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The Epidemic Of Eastern Europe And Central Asia

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THE HIV EPIDEMIC IN EASTERN EUROPE AND CENTRAL ASIA

I. Introduction:

While there is increasing evidence that HIV incidence is in decline among general populations worldwide Eastern Europe and Central Asia are notable exceptions For example HIV infections have increased 13% in the region since 2006 [2] .
A several factors contribute to these rising rates. [3]. First, the political transition in the early 1990s led to substantial economic dislocations as well as an expansion of informal and criminal economies. Second, a highly structured public health system rooted in the Soviet tradition has been unable to effectively transition to meet post-Soviet challenges. Finally, there have been dramatic increases in injection drug use (IDU), associated with an incease in opiate smuggling from the Central Asian state of Afghanistan.
Initially the HIV epidemic in the region was driven by people who inject drugs (PWIDs). However, while risk factor profiles vary substantially between countries of the region [7], surveillance data suggest heterosexual transmission has now become the leading mode of HIV transmission in this region.
Nonetheless, substance use remains an important driver of new infectoins. . Implementation of known interventions to reduce transmission in IDUs has been impeded by challenges in scaling up opioid substitution therapy (OST) as well as other harm reduction efforts such as needle exchange. The use of OST is illegal in Russia and access to these
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