"HIV testing within prison populations has been widespread in central Asia, reflecting sentinel surveillance and mandatory testing policies. HIV prevalence among prisoners ranges from 2% in Kazakhstan to nearly 7% in Tajikistan (figure 2). By the start of 2007, more than 25% of cumulative registered HIV cases in Kazakhstan were in prisoners, and in Tajikistan, a fifth of the registered HIV population are prisoners;^32,64 these proportions reflect HIV-testing policies, criminalisation of illicit drug use, and high rates of risk behaviours among prisoners, both inside and outside prison settings.⁵⁹ In central Asia, 5–25% of prisoners are estimated to have drug dependence⁴³ and up to 70% share injecting equipment.^32,69 In one study in Kazakhstan,³⁶ the prevalence of syphilis among prisoners in temporary detention was 5%. The prevalence of tuberculosis among inmates is 60–100-times higher compared with the general population, with high tuberculosis mortality.⁶⁴"

"With financial support from national Global Fund grants and cooperation from international organisations, prevention efforts are scaling-up across central Asia, largely concentrating on IDUs and female sex workers. Harm reduction efforts for IDUs have been impeded by legislative barriers and a lack of strong political support, including hard-line policing and punitive laws on drug use.^34–36 However, Kyrgyzstan has made substantial progress in harm reduction, reflecting the explicit political support received and removal of some legal barriers.^35,43 Some central Asian countries have achieved medium coverage of IDUs with low threshold services, mainly through Trust Points and outreach; for example, coverage has reached 61% in Kyrgyzstan and about 35% in Kazakhstan and services include provision of clean needles and syringes, and condoms and VCT or referral for HIV testing. However, coverage with needle and syringe exchange programmes (NEP) and opioid substitution therapy (OST) remains suboptimum in central Asia (table 4).⁸³ Efforts are ongoing to scale-up harm-reduction activities and Kazakhstan now has a pilot OST programme, with a pilot planned in Tajikistan, although the pilot in Uzbekistan was recently closed by the government.³⁵ In Kyrgyzstan, OST has been available since 2002 and recently became available to prisoners, along with NEP.⁴³ A recent study suggested that awareness of HIV services among IDUs is highest in Kyrgyzstan at 70%, is around 50% in Kazakhstan, and lower than 10% in Tajikistan.³⁴"