Reversing the Tide: Priorities for HIV/AIDS Prevention in Central Asia (World Bank Working Papers) (World Bank Working Papers)

Although the number of reported cases of HIV in Central Asia is still very low, the growth rate of the epidemic (about 500 cases in 2000 to over 12,000 in 2004) is a cause for serious concern. Central Asia lies along the drug routes from Afghanistan to Russia and Western Europe, and it is estimated that it has half a million drug users, of which more than half inject drugs. Without concerted action, we may expect to see the rapid development of an HIV epidemic concentrated among injecting drug users over the next four or five years, followed by the spread among the 15- to 30-year-old population, with sexual transmission as the predominant mode. This would follow the pattern of the epidemic in other regional countries such as Russia, Ukraine, and Moldova. Governments, NGOs, and international partners in the field have taken initial steps to avoid a major HIV/AIDS epidemic in Central Asia. All countries with the exception of Turkmenistan have put in place coherent overarching policies and strategies to control HIV, which were prepared with assistance from UNAIDS; and all countries have received grants from the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM). NGOs are active in the region, and partner organizations and international NGOs have been providing significant technical and financial assistance. Despite growing regional commitment and resources to prevent and control the epidemic, there are, however, a number of issues that are not being adequately addressed. This study identifies critical gaps, and makes recommendations for further action that will ensure effective early prevention of HIV/AIDS in Central Asia. 1. Introduction -- Global Hiv/aids Epidemic -- Eca Regional Situation -- Central Asia Aids: Study Design -- Central Asia Hiv/aids And Tb Studies And Operations -- World Bank Role On Hiv/aids In Eca -- 2. Key Emerging Issues -- Extent Of The Epidemics In Central Asia -- Risk Environment And Behavior -- Potential Economic Consequences Of An Hiv/aids Epidemic In Central Asia -- Appropriate And Effective Early Actions To Prevent The Epidemic -- Hiv/aids Strategies And Programs In Central Asia -- Political Economy Vis-a-vis Hiv/aids -- Institutional Capacity To Prevent And Control Hiv/aids -- 3. Reaching A Political And Social Consensus On Timely Implementation Of Hiv/aids Strategies In Central Asia -- World Bank's Role: Regional Aids Control Project -- A. Epidemiological And Programmatic Update -- Key Findings In Kazakhstan -- Hiv/aids And Stis In Kazakhstan: Epidemiological Trends -- Risk Behavior And Environment -- Prevention And Control -- Key Findings In The Kyrgyz Republic -- Hiv/aids And Stis In The Kyrgyz Republic: Epidemiological Trends -- Risk Behavior And Environment -- Prevention And Control -- Key Findings In Tajikistan -- Hiv/aids And Stis In Tajikistan: Epidemiological Trends -- Risk Behavior And Environment -- Prevention And Control -- Key Findings In Uzbekistan -- Hiv/aids And Sti In Uzbekistan: Epidemiological Trends -- Risk Behavior And Environment -- Prevention And Control -- B. Economic Consequences Of Hiv In Central Asia: Simulation Model Approach -- Design Of The Simulation Model And The User Interface -- Economic Model -- Quantitative Analysis Of Hiv Trends In Central Asia -- Scenarios -- Results And Discussion -- C. Strategic And Regulatory Framework For Hiv/aids Prevention In Central Asia -- Strategies To Prevent Hiv/aids In Central Asia -- Evidence Base For Prevention Of Hiv/aids In Central Asia -- National Aids Strategies And Programs -- Regional Agreements And Partnership Programs -- D. Stakeholder Analysis And Institutional