Current HIV/AIDS Reports

, Volume 10, Issue 2, pp 187–193 | Cite as

Addressing Injecting Drug Use in Asia and Eastern Europe

  • Zunyou WuEmail author
  • Cynthia X. Shi
  • Roger Detels
The Global Epidemic (Q Abdool Karim, Section Editor)


While the global HIV incidence dropped about 20 % in the past 10 years, HIV incidences among people who inject drugs (PWID) in Asia and Europe continue to increase and to account for high proportions of new HIV infections among PWID globally. Great changes have been observed in this region, such as progressing from rejection to acceptance of harm reduction strategies in Asian countries, but no such change has occurred in Eastern European countries. China has quickly scaled up harm reduction activities nationwide, resulting in the decline of HIV incidence and HIV prevalence among PWID since 2006. However, insufficient scaling up of harm reduction programs in other countries has failed to slow down their HIV epidemics. In Eastern European countries where the spread of HIV among PWID is the most severe, only about 15 % of funding for harm reduction programs are from domestic sources. Strong political and financial commitment from countries in this region is urgently needed to quickly scale up evidence-based harm reduction strategies in order to prevent the HIV epidemic from spreading rapidly from PWID to the heterosexual general population.


Injecting drug use HIV/AIDS Harm reduction Antiretroviral treatment Asia Eastern Europe People who inject drugs (PWID) HIV infection among PWID 


Conflict of Interest

Zunyou Wu declares that he has no conflict of interest.

Cynthia X. Shi declares that she has no conflict of interest.

