title: Redressing the epidemics of opioid overdose and HIV among people who inject drugs in Central Asia: the need for a syndemic approach.
abstract: BACKGROUND
  Accumulating evidence suggests that opioid overdose and HIV infection are burgeoning intertwined epidemics among people who inject drugs (PWID) in Central Asia. To date, however, research on overdose and its associations with HIV risks among PWID in Central Asia remains virtually absent. This paper aims to provide a regional overview of the hidden epidemic of overdose and how it is linked to HIV among PWID in Central Asia, using a syndemic framework that is guided by risk environment research.
  
  
  METHODS
  We conducted a comprehensive literature search of peer-reviewed publications and gray literature on opioid overdose and its associations with HIV in five countries of Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) as well as on policies and programs that address these co-occurring epidemics.
  
  
  RESULTS
  Regional data indicate high rates of fatal and non-fatal overdose among PWID. Evidence suggests mortality rates from overdose exceed HIV/AIDS as the leading cause of death among PWID. The syndemic framework suggests multiple macro-level and micro-level environmental risk factors that drive the co-occurring epidemics of HIV and overdose. This framework identifies several interacting biological and behavioral risks that result in additive effects for HIV and overdose.
  
  
  CONCLUSIONS
  The high rates of overdose and its associations with HIV underscore the need for a syndemic approach that considers overdose on parity with HIV. Such an approach should focus on the biological, behavioral and structural interactions between these epidemics to reduce social suffering, morbidity and mortality among PWID in Central Asia.
authors: Global Health Research Center of Central Asia, Columbia University School of Social Work, United States. Electronic address: lg123@columbia.edu.
authors: Louisa
authors: L
authors: Gilbert
authors: Sholpan
authors: S
authors: Primbetova
authors: Danil
authors: D
authors: Nikitin
authors: Timothy
authors: T
authors: Hunt
authors: Assel
authors: A
authors: Terlikbayeva
authors: Azzi
authors: A
authors: Momenghalibaf
authors: Murodali
authors: M
authors: Ruziev
authors: Nabila
authors: N
authors: El-Bassel
mesh_terms: D001208:Asia / Q000453:epidemiology; D062787:Drug Overdose / Q000453:epidemiology*; D058872:Epidemics; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D015995:Prevalence; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*
keywords: Central Asia; HIV; Injection drug use; Naloxone; Opioid overdose; Syndemic
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