Assessment -- Stakeholders And Institutions -- Need For Stakeholder Participation To Control Hiv/aids -- Participatory Decisionmaking -- Stakeholders -- Current Situation For Stakeholders And Organizations -- Country Commitment Within The Region -- Major Donors And International And National Ngos -- Assessment Of Strengths And Gaps -- Recommendations -- E. Central Asia Hiv/aids Communication And Participation Plan -- Proposed Short-term Communication Objectives -- Short-term Communication Activities -- 1. Newly-diagnosed Hiv Infections In Central Asia -- 2. Economic Costs Of Hiv In Kazakhstan, Kyrgyz Republic And Uzbekistan (optimistic Scenario) -- 3. Impact Of The Reduction In The Growth Rate Of Idu -- 4. Coverage Of Highly-vulnerable And Vulnerable Groups -- 5. Data On Antiretoviral (arv) Therapy Policies And Funding -- 6. Groups At Risk, Their Needs And Current/expected Coverage Rates -- 7. Hiv/aids Stakeholders In Central Asia -- 8. Early Action On Hiv/aids In Central Asia Countries -- 9. Key Elements Of Country Strategies -- 10. Funding Available And Planned For Hiv/aids Prevention And Control In Central Asia (thousands Of Us$) -- 11. Number Of Hiv Tests Carried Out In Prisons And Hiv Cases By Age And Sex: Kazakhstan: 1999-2002 -- 12. Age And Sex Distribution Of Cases Of Hiv Infection Notified: Tajikistan 1991-2003 -- 13. Ols Estimates Of Four Stages Of Development Of The Hiv Epidemic In Russia: 1987-2003 -- 14. Ols Results On Three Stages Of Development Of The Hiv Epidemic -- 15. Economic Costs Of Hiv In Kazakhstan -- 16. Economic Costs Of Hiv In The Kyrgyz Republic -- 17. Economic Costs Of Hiv In Uzbekistan -- 18. Fiscal Costs Of Antiretroviral Programs In 2020 (pessimistic Scenario) -- 19. Impact Of Reduction In The Growth Rate Of Idu -- 20. Regional Agreements In Central Asia -- 21. Strengths On Which To Build For Addressing Hiv/aids -- 22. Obstacles To Organizational Development In Addressing Hiv/aids -- 23. Communication Plan -- 1. Geographic Areas For Intervention Against The Hiv/aids Epidemic In Central Asia -- 2. Number And Rate Of Currently Registered Drug Users: Kazakhstan, 1990-2003 -- 3. New And Cumulative Notifications Of Hiv Infection: Kazakhstan, 1990-2003 -- 4. Age Distribution Of New Cases Of Hiv Infection: Kazakhstan, 1997-2003 -- 5. Regional Distribution Of New Cases Of Hiv Infection: Kazakhstan, 2001 -- 6. Number And Rate Of Currently Registered Drug Users: Kyrgyz, 1990-2003 -- 7. Number Of Registered Drug Users Across Regions: Kyrgyz Republic, 1990-2003 -- 8. Rate Of Registered Drug Users Per 100,000 Across Regions: Kyrgyz Republic, 1990-2003 -- 9. Number And Rate Of Registration Of Drug Users By Age And Sex: Kyrgyz Republic, 2003 -- 10. Estimated Number And Rate Of Registration Of Drug Users By Age And Sex: Bishkek Region And Osh City, 2003 -- 11. New And Cumulative Notifications Of Hiv Cases: Kyrgyz Republic, 1990-2003 -- 12. Regional Distribution Of Hiv Notifications And Hiv Notification Rates: Kyrgyz Republic, 2001-2003 -- 13. Number Of Notifications Of New Cases Of Syphilis By Region: 1990-2003 -- 14. Notification Rate For New Cases Of Syphilis By Region: 1990-2003 -- 15. Number And Rate Per 100,000 Of Registered Drug Users: Tajikistan, 1999-2001 -- 16. Number And Rate Of Registered Opiate Users By Age And Sex: Tajikistan, 1999-2001 -- 17. Number And Rate Of Registered Drug Users By Sex And Region: Tajikistan, 2000-2002 -- 18. New And Cumulative Notifications Of Hiv Infection: Tajikistan, 1990-2003 -- 19. Number Of New Notifications Of Syphilis By Region: Tajikistan, 1990-2003 -- 20. Rate Of New Notifications Of Syphilis Per 100,000 By Region: Tajikistan, 1990-2003 -- 21. New And Cumulative Notifications Of Hiv Infection: Uzbekistan, 1990-2003 -- 22. Numbers Of Notifications