On the occasion of the World AIDS Day being marked on 1 December, Corie Leifer, Project and Office Manager at the AIDS Foundation East-West (Amsterdam, Netherlands), wrote a piece on the topicality of the AIDS problem in the Eastern Europe and Central Asia (EECA) Region:

The EECA Region is home to the fastest growing HIV epidemic in the world. While worldwide the incidence of HIV is decreasing, in EECA, the number of new HIV cases continues to grow. Key populations (men who have sex with men, prisoners, people who Inject drugs, and sex workers) in EECA are disproportionally impacted by the HIV epidemic. Therefore, serving the needs of key populations through increasing access to healthcare can provide an effective method to reduce the spread of HIV.
AIDS Foundation East-West (AFEW) is a network of civil society organisations that is dedicated to improving the health of key populations. With a focus on Eastern Europe and Central Asia, AIDS Foundation East-West strives to promote health and increase access to prevention, treatment and care for public health concerns such as HIV, TB, viral hepatitis, and sexual and reproductive health and rights. In preparation for the World AIDS Day on 1 December, AFEW offices in Tajikistan, Kyrgyzstan, Kazakhstan, and Russia conducted multiple activities around the prevention, treatment, and care of HIV. The World AIDS Day is an important day for AFEW and the region as it allows us to raise awareness to HIV and what we can do about it.
AFEW Kazakhstan and AFEW Tajikistan participated in the European HIV and Hepatitis Testing Week on 20-27 November 2015. Working with the Republican AIDS Centre, AFEW Tajikistan distributed information about HIV prevention and referrals for HIV testing and counseling in mobile VCT units of AIDS centres in four regions of Tajikistan. Additionally, HIV counseling and testing among prisoners in two colonies of Tajikistan’s Khatlon region was provided. AFEW Kyrgyzstan also conducted activities regarding prevention, treatment, and care of HIV in prisons in cooperation with AIDS centres. AFEW Russia conducted a creative roundtable with the community of People Living with HIV.
AFEW supports human rights for key populations and the protection of their right to health. Due to an increased risk of contracting HIV, key populations have specialised needs. AFEW works with local, regional, national, and international programmes to help identify and address these needs. As advocates for harm reduction in relation to (injecting) drugs use and against stigma and discrimination, AFEW works with governmental and non-governmental organisations to promote healthy behaviours and to engage communities. At the local, regional, national, and international levels, AFEW provides trainings and support for medical and non-medical professionals that come into frequent contact with key populations.
AIDS Foundation East-West is one of the few international networks that works in prisons in EECA to help reduce the burden of infectious and communicable diseases such as HIV and TB. As experts in prison health in this region, AFEW continues to play an integral role in developing the necessary links between governmental and civil society organisations to improve the health of prisoners.
Injecting Drug Use (IDU) remains the main cause of the spread of HIV in EECA. This is the case for both the general population and for prisoners[1]. In fact, injecting drug use is the cause of 50–70 % of cumulative HIV cases in the region[2]. In prison specifically, this phenomenon is made worse by needle sharing[3]. In Central Asia, it is estimated that 5-25 % of prisoners have drug dependence issues and as many as 70 % share injecting tools[4].
Drug users and prisoners are often overlapping populations. There are two main reasons for this, and each exacerbates the other. The first reason is that drug users are overrepresented in prisons and detention centres[5]. This is due to the illegality of drug use. For instance, in Georgia, even trace amounts of drugs in a used syringe can be enough to lead to an arrest. Such strict laws almost guarantee that drug dependence will lead to criminal prosecution[6]. Between 5 % and 38 % of prisoners in Europe report injecting drugs prior to imprisonment. The second reason that prisoners are more likely to use drugs is due to their incarceration. In fact, between 2 % and 56 % of prisoners surveyed reported injecting drugs while in prison[7]. Drugs remain available in prisons, despite the confining circumstances. However, safe injecting tools are not as widely available. This leads to an inevitable situation of many people using the same needle to inject drugs[8]. Drug use can lead to incarceration, and incarceration can lead to drug use. As it is clear, this is a cycle that is difficult to break.
There is a lack of Needle Syringe Exchange Programmes and, therefore, clean needles in prisons. Additionally, there is minimal Opioid Substitution Therapy (OST) available to prisoners. As of 2010, 74 countries worldwide had opioid substitution therapy available in the community. Of these countries, only 39 also had this therapy available in prisons[9].
Prison health is public health. Unlike the prisoners, the spreading of a contagious disease is not confined by the walls of the prisons. It is, therefore, not only in the best interest of the prisoners to provide them with healthcare, but it is also in the best interest of society. This is not only the most humane approach but also the most cost-effective and socially beneficial. In health issues, it is almost always the case that prevention is the most cost-effective method to disease management. Preventing the spread of disease is a much more feasible task than managing an already prolific outbreak. Prevention measures include addressing the ‘factors related to the prison infrastructure, prison management and the criminal justice system (that) contribute to vulnerability to HIV, TB, and other health risks in prisons.’[10] Prisoners have an increased probability of contracting a contagious disease due, in part, to the lack of hygiene, proper medical care, and personal space. Therefore, the epidemics cannot be brought under control until at least some of the many contributing factors are addressed[11].


[1] https://www.euro.who.int/__data/assets/pdf_file/0005/126473/e94437.pdf?ua=1 
[2]  https://ec.europa.eu/health/sti_prevention/docs/ev_20130527_co05_en.pdf [3] Prison and Health Data and Statistics. World Health Organisation, 2010. https://www.euro.who.int/en/health-topics/health-determinants/prisons-and-health/data-and-statistics accessed on 25 March 2015
[4]  https://ec.europa.eu/health/sti_prevention/docs/ev_20130527_co05_en.pdf [5] Prison and Health Data and Statistics. World Health Organizstion, 2010. https://www.euro.who.int/en/health-topics/health-determinants/prisons-and-health/data-and-statistics accessed on 25 March 2015
[6]  https://ec.europa.eu/health/sti_prevention/docs/ev_20130527_co05_en.pdf [7] Prison and Health Data and Statistics. World Health Organisation, 2010. https://www.euro.who.int/en/health-topics/health-determinants/prisons-and-health/data-and-statistics accessed on 25 March 2015
[8]  https://ec.europa.eu/health/sti_prevention/docs/ev_20130527_co05_en.pdf [9] Prison and Health Data and Statistics. World Health Organisation, 2010. https://www.euro.who.int/en/health-topics/health-determinants/prisons-and-health/data-and-statistics accessed on 25 March 2015
[10] https://aidspan.org/gfo_article/improvement-hivtb-prevention-treatment-and-care-prisons [11] https://www.unodc.org/documents/hiv-aids/publications/Prisons_and_other_closed_settings/Good-governance-for-prison-health-in-the-21st-century.pdf