The Eurasian region, comprising Central and Eastern Europe, as well as Central Asia, is home to over 3.7 million people who inject drugs, representing almost one-quarter of people who inject drugs worldwide. Injecting drug use is driving HIV epidemics in many countries in the region, where an estimated one million people who inject drugs are living with HIV.
While harm reduction service provision has increased in recent years, coverage remains limited. Needle and syringe exchange (NSP) is now provided in all countries and territories of the region. The vast majority also provide opioid substitution therapy (OST), but most of the programmes are pilots and have not been systematically scaled up. 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 among prison populations remains a rarity.
* Please refer to the table below for ranges, where these are available. The maps display midpoint averages only.
|Country/territory with reported injecting drug use||People who inject drugsa||Adult HIV prevalence amongst people who inject drugs1||Hepatitis C (anti-HCV) prevalence among people who inject drugsb||Hepatitis B (anti-HBsAg) prevalence among people who inject drugs2||Harm Reduction responsec|
|Albania||4500–50001f||<1%2||29.21||nk||Y (3)||Y (6)3 (M)|
|Armenia||3310 (2797–4057)4||10.75||nk||nk||Y (7)||Y (4)3 (M)|
|Azerbaijan||300,000h||9.55||62.95||10.95||Y (12-14)||Y (2) (M)|
|Belarus||50,0005||135||nk||nk||Y (33)5||Y (13)6 (M)|
|Bosnia and Herzegovina||nk||nk||nk||nk||Y (6)||Y (8) (BN,M)|
|Bulgaria||20,250 (16,200-24,300)||2.2(s)7||62.3(s)8||3.1(s)9||Y (100)||Y (31)3 (BN,M,O)|
|Croatia||8500g||0.01||27.1(s)8||2.4(s)9||Y (42)||Y (B,M)|
|Czech Republic||29,000 (25,494–33,823) (s)||0.0–0.67||13.68||15.1||Y (109) (P)||Y (150-240)3 (B,M,BN)|
|Estonia||13,801 (8178–34,732)||54.3–89.9 (s) h 7||90.5||21.3||Y (36)||Y (10)10 (B,M)|
|Georgia||40,00011||3.95||58.2||7.2||Y (10)||Y (16)13 (BN,M)|
|Hungary||569912||0.07||21.4(s)8||0.3(s)9||Y (25)||Y (10)3 (BN,M)|
|Kazakhstan||119,14013||3.85||61.3||7.9||Y(155)5||Y (3)3 (M)|
|Kyrgyzstan||25,00015||14.65||5016||nk||Y (29-49)5 (P)||Y (17-20)3 (M)|
|Latvia||nk||11.25||50.0 (s)8||nk||Y (18)5||Y 103 (B,M)|
|Lithuania||545816||0.0–21.4(s)7||70.3–89.7i (s)8||3.3–8.9 h9||Y (12)17||Y (21)17(B,M)|
|Moldova||13,5625||16.45||42.7||nk||Y (31)||Y (10)j (M)|
|Montenegro||nk||nk||37.8 (22-53.6)||0||Y (18)||Y (3)3(M)|
|Poland||nk||6.87||44.3-72.4(s)8||2.5-3.89||Y (27)||Y (22) (B,M)|
|Romania||17,0005||4.218||82.9(s)8||4.79||Y (3)||Y (7) (B,M)|
|Russia||1,815,500||37.15 (0.3–74)k||72.5 (49–96)||9||Y (4)||N|
|Serbia||30,383 (2682–48,083)5||2.4–4.5 (s)5||60.5–77.4(s)5||nk||Y (13)||Y (30)3 (B,BN,M)|
|Slovakia||18,841 (13,732–34,343)||0.37||40.3(s)8||nk||Y (20)||Y (2) (BN,B,M)|
|Slovenia||7310||0.47||21.58||3.4l||Y (17) (P)||Y (20) (BN,B,M,O)|
|Tajikistan||25,000 (20,000–30,000)19||16.320||61.3||nk||Y (49)||Y (3)3(M)|
|Ukraine||296,0005||21.55||67 (60.9–73)||6.7||Y (1667)5||Y (131)3(B,M)|
nk = not known
(s) = sub-national data
a Unless otherwise stated, data on the estimated number of people who inject drugs in each country are sourced from Mathers B et al. for the Reference Group to the UN on HIV and Injecting Drug Use (2008) Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review, Lancet, 372( 9651):1733–1745. The year of estimate is provided for each figure that is sourced from 2007 or earlier.
b Unless otherwise stated, estimates for hepatitis B and C are sourced from Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D & Degenhardt L (2011) Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews, Lancet, 378(9791): 571–583.
c Unless otherwise stated, data on NSP and OST coverage are sourced from Mathers B, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick RP, Myers B, Ambekar A & Strathdee SA for the Reference Group to the United Nations on HIV and Injecting Drug Use (2010) HIV prevention, treatment and care for people who inject drugs: A systematic review of global, regional and country level coverage, Lancet, 375(9719):1014–28.
d The number in brackets represents the number of operational NSP sites, including fixed sites, vending machines and mobile NSPs operating from a vehicle or through outreach workers. (P) = needles and syringes reported to be available for purchase from pharmacies or other outlets, and (NP) = needles and syringes not available for purchase.
e The number in brackets represents the number of operational OST programmes, including publicly and privately funded clinics and pharmacy dispensing programmes. (M) = methadone, (B) = buprenorphine, (BN) = buprenorphine-naloxone combination, (O) = any other form (including morphine and codeine).
f Figure based on expert opinion and based on problem drug use rather than injecting only.
g Year of estimate: 2007.
h Year of estimate: 2005.
i Year of estimate: 2006.
j Seven of these are prison NSPs.
k Year of estimate: 2003.
l Year of estimate: 2002.