A review of medical and substance use co-morbidities in Central Asian prisons: implications for HIV prevention and treatment.
BACKGROUND
HIV incidence in Central Asia is rising rapidly. People who inject drugs (PWIDs) contribute greatest to the epidemic, with more than a quarter of all HIV cases being in the criminal justice system (CJS). This review assembled and aggregated recent data on drug-related health problems and respective healthcare services in the CJS of Central Asia and the Republic of Azerbaijan.


METHODS
Online databases and published literature (peer-reviewed and gray) were reviewed. Additionally, prison officials in the 6 countries were invited to participate in a survey and prison administrators from Kazakhstan, Kyrgyzstan and Tajikistan completed it.


RESULTS
The data on conditions and healthcare in Central Asian prisons are inconsistent and lack unbiased details. Reporting is primarily based on "official" disease registries, which markedly underestimate prevalence. Even these limited data, however, indicate that HIV prevalence and drug-related health problems are high, concentrated and, in some countries, rising rapidly in CJS. Only some of the range of HIV prevention interventions recommended by international organizations have been implemented in the region with two of the crucial interventions, needle and syringe exchange programs (NSP) and opioid substitution therapy (OST), only available in prisons in Kyrgyzstan, with Tajikistan implementing a pilot NSP and contemplating introduction of prison-based OST.


CONCLUSIONS
Despite deficiencies in routine health reporting and insufficient HIV sentinel surveillance undertaken in prisons, the data available on the concentration of HIV within at-risk populations in prisons indicate a necessity to broaden the range and increase the scale the scale of HIV prevention and treatment services.
Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
Panagiotis
P
Vagenas
Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
Lyuba
L
Azbel
Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
Maxim
M
Polonsky
United Nations Office on Drugs and Crime (UNODC), Regional Office for Central Asia, Tashkent, Uzbekistan.
Nina
N
Kerimi
United Nations Office on Drugs and Crime (UNODC), Regional Office for Central Asia, Tashkent, Uzbekistan.
Mirlan
M
Mamyrov
Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
Sergey
S
Dvoryak
Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.|Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA.
Frederick L
FL
Altice
D001208:Asia / Q000453:epidemiology; D015897:Comorbidity; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D018671:Needle-Exchange Programs; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data*; D011330:Prisons; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*
Addiction; Central Asia; HIV; HIV prevention; Injection drug use; Prisoners; Republic of Azerbaijan; Substance use disorders; Tuberculosis