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

  • Substance Use and Related Disorders (F Levin and E Dakwar, Section Editors)
  • Published:
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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).

Summary

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.

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Acknowledgments

The editors would like to thank Drs. Robert Friedel and Dwight Evans for taking the time to review this manuscript.

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Authors and Affiliations

  1. Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, 135 College Street Suite 323, New Haven, CT, 06510, USA

    Katherine LaMonaca & Frederick L. Altice

  2. Ukrainian Institute on Public Health Policy, Kyiv, Ukraine

    Kostyantyn Dumchev

  3. Academy of Labour, Social Relations and Tourism, Kyiv, Ukraine

    Sergii Dvoriak

  4. London School of Hygiene & Tropical Medicine, London, UK

    Lyuba Azbel

  5. Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA

    Olga Morozova

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  1. Katherine LaMonaca
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Correspondence to Frederick L. Altice.

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Kostyantyn Dumchev, Sergii Dvoriak, and Lyuba Azbel each declare no potential conflicts of interest. Katherine LaMonaca reports grants from NIH (awarded to Yale University). Olga Morozova reports grants from NIH (NIDA). Frederick L. Altice reports grants from Gilead, Merck, NIH, SAMHSA, and HRSA and personal fees from Gilead, Merck, and Practice Point Communications.

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LaMonaca, K., Dumchev, K., Dvoriak, S. et al. HIV, Drug Injection, and Harm Reduction Trends in Eastern Europe and Central Asia: Implications for International and Domestic Policy. Curr Psychiatry Rep 21, 47 (2019). https://doi.org/10.1007/s11920-019-1038-8

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