The Central Asian republics, close to the main production areas of opium in Afghanistan, minor opium producers themselves, and main corridors for drug trafficking to Russia and Europe, have experienced very large increases in illicit drug use including injecting drug use in recent years. According to UNDCP, opiate use prevalence may be approaching 1% of the population older than 15 years. In Temirtau in Kazakhstan, a city of 200,000, at least 3,000 of the 32,000 young people between 15 and 29 years are believed to be injecting drug users. The very big and growing populations of primarily young drug injectors in the Central Asian republics are at high and immediate risk of HIV infection. As in Russia heroin is gradually replacing home made opiates as the most commonly injected drug (Rhodes 1999).

In response to the first outbreak of HIV among injecting drug users in Central Asia, occurring in 1997 in Temirtau, Kazakhstan, local authorities adopted, on a pilot basis, legislation and regulations, which enabled the establishment of a pilot project on harm reduction the same year. In 1998 a series of rapid assessments and responses on HIV and injecting drug use were implemented in five cities in Kazakhstan, Kyrgyzstan and Uzbekistan. Subsequently, pilot projects in terms of so-called harm reduction trust points have been set up in all five countries, providing needle exchange, counselling, access to anonymous and confidential HIV and STI testing, condoms and information materials. (Rhodes 1999).

The governmental rehabilitation and detoxification programmes are largely insufficient for the number of drug addicts, and have little, if anything to offer other than punitive approaches. Injecting drug users remain strongly stigmatized, considered criminals by the public, a stigma which is reinforced by governmental campaigns against drug trafficking, which tend to blur the difference between drug addiction and drug trafficking. Consequently, the specialized STI, HIV/AIDS and narcological institutes are still largely unable to establish contact and credibility with vulnerable groups such as injecting drug users.

The pilot projects have clearly demonstrated their relevance and the high demand for such services, yet at the same time the shortcomings. In Kazakhstan more than 70% of the clients request access to drug treatment, but the existing capacity is grossly inadequate and the cost of the services well beyond what drug users can afford. According to the national Kyrgyz AIDS centres, the existing services, while providing services for three to four times as many clients as initially envisaged, only reach about two percents of the IDU population. In countries like Uzbekistan, where services are new, few drug users seek them of fear of being arrested by the police. In this case, outreach by volunteers, often former drug users themselves, has been the only option. (Rhodes 1999).

Reference

Rhodes T et al. Drug injecting, rapid HIV spread and the risk environment: implications for assessment and response. AIDS 13 Supp A S259-270, 1999.