We recently met with partners from Central Asia at the Technical Consultation on experiences and challenges in prevention of HIV in injecting drug users in the Central Asian Member States of the World Health Organization (WHO) European region. The meeting was organized under the lead of WHO Europe in collaboration with the Ministry of Health of the Republic of Kazakhstan, UNAIDS, UNODC, UNDP and UNICEF.
Together with our Government partners from Tajikistan, we presented information on the cost-effectiveness of needle exchange programmes and optimizing service delivery. The UNAIDS led regional initiative on the cost-effectiveness of needle exchange programmes engaged UNDP and the government of Tajikistan in comprehensive analysis of the research findings. See: presentations – Tajikistan: Optimizing service delivery: Promoting linkages, integration and collaboration and Evaluating the cost-effectiveness of needle and syringe exchange programmes (NSEPs) in Tajikistan.
Injecting drug users are still those most affected by the HIV epidemic in Central Asia and also constitute the highest number of newly diagnosed HIV infected individuals in the region.
Source: Evaluating the cost-effectiveness of needle and syringe exchange programmes in Tajikistan – 2012 Report
Internationally agreed guidelines exist for what we call “harm reduction,” which includes prevention, treatment, care and support, also in prison or other detention settings. By using this approach, it is feasible to have zero new infections and zero AIDS-related deaths – even for the high risk population of injecting drug users. (See: WHO, UNODC, UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users and UNAIDS 2011-2015 Strategy “Getting to Zero”).
However, harm reduction programmes face major challenges in many countries in the region, including Ukraine and Russia, which account for some 90 percent of people living with HIV in Eastern Europe and Central Asia.
Currently, countries in Central Asia do not have needle exchange programmes or opioid substitution therapy on a scale that can turn the epidemic around and fulfill the basic human right foruniversalaccess to life saving health services.
Kyrgyzstan and Tajikistan have introduced opioid substitution therapy, and are working to scale up access. Both countries have also introduced needle and syringe exchange programmes (NSEP) in prison settings with prospects of scaling up access. Kazakhstan has just successfully completed a pilot opioid substitution therapy programme, and is deciding whether to officially include it as part of their harm-reduction health care services.
The situation in the sub-region is further complicated by:
- Criminalization of drug users resulting in additional HIV risk exposure in and out of prison;
- Main drug-trafficking routes from the East and Afghanistan cross through Tajikistan, Kyrgyzstan, Ukraine and Kazakhstan;
- Worsened socio-economic perspectives of youth in Central Asia;
- The failure of international and national drug policies which have largely a negative impact on the HIV epidemic due to a restrictive framework for health interventions for most-at-risk populations.
Although UNDP is not the lead UNAIDS co-sponsor in HIV prevention, treatment and care services for injecting drug users, as convener for rights-based approaches and by playing the role of principal recipient to Global Fund HIV grants in Kyrgyzstan, Tajikistan and Uzbekistan, we have a substantive programming focus on this critical component of the HIV epidemic in Eastern Europe and Central Asia.
Needle exchange and opioid substitution therapy programmes are the most critical interventions with proven effectiveness and cost-efficiency to prevent HIV infections among injecting drug users (IDUs). They need to be implemented in all countries of the region, on a scale which matches the needs.
- IPDC briefing paper on Opioid Substitution Therapy in Eurasia
- More information on Technical Consultation meeting on experiences and challenges in the prevention of HIV in injecting drug users (IDUs) in Central Asian Member States of the WHO European region