Epidemics of HIV and sexually transmitted infections in Central Asia: Trends, drivers and priorities for control

ObjectiveTo present a synthetic review and analysis of data describing the epidemics of HIV, syphilis and drug use in Central Asia (except Turkmenistan), and structural factors driving these.DesignAchieving a comprehensive understanding of the co-epidemiology of HIV and STI and the structural factors driving these is key to the development of an effective response. We used a multi-methods situational analysis design to achieve this.MethodsWe used three primary methods of data collection during the first 6 months of 2004: interviews with key informants; recording and analysis of government statistics and review of scientific and grey literature.ResultsThe Central Asian countries are experiencing major epidemics of drug use driven by poor economic circumstances and the transit of at least 35% of global opiate production from Afghanistan through their territories. They are in the early stages of drug injection-associated epidemics of HIV infection, set against a background of high rates of sexually transmitted diseases. The region is one of the poorest in the world and experiences extremely high levels of economic migration, with attendant vulnerability to HIV transmission.ConclusionsCentral Asia is highly vulnerable to a crisis of HIV/AIDS, driven by structural factors which require a regional response. Without concerted action, we may expect to see the rapid development over 4–5 years of an HIV epidemic concentrated among IDUs, and achieving very high prevalence levels in this group; followed by a generalising epidemic, developing over 15–30 years with sexual transmission as the predominant mode. The region should be considered a global priority for intervention.