Injection Drug Use and HIV in Central Asia

"There have been substantial increases in both trafficking and use of illicit drugs in central Asia, driven by its geographic position along drug-trafficking routes from Afghanistan, domestic opium production in the south of the sub-region, and prevailing socioeconomic conditions.^{6,14,21,41,42} Although injection of heroin or home-made opiates (eg, so-called khanka) predominates, stimulant injection has also substantially increased, with 69% of IDUs in one Kazakhstan study⁴³ reporting methamphetamine use. Injecting drug use has driven the HIV epidemic in central Asia so far, accounting for 50–70% of cumulative HIV cases. Reported HIV cases among IDUs increased substantially between 2002 and 2006, with increases of 82 cases (482%) in Tajikistan, 323 (130%) in Uzbekistan, 662 (132%) in Kazakhstan, and 39 (30%) in Kyrgyzstan⁴⁴ and HIV prevalence among IDUs is increasing across the sub-region.³¹ However, HIV surveillance among IDUs is subject to selection bias, often focusing on registered IDUs who have longer injecting histories or are more likely to be in contact with health services.³² Sentinel surveillance data suggest HIV prevalence of about 7% among IDUs in Kyrgyzstan (ranging from 2% in Bishkek to 13% in the Osh province), 4% in Kazakhstan, and 16% in Uzbekistan and Tajikistan overall,³² but outbreaks of HIV among IDUs in specific cities have recently been reported, resulting in substantially higher prevalence (table 3). For example, in Dushanbe, HIV prevalence among IDUs rose from 3·9%49 in 2001 to 12% in 2004⁴⁴ and 24% in 2006,⁴⁴ whereas in Karaganda, Kazakhstan, HIV prevalence has reached 19%.³¹ Rapid and substantial increases in HIV infections have recently been reported in western Siberia, Russia, with increases of up to 700% mostly among IDUs;⁵⁰ increasing HIV prevalence has also been reported among IDUs living in Kazakhstan along the Russian border.⁵⁰"