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Central Asia is one of the few regions in the world where the HIV epidemic continues to grow. Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan face concentrated epidemics, with syringe and needle sharing among injecting drug users the most common mode of transmission. HIV seroprevalence is highest among unemployed young men and prisoners, though the proportion of women infected with HIV is steadily increasing. Several outbreaks of HIV infection have been reported in the region among children in hospital settings.
HIV in Central Asia
The provision of antiretroviral therapy to HIV-infected patients in the region began in the mid-2000s. Despite notable progress in responding to the epidemic, access to ART in Central Asia is still among the lowest in the world. Most HIV services in Central Asia are implemented through a network of specialized programs (provincial and city AIDS centers), with the Republican AIDS Center coordinating HIV surveillance, prevention, care, and treatment activities at the national level. In Kyrgyzstan, provision of antiretroviral therapy is decentralized and implemented through both specialized AIDS centers and primary care family medicine centers. Late initiation of, and low adherence to, ART remain the primary challenges in implementing effective treatment programs. Adherence support and other supportive services are generally provided through a limited number of externally-funded NGOs.
HIV prevention activities among key populations are generally implemented through a network of government or NGO-run “Trust Points,” which are tasked with distributing and exchanging needles/syringes to injecting drug users. They also distribute information, education, and communication materials; distribute condoms; and provide sexual risk reduction messages and referrals to other services (such as TB and STI screening and treatment). A number of NGOs also provide outreach services to expand HIV prevention coverage to different populations. Opioid substitution therapy (OST) is available in the region: a broad nationwide OST program exists in Kyrgyzstan and small-scale OST pilot programs exist in both Kazakhstan and Tajikistan.
ICAP in Central Asia
ICAP is based in Almaty, sharing offices with Columbia University’s Global Health Research Center of Central Asia (GHRCCA). The Almaty office implements activities in Kazakhstan and serves as the central technical unit for ICAP activities in Kyrgyzstan, Tajikistan, and—on a more limited basis—in Uzbekistan. ICAP’s principle focus in the region is on conducting situational analyses and implementing capacity building activities to improve HIV strategic information and HIV care, treatment, and prevention services.