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Eurasia - Regional Overview
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Following a rapid increase in injecting drug use during the 1990s, Central and Eastern Europe and Central Asia (or ‘Eurasia’) witnessed the fastest growing HIV epidemics in the world. Since 2001, the number of people living with HIV in the region has more than doubled, from 630,000 to 1.6 million. As a response to rapidly expanding HIV epidemics, all states in the region now have needle and syringe programmes (NSP), and the majority of states prescribe opioid substitution therapy (OST) for drug dependence.
Russia and Ukraine combined are home to 90% of the region’s injecting drug users, but the two countries have employed quite different responses. Ukraine has rapidly increased access to NSP and OST, but Russia prohibits the use of opioid substitution for drug treatment and the coverage of needle and syringe exchange sites is poor. Young people make up a large proportion of those who inject drugs in the region, but are neglected by public policy and underserved by harm reduction and drug treatment services, leaving them extremely vulnerable to HIV, hepatitis C and other drug related harms. In many countries, there remains an emphasis on drug law enforcement over drug treatment and harm reduction. Rapid increases in HIV prevalence within prison populations have led a number of countries to begin prescribing opioid substitution therapy to prisoners, but access to sterile injecting equipment remains a rarity.
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Injecting Drug Use, HIV and Hepatitis C
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The following maps and table outline the current available data on injecting drug use, as well as the prevalence of HIV and hepatitis C among injecting populations in ‘Eurasia’.
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The map below illustrates HIV prevalence among injecting drug users in countries of the region.
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The map below illustrates hepatitis C prevalence among injecting drug users in countries of the region.
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The following table provides the latest estimates of HIV and hepatitis C prevalence within injecting populations, as well as the estimated total number of injecting drug users in countries of the region.
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Countries/territory with reported injecting drug use
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| | Adult HIV prevalence amongst people who inject drugs**
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| Adult HCV prevalence amongst people who inject drugs***
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*Mathers, B. et al. Reference Group to the United Nations on HIV and injecting drug use (2008)
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The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet 2008, Volume 372.
**Mathers, B. et al. Reference Group to the United Nations on HIV and injecting drug use (2008) The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet 2008, Volume 372.
***Cook, C & Kanaef, N (2008) The Global State of Harm Reduction: Mapping the global response to drug-related HIV and hepatitis C epidemics. International Harm Reduction Association, UK
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Harm Reduction Policies
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Most countries in this region have an explicit supportive reference to harm reduction in their national policies on HIV and/or drugs. These are illustrated in the map and table below.
Although policy wording is not necessarily indicative of the implementation of effective harm reduction measures in a country, it does indicate governmental commitment to tackling drug related harms and is therefore an important advocacy target.
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| Explicit reference to harm reduction policies in official documents*
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*International Harm Reduction Association (March 2009) Harm Reduction Policy and Practice Worldwide: An overview of national support for harm reduction in policy and practice [PDF:2.59KB]
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Harm Reduction Programmes
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Key harm reduction interventions (including needle and syringe exchange and opioid substitution therapy) are available in almost all countries in this region, as illustrated in the maps and table below. Crucially however, coverage remains low in many countries and the sustainability of funds for harm reduction programmes continues to be an issue.
In addition, the lack of supportive legal and policy frameworks in many countries presents a substantial barrier to effective harm reduction in this region.
In many countries, there remains an emphasis on drug law enforcement over drug treatment and harm reduction. Rapid increases in HIV prevalence within prison populations have led a number of countries to begin prescribing opioid substitution therapy to prisoners, but access to sterile injecting equipment remains a rarity.
The following table indicates which countries have a) one or more needle and syringe exchange sites operational both in and outside prisons, b) prescription of opioid substitution therapy for maintenance in and outside of prisons c) one or more drug consumption rooms in countries of the region.
A tick in this table does not indicate the scope, quality or coverage of services. Also it should be noted that in some countries, harm reduction services, NSP in particular, are NGO-driven and may be operating without governmental support.
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*International Harm Reduction Association (March 2009) Harm Reduction Policy and Practice Worldwide: An overview of national support for harm reduction in policy and practice [PDF:2.59KB]
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The map below shows which countries have operational needle and syringe programmes and opioid substitution therapy programmes.
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The map below shows which countries have prison-based needle and syringe exchange programmes and opioid substitution therapy prescription.
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