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The HIV Epidemic in Eastern Europe and Central Asia

  • The Global Epidemic (S Vermund, Section Editor)
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Abstract

Eastern Europe and Central Asia represent one of the few regions globally where there is a continued increase in the incidence of HIV infection. For example, in Eastern Europe the rate of diagnosed cases of HIV infection per 100 000 population has increased from 11.7 in 2004 to 22.5 in 2011. Initially propelled by injection drug use, heterosexual transmission has now become a major driver of new infections in the region. Nonetheless substance use remains an important factor, with its control limited by challenges in scaling up harm reduction efforts. While most countries have implemented opioid substitution therapy programs, their scale remains very limited. Similarly, coverage of needles syringe programs across the region is variable. Complicating the control of HIV has been the emergence of non-injection drugs and inadequate access to antiretroviral therapy. In addition, structural barriers and stigma toward HIV infected people may contribute to the high proportion of late presentations for HIV care. Finally in the wake of the HIV epidemic, high rates of hepatitis C infection and tuberculosis have been noted.

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References

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

  1. Beyrer C, Abdool Karim Q. The changing epidemiology of HIV in 2013. Curr Opin HIV AIDS. 2013;8(4):306–10.

    PubMed  Google Scholar 

  2. World AIDS Day Report: 2012. Switzerland: UNAIDS, 2012. 2012.

  3. Coker RJ, Atun RA, McKee M. Health-care system frailties and public health control of communicable disease on the European Union’s new eastern border. Lancet. 2004;383:1389–92.

    Article  Google Scholar 

  4. UNICEF. A decade of transition, Regional Monitoring Report, No.8. Florence: UNICEF Innocenti Research Center; 2001.

    Google Scholar 

  5. Vlassov V. Is there epidemiology in Russia? J Epidemiol Commun Health. 2000;54:740–44.

    Article  CAS  Google Scholar 

  6. Beyrer C, DW, Celentano D. Public Health Aspects of HIV/AIDS in Low and Middle Income Countries., in “The HIV/AIDS Epidemics in the former Soviet Union, Central Asia and Iran.” I.D.C.a.C.B. (eds). Editor. 2008, New York:Springer Press.

  7. Gouws E, Cuchi P, H.I.V.I.b.M.o.T. International Collaboration on Estimating. Focusing the HIV response through estimating the major modes of HIV transmission: a multi-country analysis. Sex Transm Infect. 2012;88(Supp 2):i76–85.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Europe., E.C.f.D.P.a.C.W.R.O.f. HIV/AIDS surveillance in Europe 2011, in Stockholm: European Centre for Disease Prevention and Control. 2012.

  9. Sullivan LE, Fudala PJ, Fiellin DA. Decreasing inernational HIV transmission: the role of expanding access to opioid agonist therapies for injection drug users. Addiction. 2005;100:150–8.

    Article  PubMed  Google Scholar 

  10. Platt L, et al. Factors mediating HIV risk among female sex workers in Europe: a systematic review and ecological analysis. BMJ Open 2013; 3(7).

  11. Wagner KD et al. Drug-using male clients of female sex workers who report being paid for sex: HIV/sexually transmitted infection, demographic, and drug use correlates. Sex Transm Dis. 2013. doi:10.1097/OLQ.0b013e31829569ec. The paper examines HIV/STI among 170 drug-using male clients of FSWs in Tijuana, Mexico to determine the extent to which these men report being paid for sex and the association with positive HIV/STI results. Findings suggest that drug-using male clients of FSWs may be characterized by unique risk profiles that require tailored HIV prevention interventions. The findings have important implications for prevention for FSWs.

    PubMed  Google Scholar 

  12. Talu A et al. HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: implications for intervention. Int J Drug Policy. 2010;21(1):56–63.

    Article  PubMed  Google Scholar 

  13. Grund JP, Latypov A and Harris M. Breaking worse: the emergence of krokodil and excessive injuries among people who inject drugs in Eurasia. Int J Drug Policy. 2013.

