The former Soviet Union countries are experiencing the fastest growing HIV epidemics in the world, mostly through mounting injecting drug use. What are the social and economic factors driving this phenomenon in Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan?

Since gaining their independence from the Soviet Union in the early 1990s, the five Central Asian states have suffered economically and apart from the oil-rich Kazakhstan, now rank among the poorest countries in the world. This has resulted in huge migration flows in the region from poorer to richer areas, rendering people more vulnerable to risk behaviour and HIV infection. At the same time, injecting drug use and addiction exploded in these countries as a result of renewed opium trafficking from Afghanistan through Central Asia.   

Research by the University of East London’s Institute for Health and Human Development, the Curatio International Foundation and the World Bank examined the information currently available on this issue and looked at the HIV epidemic drivers in four of the five Central Asian countries (the fifth, Turkmenistan, remains closed politically and economically). The study also analysed the epidemiology of HIV, sexually transmitted infections and drug use. In the first half of 2004, interviews were held with key informants, while government data on HIV, syphilis, drug trafficking and migration were analysed and scientific and grey literature reviewed. 

The driving factors of the HIV epidemic include the huge growth in injecting drug use and commercial sex work, sexually transmitted infection epidemics and migration. The study found that:

• The rate of registered drug users per 100,000 population in Kazakhstan increased from 131 in 1996 to 302 in 2003, in Kyrgyzstan from 62 in 1996 to 126 in 2003, in Uzbekistan from 72 in 2002 to 91 in 2003, and in Tajikistan from 47 in 1999 to 104 in 2001.
• HIV rates per 100,000 population increased in Kazakhstan from 0.29 in 1996 to 4.46 in 2003, in Kyrgyzstan from 0.05 in 1996 to 3.1 in 2003, in Tajikistan from 0.52 in 2001 to 0.6 in 2003 and in Uzbekistan from 0.01 in 1996 to 7.72 in 2003.
• All four countries have experienced huge syphilis epidemics that peaked in the late 1990s but still remain at high levels. 
• About 50 percent of Afghan opium now passes through Central Asia to Russia. Afghanistan produces around 75 percent of the world’s opium.
• The areas with the worst epidemics lie along the drug trafficking and migration routes.

Unless urgent action is taken to address this potentially disastrous situation, the HIV epidemic will develop rapidly over the next four to five years, initially among injecting drug users but potentially widening to the population over 15 to 30 years. The study recommends:

• These emerging epidemics need urgently to be understood and an action plan put into place to prevent an HIV-related health crisis.
• As the drivers operate across the region, a regional response is needed involving structural interventions to reduce the vulnerability of migrants, sex workers and injecting drug users.
• Obstacles to effective interventions will be common to all four countries and will need a common response – for instance, improving legislation and improving the quality and coverage of interventions.

Source(s):
‘Epidemics of HIV and sexually transmitted infections in Central Asia: Trends, drivers and priorities for control’, International Journal of Drug Policy 17, pages 494-503, by Adrian Renton, David Gzirishvilli and George Gotsadze et al, 2006
HINARI subscribers can access the full-text article here. Full document.

Funded by: World Bank and UK Department of International Development (DFID)

id21 Research Highlight: 6 August 2007

Further Information:
Adrian Renton
Institute for Health and Human Development
University of East London
University House
Romford Road
London E15 4LZ
UK

Tel: +44 (0) 777 5893669
Contact the contributor: a.renton@uel.ac.uk

Institute for Health and Human Development, University of East London, UK

Curatio International Foundation, Georgia

World Bank

Other related links:
'Reducing drug demand in Afghanistan'

'Tackling drugs to reduce poverty'

'Development in a drugs environment'

'Needles and sex - understanding HIV in Russia, China and India'

'A matter of time - predicting the HIV/AIDS epidemic in Ukraine'

'HIV in prison in low-income and middle-income countries'