HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy

Abstract

Background and objectivesHIV among people who inject drugs (PWID) is a major public health concern in Eastern and Central Europe and Central Asia. HIV transmission in this group is growing and over 27 000 HIV cases were diagnosed among PWID in 2010 alone. The objective of this systematic review was to examine risk factors associated with HIV prevalence among PWID in Central and Eastern Europe and Central Asia and to describe the response to HIV in this population and the policy environments in which they live.DesignA systematic review of peer-reviewed and grey literature addressing HIV prevalence and risk factors for HIV prevalence among PWID and a synthesis of key resources describing the response to HIV in this population. We used a comprehensive search strategy across multiple electronic databases to collect original research papers addressing HIV prevalence and risk factors among PWID since 2005. We summarised the extent of key harm reduction interventions, and using a simple index of ‘enabling’ environment described the policy environments in which they are implemented.Studies reviewedOf the 5644 research papers identified from electronic databases and 40 documents collected from our grey literature search, 70 documents provided unique estimates of HIV and 14 provided multivariate risk factors for HIV among PWID.ResultsHIV prevalence varies widely, with generally low or medium (<5%) prevalence in Central Europe and high (>10%) prevalence in Eastern Europe. We found evidence for a number of structural factors associated with HIV including gender, socio-economic position and contact with law enforcement agencies.ConclusionsThe HIV epidemic among PWID in the region is varied, with the greatest burden generally in Eastern Europe. Data suggest that the current response to HIV among PWID is insufficient, and hindered by multiple environmental barriers including restricted access to services and unsupportive policy or social environments.

Factors mediating HIV risk among female sex workers in Europe: a systematic review and ecological analysis

“…We find that published epidemiological research lacks explicit focus in delineating structural risk factors potentially indirectly linked to HIV among FSWs, and note the need to better develop such measures. There is a similar tendency regarding research investigating HIV risk factors among PWID 2. Our review thus reiterates the need for improving the extent to which epidemiological studies seek to develop measures of social and structural context.…”

“…Figure 1 summarises the papers searched and retained in the review. Following full-text review 73 peer-reviewed and grey literature documents were identified as meeting our criteria of which 63 papers provided unique estimates of HIV and STI prevalence and nine papers report multivariate or univariate2 risk factors for HIV/STI among FSWs.…”

Human immunodeficiency virus prevalence and risk determinants among people who inject drugs in the Republic of Georgia

“…Based on a systematic review of Central and Eastern Europe and Central Asia literature, heroin is reported as the main drug in Central Europe [21]. Russia [22], Ukraine [23] and Moldova [24] report injection of homemade opioids alongside heroin.…”

Antiretroviral therapy for prevention of HIV transmission: Potential role for people who inject drugs in Central Asia

“…Police targeting, required "name-based" registers for drug treatment and HIV services, and mistreatment by the medical establishment hinder PWID health seeking behaviors, access to prevention and care services (Izenberg and Altice, 2010;Krusi et al, 2010;Mimiaga et al, 2010), use of drug treatment services, and enrollment in OST programs (Boltaev et al, 2012a(Boltaev et al, ,b, 2013. A review of studies from Eastern Europe and Central Asia reported that between half and three-quarters of PWID have experienced an arrest (Jolley et al, 2012). Incarceration of PWID also pose specific threats for those with HIV infection due to interruptions in care and treatment .…”