  14. El-Bassel N, Strathdee S and El Sadr W. People who inject drugs in Central Asia and HIV: Confronting the perfect storm. Drug Alcohol Depend. 2013.

  15. Thekkemuriyi DV, JS, Pillai U. ‘Krokodil’-A Designer Drug from Across the Atlantic, with Serious Consequences. Am J Med. 2013;(13): 00879-6.

  16. Beyrer C et al. Characterization of the emerging HIV type 1 and HCV epidemics among injecting drug users in Dushanbe, Tajikistan. AIDS Res Hum Retrovir. 2009;25(9):853–60.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Walsh N, Maher L. HIV and viral hepatitis C coinfection in people who inject drugs: implications of new direct acting antivirals for hepatitis C virus treatment. Curr Opin HIV AIDS. 2012;7(4):339–44.

    Article  CAS  PubMed  Google Scholar 

  18. El-Bassel N, et al. hiv among injection drug users and their intimate partners in Almaty, Kazakhstan. AIDS Behav. 2013: 1–11.

  19. Grund J-PC, Latypov A and Harris M. Breaking worse: the emergence of krokodil and excessive injuries among people who inject drugs in Eurasia. Int J Drug Policy. 2013.

  20. Europe BN. Russia reports 12% rise in HIV - 200 new cases a day. 28 November 2012.

  21. Baral S et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–49.

    Article  PubMed  Google Scholar 

  22. Decker MR, WA, Moguilnyi V, Peryshkina A, Ostrovskaya M, Nikita M, Kuznetzova J, et al. Female sex workers in three cities in Russia: HIV prevalence, risk factors and experience with targeted HIV prevention. AIDS Behav. 2013. doi: 10.1007/s10461-013-0577-y.

  23. Zohrabyan L, JL, Scutelniciuc O, Iovita A, Todirascu L, Costin T, Plesca V, et al. Determinants of HIV infection among female sex workers in two cities in the Republic of Moldova: the role of injection drug use and sexual risk. AIDS Behav. 2013;17(8): 2588–96.

  24. Dolan K et al. HIV in prison in low-income and middle-income countries. Lancet Infect Dis. 2007;7(1):32–41.

    Article  PubMed  Google Scholar 

  25. van der Werf MJ, HV, Noori T. Is tuberculosis crossing borders at the Eastern boundary of the European Union?. Eur J Public Health. 2013;23(6): 1058–63.

  26. Amirkhanian YA et al. Male labor migrants in Russia: HIV risk behavior levels, contextual factors, and prevention needs. J Immigr Minor Health. 2011;13(5):919–28.

    Article  PubMed  Google Scholar 

  27. Weine S et al. HIV sexual risk behaviors and multilevel determinants among male labor migrants from Tajikistan. J Immigr Minor Health. 2013;15(4):700–10.

    Article  PubMed  Google Scholar 

  28. Europe, E.C.f.D.P.a.C.W.R.O.f. Tuberculosis surveillance and monitoring in Europe 2013. 2013.

  29. Post FA et al. Multi-drug-resistant tuberculosis in HIV positive patients in Eastern Europe. J Infect. 2013. doi:10.1016/j.jinf.2013.09.034.

    PubMed  Google Scholar 

  30. Dalton T, Cegielski P, Akksilp S, Asencios L, Campos Caoili J, Cho S-N, et al. Prevalence of and risk factors for resistance to second-line drugs in people with multidrug-resistant tuberculosis in eight countries: a prospective cohort study. Lancet. 2012;380(9851): 1406–17.

    Google Scholar 

  31. Network, C.a.E.E.H.R. Hepatitis C Among Injecting Drug Usersin the New EU Member States and Neighboring Countries: SITUATION, GUIDELINES AND RECOMMENDATIONS. 2007.

