Central Asia

Background

Since the collapse of the Soviet Union, the health systems of countries located in Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan) underwent significant changes with severe cuts in health expenditures, and significant deterioration in health infrastructure and services. In the attempt to develop their own health care policies and planning capacities, countries implemented numerous reforms that changed the organizational structure and management of their respective Ministries of Health. During this period, the population of Central Asia has experienced a dramatic decrease in quality of life, drop in life expectancy, increase in infant mortality rate, rise in morbidity, spread of communicable diseases, including high rates of TB, and growth in numbers of sexually transmitted infections (STI) and HIV infection.

Central Asia is one of the few regions in the world where the HIV epidemic remains clearly on the rise. Currently Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan face concentrated epidemics with the most common mode of transmission being through syringe and needle sharing among injecting drug users. Most HIV infections are registered among unemployed young men and prisoners, though the proportion of women among those infected with HIV is steadily increasing. Several outbreaks of HIV cases in children in hospital settings have been reported in the region. 

Countries of Central Asia are located along the Silk Road, one of Asia’s oldest trade routes. It is also a major drug trafficking route from Afghanistan. Availability of inexpensive heroin and high prevalence of drug use creates the potential for continued rapid spread of HIV among injecting drug users. Low rates of condom use among the most at-risk groups (MARPs) and the general population facilitate sexual transmission of HIV. Large numbers of migrants from the region crossing borders complicate access to HIV prevention, care, and treatment services, as well as for diagnosis and treatment of STI. 

Antiretroviral therapy (ART) for HIV-infected patients began in the mid 2000s. Despite notable progress in responding to the epidemic, access to ART in Central Asia is still among the lowest in the world (UNICEF, 2010). Most HIV services in Central Asia are implemented through a network of specialized programs (provincial and city AIDS centers) with the Republican AIDS Center being the national body that coordinates HIV surveillance, prevention, care, and treatment activities.  In Kyrgyzstan, provision of ART is decentralized and is implemented through specialized AIDS centers as well as primary health care facilities (family medicine centers). Low adherence to and late initiation of ART remains the main challenge for implementation of effective treatment programs. Adherence support and other supportive services are generally provided through a limited number of NGOs that are funded by different donors.

HIV prevention activities among the most at-risk groups are generally implemented through a network of government or NGO-run Trust Points, which are tasked with distributing and exchanging needles/syringes to injecting drug users. They also distribute IEC materials and condoms and provide sexual risk reduction messages and referrals to other services (e.g., TB and STI screening and treatment) for all at-risk groups. A number of NGOs also provide outreach services to expand HIV prevention coverage to different populations.    Opioid substitution therapy (OST) is available in the region, with Kyrgyzstan having a wide nationwide OST program, and Kazakhstan and Tajikistan having only few small-scale OST pilot programs.  

Low motivation of medical personnel and high level of discriminating attitudes toward people living with HIV and MARPs remain key obstacles to improving services provided to those groups.

ICAP in Central Asia

ICAP is based in Almaty, where it shares offices with Columbia University’s Global Health Research Center of Central Asia (GHRCCA). The Almaty office is implementing activities in Kazakhstan, as well is serving as the central technical unit for ICAP activities that are being developed in Kyrgyzstan and Tajikistan. ICAP will conduct situational analyses and implement capacity building activities to improve HIV strategic information, care, treatment, and prevention services.