This Study aims to identify strategies for ensuring early and effective intervention to control the AIDS epidemic in Central Asia at national and regional levels, considering priorities based on global evidence. It also aims to inform the Bank’s policy dialogue and the operational work to control HIV/AIDS in Central Asia, and to strengthen the regional partnership between Governments, civil society, UN agencies, and multilateral and bilateral agencies to prevent HIV/AIDS and STIs.
Central Asia2 has been confronting four overlapping epidemics—drug use, sexually transmitted infections (STIs), HIV/AIDS, and tuberculosis (TB). The drug use, HIV/AIDS, and STIs epidemics are mainly among young adults, while the TB epidemic affects adults in their more economically productive years. Although the number of reported cases of HIV in Central Asia is still very low, the growth rate of the epidemic—from about 500 cases in 2000 to over 12,000 in 2004—is a cause for serious concern.3 Central Asia lies along the drug routes from Afghanistan to Russia and Western Europe, and it is estimated that it has half a million drug users, of which more than half inject drugs. The majority of users are men under 35, although drug use is increasing rapidly among women. However, HIV infection incidence and prevalence are estimated to be several times higher than reported figures. The lack of accuracy in reporting stems from the lack of proper diagnostic systems and the absence of an efficient surveillance system.
Current and future epidemic outbreaks of HIV throughout the region may continue to be driven by: a) the explosive growth in injecting drug and commercial sex work use; b) concurrent epidemics of sexually transmitted infections (STIs); c) economic and political migration; d) limited capacity of governments and civil society to implement effective preventive responses; and e) low levels of awareness of HIV and STIs and of knowledge about risk practices and protection. These conditions arise from economic decline since independence, as well as high volumes of illicit drug transit through the region and growth of local consumer markets for these drugs.
Therefore, the countries of Central Asia are highly vulnerable to an HIV/AIDS crisis over the next 20 years. Without concerted action, we may expect to see the rapid development over 4–5 years of an HIV epidemic concentrated among injecting drug users, followed by spread in the general population aged 15–30 years, with sexual transmission as the predominant mode. This would follow the pattern of the epidemic in other regional countries such as Russia, Ukraine and Moldova.
Governments, NGOs, and international partners in the field have taken initial steps to avoid a major HIV/AIDS epidemic in Central Asia. All countries with the exception of Turkmenistan have put in place coherent overarching policies and strategies to control HIV, which were prepared with assistance from UNAIDS; and have applied for grants from the Global Fund to Fight AIDS, TB, and Malaria (GFATM), which have been granted
2. Central Asia includes Kazakhstan, Kyrgyz Republic, Tajikistan, Turkmenistan and Uzbekistan.
3. The data were provided by the Ministries of Health of the four Central Asian countries.