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

  • Katherine LaMonaca
  • Kostyantyn Dumchev
  • Sergii Dvoriak
  • Lyuba Azbel
  • Olga Morozova
  • Frederick L. AlticeEmail author
Substance Use and Related Disorders (F Levin and E Dakwar, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Substance Use and Related Disorders

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.

Keywords

HIV prevention Drug injection Harm reduction Opioid agonist therapy Eastern Europe Central Asia 

Notes

Acknowledgments

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

Compliance with Ethical Standards

Conflict of Interest

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.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Katherine LaMonaca
    • 1
  • Kostyantyn Dumchev
    • 2
  • Sergii Dvoriak
    • 3
  • Lyuba Azbel
    • 4
  • Olga Morozova
    • 5
  • Frederick L. Altice
    • 1
    Email author
  1. 1.Department of Medicine, Section of Infectious Diseases, AIDS ProgramYale University School of MedicineNew HavenUSA
  2. 2.Ukrainian Institute on Public Health PolicyKyivUkraine
  3. 3.Academy of Labour, Social Relations and TourismKyivUkraine
  4. 4.London School of Hygiene & Tropical MedicineLondonUK
  5. 5.Department of BiostatisticsYale University School of Public HealthNew HavenUSA

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