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. 2012 Oct 18;2(5):e001465.
doi: 10.1136/bmjopen-2012-001465. Print 2012.

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, Lucy Platt, Vivian Hope, Alisher Latypov, Martin Donoghoe, David Wilson
Affiliations

HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy

Emma Jolley et al. BMJ Open. .

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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Figures

Figure 1
Figure 1
Flowchart of study selection.
Figure 2
Figure 2
The range of HIV prevalence estimates for countries in the Central and Eastern European region, along with the estimate judged ‘best’ highlighted in green.
Figure 3
Figure 3
Adjusted effect estimates of individual level risk factors present in multivariate studies of PWID. *New people who inject drugs (PWID) (≤3 years); **male PWID; †female (non- sex work (SW)) PWID; ‡female (SW) PWID.
Figure 4
Figure 4
Adjusted effect estimates of environmental level risk factors present in multivariate studies of PWID. *New people who inject drugs (PWID) (≤3 years); **male PWID; †female (non- sex work (SW)) PWID; ‡female (SW) PWID.
Figure 5
Figure 5
Estimated numbers of syringes distributed per people who inject drugs (PWID) per year and estimated number of opioid substitution treatment clients per 100 PWID in the latest year for which data is available.
Figure 6
Figure 6
Map showing the supportiveness of the policy environments for HIV among people who inject drugs in Europe.
See this image and copyright information in PMC

References

    1. Joint United Nations Programme on HIV/AIDS (UNAIDS) Global report: UNAIDS report on the global AIDS epidemic 2010, 2010
    1. European Centre for Disease Prevention and Control/WHO Regional Office for Europe HIV/AIDS surveillance in Europe 2010. Stockholm: European Centre for Disease Prevention and Control, 2011
    1. Department of Health and Social Development of Russian Federation, Federal Service for supervision of Consumer Protection and Human Welfare, Federal Government Central Science Research Agency Institute of Epidemiology, Federal Research and Methodological Center for Prevention and Control of AIDS HIV INFECTION Newsletter № 35. Moscow, 2011
    1. UNAIDS Global HIV/AIDS response: epidemic update and health sector progress towards Universal Access. Progress Report 2011
    1. Mathers BM, Degenhardt L, Phillips B, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet 2008;372:1733–45 - PubMed

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