Background

Profound social and economic change in Eastern Europe and Central Asia have created conditions that make the countries of those regions particularly vulnerable to drug use and the spread of HIV. Analysing the determinants of the HIV/AIDS epidemics, a report (MAP, 1998), which draws upon the work of epidemiologists and social researchers from the region concluded that the region was confronted with several simultaneous epidemics and trends, namely, drug use, HIV, prostitution, and classic sexually transmitted disease, noting that AIDS programme managers and epidemiologists had followed the various HIV epidemics since the 1980s and monitored the spread in different populations, including foreigners, children, men who had sex with men and, more recently, injecting drug users. The report stressed that risk behaviour certainly existed before the break-up of the former Union of Socialist Republics, but that political changes had exacerbated the situation, leading to a rapid increase in the numbers of people practising high-risk drug and sexual behaviour, which was creating the conditions for rapidly growing HIV epidemics. The report noted that there were large vulnerable populations which were not yet HIV-infected, including many young people who were either already injecting drugs and engaging in unsafe sexual behaviour or who might start doing so in the future.

The rapid spread of HIV among injecting drug users has been documented for some countries of the former Soviet Union since 1995. Although the absolute number of cases is still small in many countries, the risk of further spread of HIV within the group of injecting drug users and into other parts of the population is considered to be high (UNAIDS, 2000).

In the mid-1990s, the situation in Central and Eastern Europe and the Central Asian States presented particular circumstances that are worth noting: limited experience with drug abuse and associated problems; predominance of interdiction approaches; societies in transition with the accompanying social problems, and rapid dissemination of injecting drug use, high-risk behaviour and potential for HIV transmission. In view of this situation, several Governments, supported in many cases by international organizations, responded to the urgent need to act to prevent HIV among injecting drug users. This meant the development of new, in some cases controversial, approaches, and work towards their legitimization. As a first step, measures aimed at the avoidance of HIV transmission were assigned priority. Progressively, the need to diversify services for drug users and offer a wider range of approaches was recognized. The need to develop comprehensive drug demand reduction programmes, a component of which is prevention of the health and social consequences of drug abuse, in particular HIV infection, was understood. There is now a need to diversify and expand services. At the same time, the different interventions and components need to be monitored and evaluated in order to determine the relative importance of each so as to accumulate further knowledge of which models will have a stronger impact on the prevention of HIV infection among drug users.