By Nabila El-Bassel

For the past several years, Central Asia and Eastern Europe have been the only areas of the world where the number of new HIV infections and AIDS-related deaths are on the rise, due largely to injection drug use. This region also lags behind the rest of the world in terms of the quality and coverage of HIV services.

I am a social-behavioral scientist and social worker. I became involved in this crisis over ten years ago, when my colleagues at Columbia University and I set up the Global Health Research Center of Central Asia (GHRCCA), headquartered in Almaty, Kazakhstan.

We were sensitive to the fact that the region’s HIV/AIDS epidemic is concentrated among key populations that are highly stigmatized, not only men who have sex with men but also drug users, sex workers, and migrants. On a daily basis, such individuals face multiple social and structural barriers that prevent them from getting the treatment they need. The statistics are stark. Less that 40 percent of those who inject drugs in Central Asia and Eastern Europe are able to access antiretroviral treatment, of which only 19 percent have achieved viral suppression. Methadone treatment is not even available in several Central Asian countries.

Given my long and deep commitment to Central Asia, I have been surprised by how often the region is neglected by the global AIDS community. This year, however, I am happy to report that the situation appears to be changing. With the UNAIDS goal of 90–90–90 less than two years away, leaders in the fight against AIDS are calling for bringing the epidemic in Central Asia and Eastern Europe to the forefront of the global AIDS response. At the 2018 International AIDS Society Conference (IAS) in Amsterdam last month, researchers and advocates considered the question of how to increase access to harm reduction and medically assisted treatments for the region’s people living with HIV/AIDS. To achieve the 90-90-90 goal, they called for

  • Combining HIV prevention and treatment with mainstream primary health care services. Screening for and treating HIV should be combined with screening for and treating non-infectious diseases such as diabetes or high blood pressure. HIV care should also be integrated into reproductive and sexual health services, harm reduction programs, and overdose services. Notably, incorporating HIV services into medication-assisted treatment will help to avert fatal opioid overdoses—a major cause of mortality among people who inject drugs.
  • Restructuring health systems to address multiple health problems simultaneously. Health systems need to become more comprehensive to contend with the growing number of non-communicable diseases among people living with HIV. Research on integrating services has shown that these initiatives deliver better, more effective and cost-effective care than programs that look at single health issues in isolation.

At the conference, GHRCCA had the honor of being included at the Elton John Foundation’s press conference, where the world renowned musician announced funding for some important new AIDS prevention initiatives in Central Asia and Eastern Europe. We also led a symposium titled “Innovative multi-level HIV interventions with key populations in Kazakhstan and Central Asia: From efficacy to implementation research.” In addition to our well-established biobehavioral HIV interventions addressing individuals, couples, and structural barriers, we shared our most forward-looking research: implementation science targeting key affected populations in Central Asia and ways to address the major barriers these populations face in accessing care. Encouragingly, a number of scientists approached me afterwards for advice on becoming involved in our HIV/AIDS research in the region.

Like other presenters at this year’s conference, I fear that the HIV/AIDS epidemic will persist for years past 2020 if we fail to pay attention to the inequitable laws, poverty, stigma, discrimination, and oppression faced by people from key populations. I am grateful to the conference leaders for convincingly integrating these issues into the overarching themes. The fact that the conference took place in Amsterdam was a symbol of how seriously AIDS researchers have become about finally tackling the crisis in Central Asia and Eastern Europe. The Netherlands is an extremely progressive nation in the fight against HIV/AIDS. It has long promoted enlightened policies on addiction treatment, HIV prevention, and funding for AIDS research and care.

Some Central Asian governments such as Tajikistan, Uzbekistan and Kyrgyzstan may not be able to meet the demands for progressive and fast action in the wake of the Amsterdam conference. Moving forward, it is critical that international NGOs and donors continue to provide funding for the technical assistance needed to halt the epidemic. That said, we should remember that the Global Fund is decreasing its support in the region and will no longer fund projects in Kazakhstan—the UN now considers Kazakhstan a middle-income country. Governments in each of the Central Asian republics may need to step up self-funding for HIV/AIDS services and treatment.

Over the next two years, my two research centers, the Social Intervention Group (SIG) and GHRCCA, will wrap-up NOVA and BRIDGE—two dynamic studies funded by the National Institutes of Drug Abuse. NOVA is an HIV intervention for sex workers with a microfinance component. BRIDGE is designed to improve access to HIV care within harm reduction programs. We will also have new findings from Project UNI, which leverages social networks to help men who have sex with men access and receive HIV services and care. I am confident that these biobehavioral studies will contribute not only to the visibility of our scientific roles in the region but also to the fight to reduce the growing incidence of HIV/AIDS in Central Asia.

We know that our publications reach out to a broad audience of scientists and we intend to continue to use our findings to inform and improve policies and access to services for these key populations. My research teams also plan to expand our collaborations with governments in the region and international NGOs, taking advantage of the momentum created by the Amsterdam gathering.

In 2020 the AIDS conference will be held in San Francisco, where it was first held thirty years ago, at the height of the AIDS epidemic in the United States. By then I hope we can all report on our progress “getting to zero” in Central Asia and Eastern Europe.

Nabila El-Bassel is the Willma and Albert Musher Professor of Social Work at the Columbia School of Social Work and director of the Social Intervention Group (SIG), which was established in 1990 as a multi-disciplinary center focusing on designing and testing HIV, drug use intervention and prevention models for women, men, and couples and disseminating them to local, national, and global communities. Dr. El-Bassel is also the co-director of the Global Health Research Center of Central Asia (GHRCCA), a team of faculty, scientists, researchers, and students in both New York and Central Asia committed to advancing solutions to health and social issues in Central Asia through research, education, training, policy, and dissemination.

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