and Programmatic Update
There has been a five-fold increase in registered IDUs since the beginning of the 1990s. Estimates of a total number of drug users of around 200,000 (1.25 per 100,000) are constant in all available data. In 2004, 699 new cases of HIV positive were identified in the country, bringing the cumulative number to 4,696 (31.4 per 100,000) by the end of 2004, of which three quarters are IDUs. Current Government estimates put the number of persons living with HIV in Kazakhstan at more than 25,000, with over 80 percent of HIV-positive persons believed to be drug users. Syphilis incidence increased from 1.5 per 100,000 in 1990, to 231 per 100,000 in 1996, but then decreased to stabilize around 109 per 100,000 in 2002. It is not clear to what extent the decline in syphilis notifications since the mid-1990s reflects a true decrease in incidence or a decline in the number of people who turn to official medical services. There are strong indications that the most vulnerable groups—IDUs, CSWs, MSMs, migrants, and prisoners—have seen rapid increases in the country over the recent years. There are an estimated 200,000 IDUs and 20,000 CSWs in the country and levels of risk behavior appear to be high.
Strategic plans call for an inter-sectoral approach and this appears to have been achieved at high governmental level. In 2002, inter-sectoral strategic AIDS response programs for the period up to 2005 were developed by the Ministries of Health, Education, Defense, Interior, Justice, Culture, and Information. AIDS Coordination Committees were established at the ministries to implement strategic AIDS prevention and control programs. The Republican AIDS Center with technical and financial support from UNAIDS and other UN agencies, played a major role in this process, but the input of NGOs in the process, and indeed the role of NGOs more broadly in the field, is weak. The CCM, which was formed for Global Fund grant application and implementation, successfully applied