDUs living in Kazakhstan along the Russian border.50"

Claire Thorne, et al., "Central Asia: Hotspot in the Worldwide HIV Epidemic," The Lancet Infectious Diseases, 2010 Jul;10(7):479-88. doi: 10.1016/S1473-3099(10)70118-3
http://www.ncbi.nlm.nih.gov/pu...
http://www.thelancet.com/journ...

4. Prevalence of Hepatitis C Related to Injection Drug Use in Central Asia

"Prevalence of hepatitis C virus (HCV) and of syphilis among IDUs can indicate the extent of risky injecting and sexual behaviours respectively. HCV prevalence among IDUs exceeds 60% in Tajikistan and Uzbekistan and 70% in parts of Kazakhstan, and up to one in six IDUs have syphilis (table 3).31,55,58 Female IDUs are particularly vulnerable to infection with HIV, HCV, and STIs, because of the exchange of sex for drugs or money and risky injecting behaviours:52,59 28% of female IDUs in a study in Dushanbe, Tajikistan, had syphilis (75% of whom reported transactional sex) compared with 13% of men,55 and in a study in Kazakhstan, female IDUs were 2·3-times more likely to be HIV positive than men and had a syphilis prevalence of 11% compared with 5% among male IDUs.37 The estimated 20–24% of male IDUs who have sex with female sex workers also underscores how these risk groups intersect.32,47,56,57"

Claire Thorne, et al., "Central Asia: Hotspot in the Worldwide HIV Epidemic," The Lancet Infectious Diseases, 2010 Jul;10(7):479-88. doi: 10.1016/S1473-3099(10)70118-3
http://www.ncbi.nlm.nih.gov/pu...
http://www.thelancet.com/journ...

5. Prevalence of HIV in Eastern Europe

"Eastern Europe is one of the few areas of the world where HIV prevalence is on the rise, with severe and spreading epidemics reported in the Russian Federation and Ukraine. The prevalence of HIV infection among adults in Ukraine is the highest in Europe: over 1.6 per cent. The use of contaminated equipment for drug injection was reported as the source of infection in over 50 per cent of the newly diagnosed HIV cases in Eastern Europe. In Eastern Europe, the number of persons who abuse drugs by injection is currently estimated at 3.7 million, roughly 25 per cent of whom are believed to be infected with HIV."

"Report of the International Narcotics Control Board for 2010," International Narcotics Control Board (Vienna, Austria: January 2011), p. 110.
http://www.incb.org/documents/...

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