Roger Detels declares that he has no conflict of interest.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    UNODC. World drug report 2012. Vienna: UNODC; 2012.Google Scholar
  2. 2.
    Degenhardt L, Hall W. Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet. 2012;379:55–70.PubMedCrossRefGoogle Scholar
  3. 3.
    Degenhardt L, Bucello C, Mathers B, Briegleb C, Ali H, Hickman M, et al. Mortality among regular or dependent users of heroin and other opioids: a systemic review and meta-analysis of cohort studies. Addiction. 2011;106(1):32–51.PubMedCrossRefGoogle Scholar
  4. 4.
    •• UNAIDS. Global report 2012: UNAIDS report on the global AIDS epidemic. Geneva: UNAIDS; 2012. The annual UNAIDS reports on the HIV/AIDS epidemic provide comprehensive overviews on the global epidemiology of HIV, including testing, treatment, and risk behaviors of the most-at-risk populations. The 2012 report is based on data from 186 reporting countries and summarizes the current progress in reaching the 2015 targets outlined in the 2011 United Nations Political Declaration on HIV and AIDS.Google Scholar
  5. 5.
    Sidibé M, Piot P, Dybul M. AIDS is not over. Lancet. 2012;380:2058–60.PubMedCrossRefGoogle Scholar
  6. 6.
    Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372:1733–45.PubMedCrossRefGoogle Scholar
  7. 7.
    Strathdee SA, Stockman JK. Estimating the level of HIV prevention coverage, knowledge and protective behavior among injecting drug users: what does the 2008 UNGASS reporting round tell us? Curr HIV/AIDS Rep. 2010;7:99–106.PubMedCrossRefGoogle Scholar
  8. 8.
    Mesquita F, Jacka D, Ricard D, Shaw G, Tieru H, Hu Y, et al. Accelerating harm reduction interventions to confront the HIV epidemic in the Western Pacific and Asia: the role of WHO (WPRO). Harm Reduct J. 2008;5:26.PubMedCrossRefGoogle Scholar
  9. 9.
    Thorne C, Ferencic N, Malyuta R, Mimica J, Niemiec T. Central Asia: hotspot in the worldwide HIV epidemic. Lancet Infect Dis. 2010;10(7):479–88.PubMedCrossRefGoogle Scholar
  10. 10.
    Solomon SS, Celentano DD, Srikrishnan AK, Vasudevan CK, Murugavel KG, Iqbal SH, et al. Low incidences of human immunodeficiency virus and hepatitis C virus infection and declining risk behaviors in a cohort of injection drug users in Chennai, India. Am J Epidemiol. 2010;172(11):1259–67.PubMedCrossRefGoogle Scholar
  11. 11.
    Wolfe D, Carrieri MP, Shepard D. Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward. Lancet. 2010;376(9738):355–66.PubMedCrossRefGoogle Scholar
  12. 12.
    World Health Organization. Russian Federation: Summary country profile for HIV/AIDS treatment scale-up. 2005. Accessed December 29 2012.
  13. 13.
    Volik MV, Karmanova G, Berezina EB, Kresina TF, Sadykova RG, Khalabuda LN, et al. Development of combination HIV prevention programs for people who inject drugs through government and civil society collaboration in the Russian Federation. Adv Prev Med. 2012;2012:874615.PubMedGoogle Scholar
  14. 14.
    Rhodes T, Sarang A, Bobrik A, Bobkov E, Platt L. HIV transmission and HIV prevention associated with injecting drug use in the Russian Federation. Int J Drug Policy. 2004;15(1):1–16.CrossRefGoogle Scholar
  15. 15.
    Niccolai LM, Verevochkin SV, Toussova OV, White E, Barbour R, Kozlov AP, et al. Estimates of HIV incidence among drug users in St. Petersburg, Russia: continued growth of a rapidly expanding epidemic. Eur J Public Health. 2010;21(5):613–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Gyarmathy VA, Li N, Tobin KE, Hoffman IF, Sokolov N, Levchenko J, et al. Unprotected sex in heterosexual partnerships of injecting drug users in St Petersburg, Russia. AIDS Behav. 2011;15(1):58–64.PubMedCrossRefGoogle Scholar
  17. 17.
    Hayward P. First reduce harm: tackling HIV in Ukraine. Lancet. 2010;376:1287–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Laisaar KT, Avi R, DeHovitz J, Uusküla A. Estonia at the threshold of the fourth decade of the AIDS era in Europe. AIDS Res Hum Retroviruses. 2011;27(8):841–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Sa S, Hallett TB, Bobrova N, Rhodes T, Booth R, Abdool R, et al. HIV and risk environment for injecting drug users: the past, present, and future. Lancet. 2010;376(9737):268–84.CrossRefGoogle Scholar
  20. 20.
    Spicer N, Bogdan D, Brugha R, Harmer A, Murzalieva G, Semigina T. 'It's risky to walk in the city with syringes': understanding access to HIV/AIDS services for injecting drug users in the former Soviet Union countries of Ukraine and Kyrgyzstan. Glob Heal. 2011;7:22.CrossRefGoogle Scholar
  21. 21.
    Mimiaga MJ, Safren SA, Dvoryak S, Reisner L, Needle R, Woody G. “We fear the police, and the police fear us”: structural and individual barriers and facilitators to HIV medication adherence among injection drug users in Kiev, Ukraine. AIDS Care. 2011;22(11):1305–13.CrossRefGoogle Scholar
