Boltaev, A.A., El-Bassel, N., Deryabina, A.P., et al. Drug and Alcohol Dependence (November 2013), Vol. 132 Suppl. 1, pp. S41-S47.
Boltaev et al. reviewed the status and trends of national HIV responses for people who inject drugs (PWID) in Central Asia, highlighting structural and social barriers that enable HIV transmission among PWID, including barriers to key harm reduction services. While an increasing number of health facilities provide evidence-based interventions for PWID, structural causes of HIV risk behavior and transmission remain inadequately addressed. Barriers to an effective HIV response include discriminatory legal environments that violate the human rights of PWID, though Tajikistan and Kazakhstan have taken some action toward liberalizing drug laws. Several challenges limit implementation of evidence-based interventions. Opioid substitution therapy remains one of the region’s most politicized interventions. Other barriers include lack of qualified health care providers to address the needs of PWID, dependence on external donors, low resource allocation for key services for PWID, poorly integrated HIV services, and limited engagement of PWID in the HIV response. Effective responses to the HIV and drug use epidemics must eliminate stigma and discrimination, which requires more research. PWID must contribute to strengthening HIV service delivery. Central Asia must recognize the need for increased coverage through combinations of services to reduce HIV among PWID, and identify strategies to implement multi-level interventions.