Guest Editor: Frederick Altice, MD, MA (Yale School of Medicine, USA)
Editor-in-Chief: Nick Crofts
Eastern Europe and Central Asia are facing ongoing epidemics of opioid use and overdose. Region-wide, the opioid epidemic is fueling a HCV epidemic and threatening progress on stemming HIV morbidity and mortality, particularly among people who inject drugs (PWID). Driven by injection drug use, Central Asian countries are currently experiencing the world’s fastest growing HIV incidence.
PWID are the most criminalized among key groups and are most vulnerable to discrimination and violations of rights by the law enforcement authorities and medical workers. Many PWID, as well as people living with HIV, are in prisons, where there are cases of violation of their rights, including the right to access to health services. Stigma, lack of documentation, inability to get insurance and be registered with health facilities create barriers to access to services in HIV prevention, treatment, care and support. Illegal law enforcement practices, as well as myths and stereotypes that jeopardize access of key populations with risky behavior to prevention and treatment that leads to hidden spread of HIV in those communities.
Drug treatment remains hard to access for injection drug users and is even less accessible to women who use drugs because of public stigma, which discourages them from seeking help. Among the PWID community, women remain the most vulnerable. Violence against this group is systemic, and perpetrated by individuals and some government agencies’ staff, including police, whose primary mission should be the protection of their rights and providing them with services regardless to their background, behavioral specifics and other factors. Violence by law enforcement officers is one of the reasons for the mistrust of women who use drugs towards state officials and their unwillingness to appeal for police help in case of violence.
Against this backdrop of continuing crisis, it is timely now to review progress – or lack of progress - in implementation of harm reduction policies and programs in the EECA regions.