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BMJ Open. 2012; 2(5): e001465.
Published online Oct 18, 2012. doi:  10.1136/bmjopen-2012-001465
PMCID: PMC3488708
HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy
Emma Jolley,1 Tim Rhodes,1 Lucy Platt,1 Vivian Hope,1,2 Alisher Latypov,3,4 Martin Donoghoe,5 and David Wilson6
1Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
2Centre for Infections, Health Protection Agency, London, UK
3Eurasian Harm Reduction Network, Vilnius, Lithuania
4Global Health Research Center of Central Asia, Columbia University, New York, New York, USA
5Division of Communicable Diseases, Health Security and Environment, World Health Organization Regional Office for Europe, Copenhagen, Denmark
6Global HIV/AIDS Programme, World Bank, Washington DC, USA
Correspondence to Tim Rhodes; tim.rhodes/at/lshtm.ac.uk
Received May 10, 2012; Accepted September 6, 2012.
Abstract
Background and objectives
HIV among people who inject drugs (PWID) is a major public health concern in Eastern and Central Europe and Central Asia. HIV transmission in this group is growing and over 27 000 HIV cases were diagnosed among PWID in 2010 alone. The objective of this systematic review was to examine risk factors associated with HIV prevalence among PWID in Central and Eastern Europe and Central Asia and to describe the response to HIV in this population and the policy environments in which they live.
Design
A systematic review of peer-reviewed and grey literature addressing HIV prevalence and risk factors for HIV prevalence among PWID and a synthesis of key resources describing the response to HIV in this population. We used a comprehensive search strategy across multiple electronic databases to collect original research papers addressing HIV prevalence and risk factors among PWID since 2005. We summarised the extent of key harm reduction interventions, and using a simple index of ‘enabling’ environment described the policy environments in which they are implemented.
Studies reviewed
Of the 5644 research papers identified from electronic databases and 40 documents collected from our grey literature search, 70 documents provided unique estimates of HIV and 14 provided multivariate risk factors for HIV among PWID.
Results
HIV prevalence varies widely, with generally low or medium (<5%) prevalence in Central Europe and high (>10%) prevalence in Eastern Europe. We found evidence for a number of structural factors associated with HIV including gender, socio-economic position and contact with law enforcement agencies.
Conclusions
The HIV epidemic among PWID in the region is varied, with the greatest burden generally in Eastern Europe. Data suggest that the current response to HIV among PWID is insufficient, and hindered by multiple environmental barriers including restricted access to services and unsupportive policy or social environments.
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