Of New Cases Of Hiv Infection By Region: Uzbekistan, 1990-2003 -- 23. Rate Of Notifications Of New Cases Of Hiv Infection Per 100,000: Uzbekistan, 1990-2003 -- 24. Number Of Notifications Of New Cases Of Syphilis By Region: Uzbekistan, 1990-2003 -- 25. Rates Of Notifications Of New Cases Of Syphilis Infection Per 100,000 By Region: Uzbekistan, 1990-2003 -- 26. Logarithms Of The Cumulative Number Of Hiv-positive Registered Cases In Russia 1998-2003: Four Phases Of The Development Of The Epidemic -- 27. Logarithms Of The Cumulative Number Of Hiv-positive Registered Cases In Kazakhstan, Kyrgyz Republic, And Uzbekistan -- 28. Ladder Of Citizen Participation -- 1. Objectives Of The Central Asia Aids Study -- 2. Objectives Of The Hiv/aids And Tb Studies In Central Asia -- 3. Findings Of The Central Asia Tb Study -- 4. Public Opinion Research In The Kyrgyz Republic -- 5. Proposed Bank-financed Operations On Hiv/aids In Central Asia -- 6. Bank-financed Aids Control Projects In Eca -- 7. Potential Epidemiological And Economic Impact Of Hiv/aids In Central Asia -- 8. Injecting Drug Use Interventions Related To Hiv/aids -- 9. Un Three Ones -- 10. Strategies To Prevent Hiv/aids Epidemic Growth In Central Asia -- 11. Kazakhstan Hiv/aids National Program -- 12. Kazakhstan Gfatm Grant -- 13. Kyrgyz Republic Gfatm Grant -- 14. Tajikistan Gfatm Grant -- 15. Uzbekistan Strategic Plan -- Unnumbered Boxes -- Critical Gaps -- Reaching A Political And Social Consensus On Timely Implementation Of Hiv/aids Strategies In Central Asia -- Hiv/aids Program Coordination -- Strategic And Policy Development -- Surveillance And Monitoring And Evaluation -- Capacity Building -- Regional Drivers And Coverage Of Highly-vulnerable Groups -- Funding Of Hiv/aids Programs -- Implementation Of The Approved Hiv/aids Strategies In Central Asia Raises The Following Questions. Joana Godinho ... [et Al.]. Includes Bibliographical References. Reversing the Tide is part of the World Bank Working Paper series. These papers are published to communicate the results of the Bank's ongoing research and to stimulate public discussion.Although the number of reported cases of HIV in Central Asia is still very low, the growth rate of the epidemic (about 500 cases in 2000 to over 12,000 in 2004) is a cause for serious concern. Central Asia lies along the drug routes from Afghanistan to Russia and Western Europe, and it is estimated that it has half a million drug users, of which more than half inject drugs. Without concerted action, we may expect to see the rapid development of an HIV epidemic concentrated among injecting drug users over the next four or five years, followed by the spread among the 15- to 30-year-old population, with sexual transmission as the predominant mode. This would follow the pattern of the epidemic in other regional countries such as Russia, Ukraine, and Moldova.Governments, NGOs, and international partners in the field have taken initial steps to avoid a major HIV/AIDS epidemic in Central Asia. All countries with the exception of Turkmenistan have put in place coherent overarching policies and strategies to control HIV, which were prepared with assistance from UNAIDS; and all countries have received grants from the Global Fund to Fight AIDS, TB, and Malaria (GFATM). NGOs are active in the region, and partner organizations and international NGOs have been providing significant technical and financial assistance. Despite growing regional commitment and resources to prevent and control the epidemic, there are, however, a number of issues that are not being adequately addressed. This study identifies critical gaps, and makes recommendations for further acton that will ensure effective early prevention of HIV/AIDS in Central Asia.