  32. Ocheret D, BD, Sultangaziev A, Matuizaite E. Eurasian Harm reduction Network. Current situation regarding access to hepatitis C treatment in Eastern Europe and Central Asia. 2012.

  33. Mathers BM 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.

    Article  PubMed  Google Scholar 

  34. Hurley SF, Jolley DJ, Kaldor JM. Effectiveness of needle-exchange programmes for prevention of HIV infection. Lancet. 1997;349(9068):1797–800.

    Article  CAS  PubMed  Google Scholar 

  35. Uusküla A, DJD, Kals M, Rüütel K, Abel-Ollo K, Talu A, Sobolev I. Expanded syringe exchange programs and reduced HIV infection among new injection drug users in Tallinn, Estonia. BMC Public Health. 2011;30(11): 517.

  36. Vasquez C, LD, Nikolaenko S, Yatsishin S, Lesnikova D, Cox D, Pankovich J, et al. St Petersburg-CIHR Canadian HIV Trials Network Collaboration. Gender disparities in HIV risk behavior and access to health care in St. Petersburg, Russia. AIDS Patient Care STDS. 2013;27(5): 304–10.

  37. Uusküla A, LK, Raag M, Šmidt J, Semjonova S, Kogan J, Amico KR, et al. Antiretroviral therapy (ART) adherence and correlates to nonadherence among people on ART in Estonia. AIDS Care. 2012;24(12): 1470–9.

  38. Mocroft A et al. Risk factors and outcomes for late presentation for HIV-positive persons in europe: results from the collaboration of observational HIV epidemiological research europe study (COHERE). PLoS Med. 2013;10(9):e1001510.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Sarang A, RT, Sheon N. Systemic barriers accessing HIV treatment among people who inject drugs in Russia: a qualitative study. Health Policy Plan. 2013;28(7): 681–9.

  40. Des Jarlais DC, U.A. Multiple HIV Prevention Packages for IDUs in Estonia. Presentation at the NIH MP3 Investigators meeting, NIH, Bethesda, USA 2013.

  41. Spicer N, et al. ‘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. Global Health. 2011;7(7): 22.

    Google Scholar 

  42. Amirkhanian YA et al. People with HIV in HAART-era Russia: transmission risk behavior prevalence, antiretroviral medication-taking, and psychosocial distress. AIDS Behav. 2011;15(4):767–77.

    Article  PubMed  Google Scholar 

  43. Bikmukhametov DA et al. Bias in medicine: a survey of medical student attitudes towards HIV-positive and marginalized patients in Russia, 2010. J Int AIDS Soc. 2012;15(2):17372.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Kiriazova TK, PO, Perehinets IB, Neduzhko OO. Association of injecting drug use and late enrolment in HIV medical care in Odessa Region, Ukraine. HIV Med. 2013;14(Supp 3): 38–41.

  45. Opioid treatment in Ukraine risks losing momentum, in Bulletin of the World Health Organization. 2013. p. 81–156.

  46. World AIDS. Day Report: 2012. Switzerland: UNAIDS; 2012.

    Google Scholar 

  47. UNAIDS. Country report on progress in implementation of the global response to HIV infection, Kazakhstan 2012. 2012, Joint United Nations Programme on HIV/AIDS Geneva, Switzerland.

  48. Donoghoe M. Why is the HIV epidemic in Eastern Europe and Central Asia the fastest growing in the world and what can we do to stop it? , in XIX International AIDS Conference. 2012: Washington, D.C.

  49. Jolley E, 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(5).

  50. Thorne C et al. Central Asia: hotspot in the worldwide HIV epidemic. Lancet Infect Dis. 2010;10(7):479–88.

    Article  PubMed  Google Scholar 

  51. UNAIDS. Country report on progress in implementation of the global response to HIV infection, Kyrgyz Republic 2012. 2012, Joint United Nations Programme on HIV/AIDS Geneva, Switzerland.

