The Strategic and Regulatory
Framework for HIV/AIDS
Prevention in Central Asia
This section reviews approaches to HIV/AIDS prevention and control that are supported or even implemented through legislative and regulatory policy in Central Asia. These are primarily directed through the public health systems, but they involve multisectoral components as befits a multisectoral health challenge. The study considers funding for these approaches, vis-à-vis existing limited evidence as to costs and cost-effectiveness, and where applicable, best practices from other regions.
The policy environment of all five Central Asia Republics regarding HIV/AIDS prevention reflects the previous history of Soviet approaches to communicable diseases. The moral climate related to HIV within the Central Asia Republics depends greatly on religion, economic disruption, the rule of law, and the influence of health over policing policies. This climate has changed considerably since the beginning of the HIV epidemic, but further policy support for tolerance, human rights protections, and appropriate medical and social support for HIV-related medical conditions is needed.
Drug-related laws seem to shy away from specific criminalization for drug use, while making the possession of small amounts of illegal drugs a crime. This sets the stage for both repression and corruption. It also creates a situation in which injecting drug users (IDUs) are segregated from medical and social support systems, allowing HIV infection to become more and more concentrated until it bridges through sexual networks outside the IDU community. In terms of policy on IDU approaches, it is necessary as a priority widespread adoption of harm reduction approaches. These include non-specialized, decentralized, and more freely available substitution therapy for drug use. For this to occur, legislative change is necessary to liberalize the use of methadone and other substitution drugs, perhaps even including medically administered heroin. Narcology Centers should not be the only places authorized to provide this treatment. Needle exchange needs legalization and