Illicit drugs in Central Asia: What we know, what we don’t know, and what we need to know

Latypov, Alisher; Grund, Jean‐Paul C.; El‐Bassel, Nabila; Platt, Lucy; Stöver, Heino; Strathdee, Steffanie A.

doi:10.1016/j.drugpo.2014.09.015

Cited by 7 publications

(10 citation statements)

References 45 publications

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“…56 There is relatively poor access to HIV testing and ART in EECA, due at least in some places to fear of police harassment or arrest, as well as to systematic exclusion of PWUD from treatment programmes. 89 UNAIDS’ 2014 report on gaps in the global HIV response summarises the crisis of inaccessibility of ART for PWID, also noting that less than 1% of HIV-positive PWID in Africa receives ART (Figure 8). 57 …”

Section: Drug Policy and Infectious Diseasesmentioning

confidence: 99%

“…Harsh anti-drug policies and moral judgments against PWUD contribute to making health services for this population a low political priority. 89 In the first decade of its work, financial support from the Global Fund helped to overcome these difficult political environments and supported the expansion of harm reduction services, especially NSP and OST, in a number of EECA countries as well as in East and Southeast Asia. 107 However, with changes in Global Fund policy that have eliminated or reduced funding for middle-income countries, some of these services have been cut (see Box 3 below).…”

Section: Drug Policy and Infectious Diseasesmentioning

confidence: 99%

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Public health and international drug policy

et al. 2016

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Executive summary In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms. Health impact of drug policy based on enforcement of prohibition The pursuit of drug prohibition has generated a parallel economy run by criminal networks. Both these networks, which resort to violence to protect their markets, and the police and sometimes military ...

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Section: Drug Policy and Infectious Diseasesmentioning

confidence: 99%

Section: Drug Policy and Infectious Diseasesmentioning

confidence: 99%

Public health and international drug policy

et al. 2016

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“…8,56 Consequently, volatile opioid injection and HIV epidemics followed. 10 Many harsh criminal sanctions towards people who inject drugs ensued, resulting in escalating incarceration rates, especially of those who either had or were at high risk for HIV.…”

Section: The Confluence Of Mass Incarceration Substance Use Disordermentioning

confidence: 99%

The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

et al. 2016

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Despite global reductions in HIV incidence and mortality, the 15 UNAIDS-designated countries of Eastern Europe and Central Asia (EECA) that gained independence from the Soviet Union in 1991 constitute the only region where both continue to rise. HIV transmission in EECA is fuelled primarily by injection of opioids, with harsh criminalisation of drug use that has resulted in extraordinarily high levels of incarceration. Consequently, people who inject drugs, including those with HIV, hepatitis C virus, and tuberculosis, are concentrated within prisons. Evidence-based primary and secondary prevention of HIV using opioid agonist therapies such as methadone and buprenorphine is available in prisons in only a handful of EECA countries (methadone or buprenorphine in five countries and needle and syringe programmes in three countries), with none of them meeting recommended coverage levels. Similarly, antiretroviral therapy coverage, especially among people who inject drugs, is markedly under-scaled. Russia completely bans opioid agonist therapies and does not support needle and syringe programmes—with neither available in prisons—despite the country’s high incarceration rate and having the largest burden of people with HIV who inject drugs in the region. Mathematical modelling for Ukraine suggests that high levels of incarceration in EECA countries facilitate HIV transmission among people who inject drugs, with 28–55% of all new HIV infections over the next 15 years predicted to be attributable to heightened HIV transmission risk among currently or previously incarcerated people who inject drugs. Scaling up of opioid agonist therapies within prisons and maintaining treatment after release would yield the greatest HIV transmission reduction in people who inject drugs. Additional analyses also suggest that at least 6% of all incident tuberculosis cases, and 75% of incident tuberculosis cases in people who inject drugs are due to incarceration. Interventions that reduce incarceration itself and effectively intervene with prisoners to screen, diagnose, and treat addiction and HIV, hepatitis C virus, and tuberculosis are urgently needed to stem the multiple overlapping epidemics concentrated in prisons.

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“…11 Although women are disproportionally affected by violence and the drug use epidemic, there are considerable gaps in our understanding of the factors associated with overdose among women. 12 Overdose among women may be driven by the physical and psychological effects of violence, [13][14][15] which adversely affect quality of life and health outcomes. Intimate partner violence (IPV) refers to any behavior in an intimate relationship that causes physical, psychological, or sexual harm.…”

Section: Introductionmentioning

confidence: 99%

Association of Violence Against Female Sex Workers Who Use Drugs With Nonfatal Drug Overdose in Kazakhstan

et al. 2020

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IMPORTANCE Female sex workers (FSWs) who use drugs face increased risk of intimate partner violence (IPV) and nonpartner violence (NPV). The association between violence and drug overdose is unknown. OBJECTIVE To examine the association between IPV, NPV, and nonfatal drug overdose among FSWs who use drugs in Kazakhstan. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 400 adult FSWs in Kazakhstan who reported illicit drug use in the past year, exchanged sex for money or drugs, and reported having unprotected sex in the past 90 days. Baseline data were collected from February 2015 to May 2017 from Project Nova, an HIV prevention study among FSWs who use drugs in Kazakhstan. Data analysis was conducted from April 2019 to March 2020. EXPOSURES Lifetime and recent (past 90 day) experiences of physical, sexual, and psychological IPV and NPV using the Revised Conflict Tactics Scale. Subtypes of violence were identified using exploratory factor analysis. MAIN OUTCOMES AND MEASURES Lifetime and recent incidence of nonfatal overdose; sociodemographic characteristics as well as lifetime and recent sex work and drug use behaviors were also collected. RESULTS The 400 participants had a mean (SD) age of 34.1 (8.4) years. Most experienced food insecurity (358 [89.5%]) and homelessness (232 [58.0%]) in the past 90 days; one-third (130 [32.5%]) reported a history of incarceration. Most (359 [89.7%]) experienced some form of violence; 150 (37.5%) reported a lifetime nonfatal overdose, of whom 27 (18.0%) reported nonfatal overdose in the past 90 days. Lifetime severe physical violence (adjusted odds ratio [aOR], 1.27; 95% CI,

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Illicit drugs in Central Asia: What we know, what we don’t know, and what we need to know

Cited by 7 publications

References 45 publications

Public health and international drug policy

Public health and international drug policy

The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

Association of Violence Against Female Sex Workers Who Use Drugs With Nonfatal Drug Overdose in Kazakhstan

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