Key Emerging Issues
Central Asia has been confronting four overlapping epidemics—drug use, sexually transmitted infections (STIs), HIV/AIDS, and TB—mostly having youth at its center. The drug use, HIV/AIDS and STIs epidemics mainly affect young people, while the TB epidemic affects people in their more economically productive years. Although the number of identified 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 cause for serious concern. Central Asia lies along the drug routes from Afghanistan to Russia and Western Europe, and it is estimated to have 500,000 drug users, of which more than half inject drugs. There is a risk of major growth in the HIV/AIDS epidemic because of the risky practices reported by injecting drug users (IDUs), the high prevalence of sexually-transmitted infections (STIs), and increases in both commercial sex work (CSW) and labor migration to countries with higher prevalence of HIV/AIDS, such as Russia.
Current and future epidemics of HIV are and may continue to be driven by: a) explosive growth in injecting drug and commercial sex work use throughout the region; b) concurrent epidemics of STIs; c) economic and political migration; d) reduced capacity of governments/civil society to implement effective preventive responses; and e) low levels of awareness of HIV and STIs and of knowledge about risk behaviors and protection. These conditions in turn arise from economic decline since independence, as well as high volumes of drug transit through the region and growth of local consumer markets for these drugs.
Therefore, the countries of Central Asia are hyper-vulnerable to a serious crisis of HIV/AIDS 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, and achieving very high prevalence levels in this group; followed by a generalized epidemic, developing over 15–30 years, with sexual transmission as the predominant mode.