HIV, Drug Injection, and Harm Reduction Trends in Eastern Europe and Central Asia: Implications for International and Domestic Policy

Curr Psychiatry Rep. 2019 Jun 3;21(7):47. doi: 10.1007/s11920-019-1038-8.

Abstract

Purpose of review: Scaling up evidence-based HIV prevention strategies like opioid agonist therapies (OAT), syringe services programs (SSPs), and antiretroviral therapy (ART) to mitigate the harms of drug injection is crucial within Eastern Europe and Central Asia (EECA), the only region globally where HIV incidence and mortality are increasing.

Recent findings: Though the proportion of new HIV cases directly attributable to drug injection has recently declined, it remains a critical driver of HIV, especially to sexual partners. Concurrently, scale-up of OAT, SSPs, and ART has remained low, contributing to a volatile HIV epidemic among people who inject drugs (PWID). Despite evidence that drug injection contributes to an evolving HIV epidemic in EECA, coverage of evidence-based harm reduction programs remains substantially below needed targets. Due to a combination of punitive drug laws, ideological resistance to OAT among clinicians and policymakers, and inadequate domestic and international funding, limited progress has been observed in increasing the availability of these programs.

Keywords: Central Asia; Drug injection; Eastern Europe; HIV prevention; Harm reduction; Opioid agonist therapy.

Publication types

  • Review

MeSH terms

  • Anti-HIV Agents / therapeutic use
  • Asia
  • Europe, Eastern
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control*
  • Harm Reduction*
  • Health Policy*
  • Humans
  • Narcotic Antagonists / therapeutic use
  • Needle-Exchange Programs
  • Substance Abuse, Intravenous / complications*
  • Substance Abuse, Intravenous / drug therapy

Substances

  • Anti-HIV Agents
  • Narcotic Antagonists