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The state of harm reduction in Eastern Europe and Central Asia

The state of harm reduction in Eastern Europe and Central Asia

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.

  1. To improve healthcare entry and antiretroviral therapy (ART) initiation for HIV-positive people who inject drugs (PWID) in Ukraine, an intervention built upon a successful community-based harm reduction projec...

    Authors: Alexandra Dmitrieva, Vladimir Stepanov, Ievgeniia-Galyna Lukash and Anna Martynyuk
    Citation: Harm Reduction Journal 2019 16:8
  2. We conducted a cross-sectional integrated bio-behavioral survey among sex partners of persons who inject drugs (PWID) to explore reasons for reported increase in reporting of heterosexually transmitted HIV in ...

    Authors: Anna P. Deryabina, Padmaja Patnaik and Wafaa M. El-Sadr
    Citation: Harm Reduction Journal 2019 16:1
  3. In 2012, the World Health Organization recommended that needle and syringe programs offer their clients low dead space insulin syringes with permanently attached needles. However, in many countries, these syri...

    Authors: William A. Zule, Alisher Latypov, David Otiashvili, Steffani Bangel and Georgiy V. Bobashev
    Citation: Harm Reduction Journal 2018 15:44