  22. 22.
    Ministry of Health of the People’s Republic of China. 2012 China AIDS response progress report. Beijing: Ministry of Health; 2012.Google Scholar
  23. 23.
    Vuong T, Ali R, Baldwin S, Mills S. Drug policy in Vietnam: a decade of change? Int J Infect Dis. 2012;23(4):319–26.Google Scholar
  24. 24.
    Reid G, Kamarulzaman A, Sran SK. Malaysia and harm reduction: the challenges and responses. Int J Drug Policy. 2007;18(2):136–40.PubMedCrossRefGoogle Scholar
  25. 25.
    Ding Y, Detels R, He N. Circumstances of initiation into new-type drug use among adults in Shanghai: Are there differences by types of first new-type drug used? Drug Alcohol Depend. 2013; doi: 10.1016/j.drugalcdep.2012.12.019.
  26. 26.
    Kissin DM, Mandel MG, Akatova N, Belyakov N, Rakhmanova AG, Voronin EE, et al. Five-year trends in epidemiology and prevention of mother-to-child HIV transmission, St. Petersburg, Russia: results from perinatal HIV surveillance. BMC Infect Dis. 2011;11:292.PubMedCrossRefGoogle Scholar
  27. 27.
    Sarang A, Stuikyte R, Bykov R. Implementation of harm reduction in Central and Eastern Europe and Central Asia. Int J Drug Policy. 2007;18:129–35.PubMedCrossRefGoogle Scholar
  28. 28.
    Narayanan S, Vicknasingam B, Robson N. The transition to harm reduction: understanding the role of non-governmental organisations in Malaysia. Int J Drug Policy. 2011;22(4):311–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Sullivan LE, Metzger DS, Fudala PJ, Fiellin D. Decreasing international HIV transmission: the role of expanding access to opioid agonist therapies for injection drug users. Addiction. 2005;100(2):150–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Metzger DS, Zhang Y. Drug treatment as HIV prevention: expanding treatment options. Curr HIV/AIDS Rep. 2010;7(4):220–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Mathers BM, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick RP, et al. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet. 2010;375(9719):1014–28.PubMedCrossRefGoogle Scholar
  32. 32.
    • Hammett TM, Des Jarlais DC, Kling R, Kieu BT, McNicholl JM, Wasinrapee P, et al. Controlling HIV Epidemics among injection drug users: eight years of cross-border HIV prevention interventions in Vietnam and China. PLoS One. 2012;7(8):e43141-e. This article reports on one of the longest studies of HIV prevention among PWID in Asia. The research found that a peer-based needle/syringe exchange intervention was strongly correlated with significant reductions in HIV incidence through 96 months.CrossRefGoogle Scholar
  33. 33.
    •• MacArthur GJ, Minozzi S, Martin N, Vickerman P, Deren S, Bruneau J, et al. Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis. BMJ. 2012;345:e5945. This article provides a systematic review and meta-analysis of studies that assessed the impact of OST in relation to HIV incidence. OST was associated with a 54 % reduction in risk of HIV infection among PWID.PubMedCrossRefGoogle Scholar
  34. 34.
    World Health Organization. Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. Geneva: World Health Organization; 2004.Google Scholar
  35. 35.
    Alistar SS, Owens DK, Brandeau ML. Effectiveness and cost effectiveness of expanding harm reduction and antiretroviral therapy in a mixed HIV epidemic: a modeling analysis for Ukraine. PLoS Med. 2011;8(3):e1000423-e.CrossRefGoogle Scholar
  36. 36.
    Lin C, Wu Z, Rou K, Yin W, Shoptaw S, Detels R. Structural-level factors affecting implementation of the methadone maintenance therapy program in China. J Subst Abuse Treat. 2010;38(2):119.PubMedCrossRefGoogle Scholar
  37. 37.
    Liu E. Factors influencing client retention in methadone maintenance treatment clinics in China [dissertation]. Los Angeles: University of California, Los Angeles; 2008.Google Scholar
  38. 38.
    Hsieh J. Perceived barriers to post-release participation in methadone maintenance treatment: Perspectives of compulsory drug detoxification center detainees in Yunnan, China [dissertation]. Los Angeles: University of California, Los Angeles; 2013.Google Scholar
  39. 39.
    • Jolley E, Rhodes T, Platt L, Hope V, Latypov A, Donoghoe M, et al. HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy. BMJ Open. 2012;2:e001465. This article provides a systematic review of the risk factors associated with HIV prevalence among PWID in Central and Eastern Europe and Central Asia and a discussion of the response to HIV and the policy environments in these regions.PubMedCrossRefGoogle Scholar
  40. 40.