  52. UNAIDS. Country report on progress in implementation of the global response to HIV infection, Uzbekistan 2012. 2012, Joint United Nations Programme on HIV/AIDS Geneva, Switzerland.

  53. Kazakhstan R.A.C.-. Report on AIDS service activities for 2012. 2012, Republican AIDS Center of the Republic of Kazakhstan: Almaty.

  54. Kyrgyzstan R.N.C.-. Program monitoring data. 2013, Republican Center of Narcology of the Kyrgyz Republic.

  55. Tajikistan R.A.C.-. 2011. Republican AIDS Center of the Republic of Tajikistan: Dushanbe.

  56. Uzbekistan R.A.C.-. Results of the sentinel surveillance study. 2011, Republican AIDS Center of the Republic of Uzbekistan: Tashkent.

  57. Yusopov O. National report on the drug situation in the Republic of Kazakhstan for 2011. 2012, National scientific-practical center on medical and social problems of drug addiction/CADAP: Astana-Prague.

  58. Mravcik V. National report on the drug situation in the Republic of Uzbekistan for 2011. 2012: Prague.

  59. Boltaev A, et al. The scaling up of HIV prevention for people who inject drugs in Central Asia: a review of structural challenges and ways forward. Drug Alcohol Depend. 2013.

  60. Boltaev A et al. Evaluation of a PilotMedication-assisted therapy program in kazakhstan: successes, challenges, and opportunities for scaleup advances. Prev Med. 2012. doi:10.1155/2012/308793. The paper reviews the current status and trends of national efforts in CA countries to control HIV among people who inject drugs and key structural and health systems-related challenges. The paper underscores that scaling up prevention and treatment demand attention to structural, health-care and social factors that facilitate HIV risk andimpede utilization of harm reductionservices.

    Google Scholar 

  61. UNAIDS. UNAIDS Report on the Global AIDS Epidemic 2012 (Annexes). Geneva: UNAIDS; 2012.

    Google Scholar 

  62. Cáceres C et al. Estimating the number of men who have sex with men in low and middle income countries. Sex Transm Infect. 2006;82 suppl 3:iii3–9.

    PubMed Central  PubMed  Google Scholar 

  63. Morris MD et al. Factors associated with pathways toward concurrent sex work and injection drug use among female sex workers who inject drugs in northern Mexico. Addiction. 2013;108:161–70.

    Article  PubMed Central  PubMed  Google Scholar 

  64. Syvertsen JL et al. Where sex ends and emotions begin’: love and HIV risk among female sex workers and their intimate, non-commercial partners along the Mexico-US border. Cult Health Sex. 2013;15(5):540–54. This study among female sexworkers utilizes qualitative data to understand emotional relationships between females and their non-commercial partners, pointing to the role of intimacyin decisions about drug and sexual risk behaviors.

    Article  PubMed Central  PubMed  Google Scholar 

  65. Uusküla A et al. Condom use and partnership intimacy among drug injectors and their sexual partners in Estonia. Sex Transm Infect. 2012;88(1):58–62.

    Article  PubMed  Google Scholar 

  66. Hillis SD et al. HIV seroprevalence among orphaned and homeless youth: no place like home. AIDS. 2012;26:105–10.

    Article  PubMed  Google Scholar 

  67. WHO. Global tuberculosis report. Geneva: World Health Organization; 2012.

    Google Scholar 

  68. Schluger NW et al. Tuberculosis, drug use and HIV infection in Central Asia: an urgent need for attention. Drug Alcohol Depend. 2013;132:S32–6.

    Article  PubMed  Google Scholar 

  69. Schluger NW, E-BN, Hermosilla S, Terlikbayeva A, Darisheva M, Aifah A, et al. Tuberculosis, drug use and HIV infection in Central Asia: An urgent need for attention. Drug Alcohol Depend. 2013;132: S32–6.

