title: Uncovering the epidemic of HIV among men who have sex with men in Central Asia.
abstract: BACKGROUND
  Research among people who inject drugs (PWID) in Central Asia has described same sex behavior among male PWID and may be associated with HIV and other infections. Little is known about the population of men who have sex with men (MSM) and the burden of HIV among MSM in Central Asian countries.
  
  
  METHODS
  We conducted a comprehensive search of peer-reviewed publications and gray literature on MSM and HIV in the region. Search strategies included terms for MSM combined with five Central Asian countries and neighbors, including Mongolia, Afghanistan, and Xinjiang Province, China.
  
  
  RESULTS
  230 sources were identified with 43 eligible for inclusion: 12 provided HIV prevalence and population size estimates for MSM, none provided incidence estimates, and no publications for Turkmenistan were identified. National reports estimate HIV prevalence among MSM to range from 1 to 2% in Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan, Xinjiang, to 10% in Mongolia. Biobehavioral studies estimated HIV prevalence at 0.4% in Afghanistan and 20.2% in Kazakhstan. Sexual identities and behaviors vary across countries. Injection drug use was relatively low among MSM (<5% for most). Non-injection drugs, alcohol use prior to sex, and binge drinking were more common and potentially associated with violence. Criminalization of homosexuality (Afghanistan, Uzbekistan, and Turkmenistan) and stigma has limited research and HIV prevention.
  
  
  CONCLUSIONS
  Improved understanding of risks, including potential linkages between sexual exposures and substance use, among MSM are important for response. The little known about HIV among MSM in Central Asia speaks to the urgency of improvements in HIV research, prevention, and care.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, USA; Johns Hopkins Medical Institute, USA. Electronic address: awirtz@jhsph.edu.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Wirtz
authors.forename: Anna
authors.initials: A
authors.lastname: Kirey
authors.forename: Alena
authors.initials: A
authors.lastname: Peryskina
authors.forename: Fabrice
authors.initials: F
authors.lastname: Houdart
authors.forename: Chris
authors.initials: C
authors.lastname: Beyrer
mesh_terms: D000328:Adult; D001208:Asia / Q000453:epidemiology; D058872:Epidemics; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000635:transmission; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior; D019966:Substance-Related Disorders / Q000453:epidemiology*; D047568:Unsafe Sex
keywords: Central Asia; Epidemiology; HIV; Human rights; Men who have sex with men (MSM); Substance use