Central Asia and Eastern Europe


Page last updated June 9, 2020 by Doug McVay, Editor/Senior Policy Analyst.

6. Disconnect Between Official Estimates And Actual Prevalence Of Injection Drug Use In Tajikistan

"The problem of injecting drug use and the related increase in the number of diagnosed HIV infections remains of high importance in the Republic of Tajikistan. According to official statistics, 7,135 drug-dependent persons were registered in the Republic as of January 1, 2012.
"It should be noted that these figures do not reflect the actual situation. According to an estimate by the AIDS Projects Management Group (APMG), made using calibrated empirical data and the data on registration in the drug service, the number of IDUs in Tajikistan should be estimated at 25,000, with a possible range of 20,000-30,000 (AIDS Projects Management Group, 2009).
"The number of registered heroin-dependent persons in Tajikistan between 1997 (the beginning of the epidemic of heroin use in Tajikistan) and 2011 is 5,755."

Hasanov Kh.B., Muhabatov M.S., Makhsutov M.N., Chikalov Y.P., Murodova F.R., and Nurlyaminova Z.A. "2012 National Report on the Drug Situation in the Republic of Tajikistan (Drug situation in 2011)" (Dushanbe: National Centre for Monitoring and Prevention of Drug Addiction, Ministry of Health of the Republic of Tajikistan/Central Asia Drug Action Programme (CADAP)), p. 22.

7. Injection Drug Use in Georgia

"There are approximately 40,000 people who inject drugs in Georgia, but only 4,000 of them are covered by harm reduction services. OST [Opiate Substitution Treatment] and NSPs [Needle and Syringe Programs] are largely funded through Global Fund; they cover only a few regions and at best cover up to 10% of people in need78. The state budget of Georgia allocates just $700,000 for treatment programs for people who use drugs at the same time that $10.5 million per year is spent enforcing rigid drug criminalization policies (as noted previously in this report). The skewed priorities are extremely costly from a public health and budget perspective, as criminalizing people instead of supporting them in effective drug treatment not only costs more money but increases health risks."

Merkinaite, S. "A war against people who use drugs: the costs" (Eurasian Harm Reduction Network (EHRN): Vilnius, Lithuania, 2012), p. 25.

8. Prevalence of High-Risk Behaviors Among Injection Drug Users in Central Asia

"The rapid spread of HIV among IDUs in central Asia has been aided by high prevalence of risky behaviours; 50–70% of IDUs share injecting equipment, purchase pre-filled syringes, or draw-up from common containers, and the use of condoms is low (table 4).6,32,34,52–55 Specific drug preparation practices might also increase risk, with blood used in the preparation of so-called vtoryak, a solution obtained by reprocessing materials after preparation of khanka; however, vtoryak was used by less than half of IDUs in a 2002 study in Kazakhstan.37 Studies have shown average durations of injecting of 3–9 years among IDUs, the average age of whom is decreasing.34,55–57 In Tajikistan, recent initiates were twice as likely to be HIV infected than those with longer injecting histories, suggesting riskier behaviours46 and potentially less use of harm reduction services than older, more established IDUs."

Claire Thorne, et al., "Central Asia: Hotspot in the Worldwide HIV Epidemic," The Lancet Infectious Diseases, 2010 Jul;10(7):479-88. doi: 10.1016/S1473-3099(10)70118-3

9. Harm Reduction and Treatment Lacking in East European and Central Asian (EECA) Nations

"Russia is an extreme case in many ways given its strict legal prohibition on any form of OST whatsoever for any reason. It is not entirely alone, however. In most other EECA countries, governments’ inability to allocate funds for harm reduction programming (including OST [Opioid Substitution Treatment]), HIV treatment and even treatment for hepatitis C is determined not by insufficiency of national funding, but by inadequate national priorities. Political leadership is lacking in support of prevention services for people who inject drugs, and as a result international donor mechanisms are the biggest source of funding for evidence-based services for people who use drugs. Yet the reach and effectiveness of donor investments are limited by existing law enforcement policies that do not create supportive legal environments for protecting the health of people who inject drugs."

Merkinaite, S. "A war against people who use drugs: the costs" (Eurasian Harm Reduction Network (EHRN): Vilnius, Lithuania, 2012), pp. 22-23.

10. Limited Resources Available for Harm Reduction in Ukraine

"In some places in the region, governments struggling with negative health consequences are introducing harm reduction services with international support and under pressure from civil society and international donors. For example in Ukraine, the country with the highest adult HIV prevalence in all of Europe, total annual HIV/AIDS spending has increased over the past few years, totaling for example $30 million in 2011 compared with $23 million in 200969. Yet HIV prevention programming among vulnerable populations comprised less than 1% of all HIV/AIDS expenses in 2010–2011 even as HIV among people who use drugs continued to increase70, which underscores the fact that most harm reduction interventions are dependent on international financial support."

Merkinaite, S. "A war against people who use drugs: the costs" (Eurasian Harm Reduction Network (EHRN): Vilnius, Lithuania, 2012), p. 23.