  70. Walsh N, Maher L. HIV and HCV among people who inject drugs in Central Asia. Drug Alcohol Depend. 2013. doi:10.1016/j.drugalcdep.2013.06.030. The paper examines the relationship between HCV and HV among people who use drugs in CA .It shows that while the HIV treatment response has, HCV diagnosis and treatment in the region for people who use drugs remain limited. Improving access to HCV diagnosis and treatment is urgently needed in CA especially for people who use drugs.

    PubMed Central  Google Scholar 

  71. Larney S et al. The incidence and prevalence of hepatitis C in prisons and other closed settings: results of a systematic review and meta‐analysis. Hepatology. 2013. doi:10.1002/hep.26387.

    Google Scholar 

  72. PEPFAR. Central Asia Region Operational Plan Report FY 2010. Washington, D.C: United States Government; 2010.

    Google Scholar 

  73. WHO. European action plan for HIV/AIDS 2012-2015. Geneva: World Health Organization; 2011.

    Google Scholar 

  74. UNAIDS. UNAIDS Global AIDS Response Progress Reporting: Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan. 2012, UNAIDS: Available at: http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/.

  75. WHO. Antiretroviral Therapy for HIV infection in adults and adolescents: recommendations for a Public Health Approach. 2010 Revision. Austria: WHO; 2010.

    Google Scholar 

  76. Deryabina A et al. Report on the Evaluation of HIV integrated biobehavioral surveillance in the Republic of Kazakhstan. Almaty: ICAP; 2012.

    Google Scholar 

  77. Deryabina A. Mapping of key HIV services, assessment of their quality, and analysis of gaps and needs of most-at-risk populations in Chui Oblast and Bishkek City, Kyrgyzstan. Arlington: USAID’s AIDS Support and Technical Assistance Resources, AIDSTAR-One, Task Order 1; 2011.

    Google Scholar 

  78. Spicer N et al. Circus monkeys or change agents? Civil society advocacy for HIV/AIDS in adverse policy environments. Soc Sci Med. 2011;73(12):1748–55.

    Article  PubMed  Google Scholar 

  79. 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.

    Article  PubMed  Google Scholar 

  80. Mimiaga MJ et al. “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. 2010;22(11):1305–13.

    Article  PubMed Central  PubMed  Google Scholar 

  81. Grabbe KL et al. Increasing access to HIV counseling and testing through mobile services in Kenya: Strategies, utilization and cost-effectiveness. J Acquir Immune Defic Syndr. 2010;54(3):317.

    Article  PubMed Central  PubMed  Google Scholar 

  82. El-Bassel N, Terlikbaeva A, Pinkham S. HIV and women who use drugs: double neglect, double risk. Lancet (Br Ed). 2010;376(9738):312.

    Google Scholar 

  83. Wood RA. Issues of gender in injection drug use: examining contextual circumstances of women’s first injecting experience and factors associated with treatment engagement. 2010.

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Acknowledgements

Dr. DeHovitz acknowledges partial support from grant from Fogarty International Center and National Institute of Drug Abuse, (D43 TW000233). Dr. El-Bassel acknowledges the partial support received from a grant from the National Institute of Drug Abuse (R01DA033168).

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Conflict of Interest

Jack DeHovitz, Anneli Uuskula, and Nabila El-Bassel declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. SUNY Downstate Medical Center, 450 Clarkson Ave., MSC 1240, Brooklyn, NY, 11203, USA

    Jack DeHovitz

  2. Department of Public Health, University of Tartu, Ravila 19, Tartu, 50411, Estonia

    Anneli Uuskula

  3. Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 814, New York, NY, 10027, USA

    Nabila El-Bassel

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  3. Nabila El-Bassel
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Correspondence to Jack DeHovitz.

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DeHovitz, J., Uuskula, A. & El-Bassel, N. The HIV Epidemic in Eastern Europe and Central Asia. Curr HIV/AIDS Rep 11, 168–176 (2014). https://doi.org/10.1007/s11904-014-0202-3

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