McNairy, M.L., Deryabina, A., Hoos, D., et al. Drug and Alcohol Dependence (July 2013), E-publication ahead of print.
The authors reviewed HIV services available for people who inject drugs (PWID) in Central Asian countries and discussed concerns about research on and implementation of antiretroviral therapy (ART) for prevention in this group. Overall, ART for HIV prevention among PWID in this region must be coordinated with current HIV services, ensuring that those who are HIV-positive have access to ART for treatment. HIV incidence continues to rise in Central Asia, particularly among PWID. Injection drug use accounts for nearly 63 percent, 57 percent, and 50 percent of HIV infections in Kazakhstan, Kyrgyzstan, and Tajikistan, respectively, and a high proportion of PWID engage in risky sexual behaviors. Stigma, marginalization, and restrictive policies prevent PWID from accessing HIV prevention services or drug-related treatment; creating gaps in the cascade of HIV care, including HIV testing and linkage to care and treatment. Poor adherence to ART may stem from discrimination or lack of support and counseling from trained providers to address issues for PWID. Risk-reduction strategies, such as pre-exposure prophylaxis and opioid substitution therapy, should be evaluated within a combination approach. The gaps in the HIV continuum must be addressed in a comprehensive strategy, combined with research on feasibility and interventions to increase demand for HIV testing and to strengthen retention and adherence.