Redressing the epidemics of opioid overdose and HIV among people who inject drugs in Central Asia: The need for a syndemic approach

Abstract

Background Accumulating evidence suggests that opioid overdose and HIV infection are burgeoning intertwined epidemics among people who inject drugs (PWID) in Central Asia. To date, however, research on overdose and its associations with HIV risks among PWID in Central Asia remains virtually absent. This paper aims to provide a regional overview of the hidden epidemic of overdose and how it is linked to HIV among PWID in Central Asia, using a syndemic framework that is guided by risk environment research. Methods We conducted a comprehensive literature search of peer-reviewed publications and grey literature on opioid overdose and its associations with HIV in five countries of Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) as well as on policies and programs that address these co-occurring epidemics. Results Regional data indicate high rates of fatal and non-fatal overdose among PWID. Evidence suggests mortality rates from overdose exceed HIV/AIDS as the leading cause of death among PWID. The syndemic framework suggests multiple macro-level and micro-level environmental risk factors that drive the co-occurring epidemics of HIV and overdose. This framework identifies several interacting biological and behavioral risks that result in additive effects for HIV and overdose. Conclusion The high rates of overdose and its associations with HIV underscore the need for a syndemic approach that considers overdose on parity with HIV. Such an approach should focus on the biological, behavioral and structural interactions between these epidemics to reduce social suffering, morbidity and mortality among PWID in Central Asia.

Intersecting epidemics of HIV, HCV, and syphilis among soon-to-be released prisoners in Kyrgyzstan: Implications for prevention and treatment

“…Sexual risk reductions interventions should be adapted to the Kyrgyz context, particularly for women, to improve condom use skills, HIV/STI knowledge, and reduce sexual risk behaviors both during incarceration (DiClemente et al, 2014) and during community re-entry (Wolitski, 2006). Given the syndemic nature of drug injection, syphilis, and HIV (Gilbert et al, 2013; Singer & Clair, 2003) within Kyrgyz prisons, our results point to an urgent need for an integrated harm reduction approach which would incorporate STI testing and treatment. In the absence of effective screening and treatment of syphilis, HIV threatens to expand and bridge to sexual partners of PWID during the post-release period.…”

Differences by sex in associations between injection drug risks and drug crime conviction among people who inject drugs in Almaty, Kazakhstan

“…FWID face multiple intersecting HIV risk factors including sex work, injection drug risk factors, intimate partner violence and mental health problems (El-Bassel, Gilbert et al, 2013). FWID face numerous relationship power inequities including constraints on communication about the need to adopt safe injection practices, and HIV injection drug risk reduction communication.…”

“…Although males who inject drugs (MWID) are more likely to experience conviction for a drug crime and resulting incarceration, females (FWID) who are involved in the criminal justice system are at greater risk of injection drug risk behaviors, and HIV and HCV infection (El-Bassel, Strathdee, & El Sadr, 2013; El-Bassel, Gilbert et al, 2013). FWID accounts for approximately 12.1% of PWID in Central Asia (Degenhardt et al, 2017).…”

“…The intersection of drug-related stigma, gender inequities, and sexual violence place FWID at greater risk of HIV and drug related harms compared to MWID (Iversen, Page, Madden, & Maher, 2015; Lunze et al, 2016; El-Bassel, Strathdee et al, 2013). However, FWID are more likely than MWID to engage in drug and sexual risks due to greater discrimination and cultural stigma surrounding injection drug use, poor mental health and exposure to gender-based violence particularly intimate partner violence (IPV) (Gilbert et al, 2013; Shaw et al, 2016; El-Bassel & Strathdee, 2015; El-Bassel, Shaw, Dasgupta, & Strathdee, 2014; Gilbert et al, 2013; Shannon et al, 2008; Pinkham & Malinowska-Sempruch, 2007). Within the context of intimate partnerships, in Kazakhstan, MWID are more likely to provide syringes and other equipment (receptive sharing), prepare syringes and equipment for their female sex partners, and share injection equipment with a greater number of partners (El-Bassel, Gilbert et al, 2013; El-Bassel, Strathdee et al, 2013; El-Bassel, Gilbert et al, 2014).…”

HIV and people who use drugs in central Asia: Confronting the perfect storm

“…Although naloxone is registered as an essential medicine throughout CA, its availability is exceedingly limited (Coffin, 2008; Coffin et al, 2012). Gilbert et al (in press) provided an overview of the hidden epidemic of drug overdose and how it is linked to HIV among PWID in CA. The authors consider overdose as a medical event on par with HIV transmission and focused on the biological, behavioral and structural interactions between overdose and HIV.…”