Drug Use and HIV

Eastern Europe and Central Asia (EECA) remains the only region in the world where new HIV infections continue to increase, reflecting the failure to implement the set of harm reduction approaches for people who inject drugs (PWID) that are recommended by the World Health Organization.

While much of the world is seeing declines in new HIV infections, the HIV epidemic in EECA continues to expand. The HIV epidemic continues to be concentrated among people who inject drugs (PWID), the population severely affected by HIV worldwide and especially in our region. Of the estimated 12.7 million (range from 8.9 to 22.4 million) PWID worldwide, 13.1% or 1.7 million (range from 0.9 to 4.8 million) live with HIV. Of the 1.7 million PWID living with HIV worldwide, almost 700,000 or 41% live in two sub-regions: Eastern and South-Eastern Europe and Central Asia and Caucasus. The HIV prevalence among PWID is particularly high: 23% of PWID live with HIV in Eastern and South-Eastern Europe and 7.7%of PWID live with HIV in Central Asia and Caucasus. PWID are particularly burdened by HIV in two countries of our region – 21,5%of PWID live with HIV in Ukraine and this rate may range from 18.4 to 30.7% in the Russian Federation. In many countries in the region, HIV prevalence rates among PWID are much higher than the prevalence rate in the general population: for example, in Ukraine 21.5% of PWID are living with HIV versus 0.8% in the general population; in Belarus, more than 15% of PWID are living with HIV versus 0.4% in the general population; in Estonia, more than 50% of PWID are living with HIV versus 1.3% in the general population; and in Tajikistan, more than 15% of PWID are living with HIV versus 0.3% in the general population.

While the burden of injection drug use and the burden of HIV among PWID is heavy in our region, harm reduction services are inadequate for an effective HIV prevention among PWID in many countries of our region. Few countries achieve the recommended 200 sterile syringes per PWID per year or higher coverage: 202  in the Czech Republic and 253  in Kyrgyzstan. Most of the countries, including those considered middle or higher-income countries are way below the recommended “200” coverage level. For example, in Georgia, 23 syringes are distributed per PWID per year; in Belarus – 21; in Latvia – 19; in Lithuania -32. Only 10% of PWID in Eastern Europe and 36% in Central Asia access NSPs.

Twenty-six countries in the region, with the exception of Russia, Turkmenistan and Uzbekistan, implement opioid substitution therapy (OST). OST programs continue to have limited reach, with coverage and quality varying significantly among and within states and a number of barriers remaining to implementation and scale-up.

The proportion of PWID living with HIV who receive ART in EECA varies between 3.5% in Kazakhstan and 10% in Moldova. The highest numbers of PWID living with HIV who access ART are in Ukraine (1732) and Poland (1372). While 62% of those living with HIV in the region are PWID, they account for only 22% of those receiving antiretroviral therapy (ART).



67.8% of women and 53.7% of men 

among people who inject drugs in Yekaterinburg, Russia, are living with HIV.

Bridging the Gaps: Using drugs, reducing risks
HCLU video: Ukraine is winning the battle against HIV/AIDS, but still has to fight the war.
HCLU video: Kyrgyzstan - Pioneers of Harm Reduction