Central Asia in the spotlight: growing HIV epidemic among people who inject drugs
In Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan more than half of newly diagnosed HIV infections occur among people who inject drugs.
Copenhagen and Astana, 19 June 2012
In the WHO European Region, people who inject drugs are particularly at risk of being infected with HIV. Concern is increasing in five central Asian countries (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan), where more than half of newly diagnosed HIV infections occur among such people. This is the focus of the first meeting organized by WHO/Europe to address HIV prevention in this group in the central Asian republics. The meeting is an expert consultation, hosted by the Ministry of Health of Kazakhstan and held in Astana on 19–21 June 2012. It spotlights an area of the world where the problem has not received sufficient attention and needs urgent action.
These five countries report that almost 190 000 people practise injecting drug use. While the number of new HIV infections is decreasing globally, the number of newly diagnosed infections in central Asia is 14 times that in 2000; people who inject drugs account for over half of these cases. In addition, the five countries have a high prevalence of hepatitis C in this group (5–75%), and the highest rates of multidrug-resistant tuberculosis (MDR-TB) in the world, with people who inject drugs among the most vulnerable.
Reducing by 50% the number of new HIV infections acquired through injecting drug use is one of the key goals of the European Action Plan for HIV/AIDS 2012–2015, which all countries in the WHO European Region adopted in 2011. Evidence indicates that interventions can prevent the spread of HIV in people who inject drugs, including distribution of sterilized needles and syringes at little or no cost, substitution of illicit drug use with opioid therapy, testing and counselling for people living with HIV and antiretroviral therapy.
In central Asia, however, only 11% of all HIV-prevention investment focuses on populations at higher risk. Only one third of people who inject drugs are reached by needle and syringe programmes, and just 1% receive opioid substitution therapy. This group accounts for more than half of people living with HIV in central Asia, but less than one fourth of all people living with HIV who are receiving antiretroviral therapy.
The interaction of injecting drug use with sex work and imprisonment is further accelerating the spread of HIV in central Asia. Up to 9 out of 10 people who inject drugs are imprisoned at some stage in their lives. In prison, they are exposed to behaviour with a high risk of the transmission of HIV and other infectious diseases, such as sharing injecting equipment, tattooing and piercing. HIV prevalence has been reported to be 8% among prisoners, significantly higher than in the general population.
The consultation is the first in central Asia to look at the link between people who inject drugs and HIV from a multisectoral perspective, and includes national experts from the health, justice and interior sectors, and civil-society organizations. Many United Nations agencies have worked closely with WHO/Europe to organize the consultation, including the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Office on Drugs and Crime (UNODC), the United Nations Development Programme (UNDP), the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA). The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) are also involved.
The 70 experts gathered in Astana are expected to review barriers to access to HIV prevention services in central Asian countries and identify ways to increase the coverage, penetration and quality of HIV prevention, treatment and care services for people who inject drugs. It is hoped that this will help to reduce new infections acquired through injecting drug use by 50%, and eventually to control the HIV epidemic in the European Region.
Source: WHO Europe