    Bergenstrom AM, Abdul-Quader AS. Injection drug use, HIV and the current response in selected low-income and middle-income countries. AIDS. 2010;24 Suppl 3:S20–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Fu JJ, Bazazi AR, Altice FL, Mohamed MN, Kamarulzaman A. Absence of antiretroviral therapy and other risk factors for morbidity and mortality in Malaysian compulsory drug detention and rehabilitation centers. PLoS One. 2012;7(9):e44249.PubMedCrossRefGoogle Scholar
  42. 42.
    Vlahov D, Robertson AM, Strathdee S. Prevention of HIV infection among injection drug users in resource-limited settings. Clin Infect Dis. 2010;50 Suppl 3:S114–21.PubMedCrossRefGoogle Scholar
  43. 43.
    Sarang A, Rhodes T, Sheon N, Page K. Policing drug users in Russia: risk, fear, and structural violence. Subst Use Misuse. 2010;45(6):813–64.PubMedCrossRefGoogle Scholar
  44. 44.
    Chatterjee A, Sharma M. Moving from a project to programmatic response: scaling up harm reduction in Asia. Int J Drug Policy. 2010;21(2):134–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Zhao Y, Shi CX, McGoogan JM, Rou K, Zhang F, Wu Z. Methadone maintenance treatment and mortality in HIV-positive people who inject opioids in China. Bull World Health Organ. 2013;91:93–101.Google Scholar
  46. 46.
    Hogg R, Heath K, Yip B, Craib K, O'Shaughnessy M, Schechter M, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279(6):450–4.PubMedCrossRefGoogle Scholar
  47. 47.
    Hull MW, Wu Z, Montaner JS. Optimizing the engagement of care cascade: a critical step to maximize the impact of HIV treatment as prevention. Curr Opin HIV AIDS. 2012;7(6):579–86.PubMedCrossRefGoogle Scholar
  48. 48.
    Cohen M, Chen Y, McCauley M, Gamble T, Hosseinipour M, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.PubMedCrossRefGoogle Scholar
  49. 49.
    Zhang F, Dou Z, Yu L, Xu J, Jiao JH, Wang N, et al. The effect of highly active antiretroviral therapy on mortality among HIV-infected former plasma donors in China. Clin Infect Dis. 2008;47(6):825–33.PubMedCrossRefGoogle Scholar
  50. 50.
    Attia S, Egger M, Müller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS. 2009;23(11):1397–404.PubMedCrossRefGoogle Scholar
  51. 51.
    Binford MC, Kahana SY, Altice FL. A systematic review of antiretroviral adherence interventions for HIV-infected people who use drugs. Curr HIV/AIDS Rep. 2012;9(4):287–312.PubMedCrossRefGoogle Scholar
  52. 52.
    Malta M, Bastos FI, Silva CMFP, Pereira GFM, Lucena FFA, Fonseca MGP, et al. Differential survival benefit of universal HAART access in Brazil: a nation-wide comparison of injecting drug users versus men who have sex with men. J Acquir Immune Defic Syndr. 2009;52(5):629–35.PubMedCrossRefGoogle Scholar
  53. 53.
    Bobrova N, Sarang A, Stuikyte R, Lezhentsev K. Obstacles in provision of anti-retroviral treatment to drug users in Central and Eastern Europe and Central Asia: a regional overview. Int J Drug Policy. 2007;18:313–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Dou Z, Chen RY, Xu J, Ma Y, Jiao JH, Durako S, et al. Changing baseline characteristics among patients in the China National Free Antiretroviral Treatment Program, 2002-09. Int J Epidemiol. 2010;39 Suppl 2:ii56–64.PubMedCrossRefGoogle Scholar
  55. 55.
    Wen Y, Zhao D, Ma Y, Zhao Y, Lu L, Liu W, et al. Some patient-related factors associated with late access to ART in China' s free ART program. AIDS Care. 2011;23(10):1226–35.PubMedCrossRefGoogle Scholar
  56. 56.
    Zhang F, Haberer J, Wang Y, Zhao Y, Ma Y, Zhao D, et al. The Chinese free antiretroviral treatment program: challenges and responses. AIDS. 2007;21 Suppl 8:S143–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Des Jarlais DC. Learning from HIV epidemics among injecting drug users. Int J Drug Policy. 2010;21(2):97–9.CrossRefGoogle Scholar
  58. 58.
    Smith K, Bartlett N, Wang N. A harm reduction paradox: comparing China's policies on needle and syringe exchange and methadone maintenance. Int J Infect Dis. 2012;23(4):327–32.Google Scholar
  59. 59.
    Wu Z, Sullivan SG, Wang Y, Rotheram-Borus MJ, Detels R. Evolution of China's response to HIV/AIDS. Lancet. 2007;369(9562):679–90.PubMedCrossRefGoogle Scholar
  60. 60.
    Wu Z, Rou K, Cui H. The HIV/AIDS epidemic in China: history, current strategies and future challenges. AIDS Educ Prev. 2004;16(3 Suppl A):7–17.PubMedCrossRefGoogle Scholar
  61. 61.
    Wu Z, Liu Z, Detels R. HIV-1 infection in commercial plasma donors in China. Lancet. 1995;346:61–2.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.National Center for AIDS/STD Control and PreventionChinese Center for Disease Control and PreventionBeijingChina
  2. 2.School of Public HealthUniversity of CaliforniaLos AngelesUSA

Personalised recommendations