DUSHANBE, March 10, 2010, Asia-Plus — The study “Opioid Substitution Therapy in Central Asia: Towards Diverse and Effective treatment Options for Drug Dependence” authored by Latypov, A., Otiashvili, D., Aizberg, O., Boltaev, and published the Eurasian Harm Reduction Network (EHRN) analyses the current legal, political and programmatic contradictions and barriers to wider access to the opioid substitution therapy (OST), with the aim of providing governmental, civil society and international specialists with recommendations for overcoming barriers to further scale up of access to OST in the region.
According to the study, globally an estimated 15.9 million people inject drugs, and 3 million of them have been infected with HIV. In addition to being vulnerable to HIV, people who inject drugs are also vulnerable to viral hepatitis and tuberculosis, sexually transmitted infections, other bacterial infections and death by overdose. Universally the coverage and quality of services available to drug users remain low. In the countries of Central Asia, injection drug use (mostly opiates) with unsterile injection equipment is the main route of transmission of HIV. In addition many heterosexual HIV cases are associated with injecting drug use, particularly among the non-injecting female sexual partners of drug injectors.
The rapid scale up of prevention and treatment programs specifically targeting injecting drug users must be central to efforts to stop the spread of HIV and treat those affected by it. OST combined with psychosocial support is the most effective treatment option for opioid dependency and is an essential part of measures to prevent HIV transmission among injecting drug users (IDUs) and to support their adherence to antiretroviral therapy. OST is one of nine interventions in a comprehensive package of HIV-related services for injecting drug users endorsed by the United Nations. The UN Economic and Social Council (ECOSOC) and the Program Coordinating Board of UNAIDS in 2009 indicate the existence of a common understanding within the United Nations about what a comprehensive package of HIV-related services for injecting drug users contains.
The governments of Kazakhstan, Kyrgyzstan and Tajikistan have commendably made the decision to introduce opioid substitution therapy programs, despite internal and external opposition. Kyrgyzstan has a strong reputation for leadership in harm reduction programming with some of the highest levels of access to services in Central Asia, and was one of the first countries in the Eastern European and Central Asian region to offer OST.
There are still many barriers to overcome to provide adequate access in Central Asia. In Uzbekistan a pilot OST program was closed in 2009 and the Uzbek government is currently opposed to restarting the program. Turkmenistan has never provided OST. None of the Central Asian countries where OST is available (Kazakhstan, Kyrgyzstan and Tajikistan) have managed to reach even 5 percent of the estimated IDU population, while the WHO/UNODC/UNAIDS 2009 target setting guide considers anything below 20% as “low” coverage and anything above 40% as “high” coverage. In Kyrgyzstan only approximately 3% have access and in Kazakhstan and Tajikistan, less than 1% do. In Tajikistan, a pilot program is due to be introduced in the first quarter of 2010, with plans proposed to cover up to 700 people by 2014.
The Eurasian Harm Reduction Network (EHRN) is a non-governmental network with a mission to promote humane, evidence-based harm reduction approaches to drug use, with the aim of improving health and protecting human rights at the individual, community, and societal level.
