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Purpose: Women engaged in sex work (WESW) who use drugs face barriers to HIV testing. HIV self-testing (HST) may empower sex workers to learn their HIV status; however, it is not scaled up among WESW in Kazakhstan. This study aimed to explore barriers and facilitators to traditional HIV testing and HST among this population. Method: We conducted 30 in-depth interviews (IDIs) and four focus groups (FGs) with Kazakhstani WESW who use drugs. Pragmatic analysis was used to explore key themes from qualitative data. Results: Participants welcomed HST due to its potential to overcome logistical challenges by accessing HIV testing, as well as the stigma that WESW faces in traditional HIV testing. Participants desired emotional and social support for HST, and for linkage to HIV care and other services. Discussion: HST among women who exchange sex and use drugs can be successfully implemented to mitigate stigma and barriers to HIV testing. [ABSTRACT FROM AUTHOR]

Background: In Central Asia, between 33% and 72% of cumulative HIV infections has been attributed to unsafe injection practices among people who inject drugs (PWID)., Methods: We reviewed the current status and trends of national efforts in Central Asian countries to control HIV among PWID, and also reviewed the key structural and health-systems-related challenges that facilitate drug-use-related HIV risk in Central Asia., Results: The spectrum and scale of HIV prevention services targeting PWID vary considerably among Central Asian countries. In all countries, the potential impact of these interventions is hindered by several key features: a restrictive legal environment, poor performance of service providers, widespread opposition to harm reduction, deficient human resources and funding mechanisms, poor services integration, insufficient community involvement, and other structural factors., Conclusions: Scaling up HIV prevention interventions in Central Asia will demand greater attention to the structural, health-care-related and social factors that facilitate HIV risk and impede service utilization among PWID. Multi-level combination prevention interventions should be developed with a focus on the sexual partners and risk networks of PWID, aiming at early detection of HIV, timely enrollment in HIV care, and retention in HIV care., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Introduction: As a population profoundly affected by the HIV epidemic and in critical need of linkages to HIV treatment and care, PWID in Central Asia remain largely underserved. This paper provides an overview of the current state of HIV testing and counseling in Central Asia for PWID, identifies main barriers leading to gaps in service delivery, and discusses implications for improving strategies that promote HIV testing for PWID., Methods: We reviewed a number of sources for this paper including unpublished government reports, published papers, and Ministries of Health of Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan country progress reports to the UN General Assembly Special Session on HIV/AIDS (UNGASS) for 2012., Results: Between 29 and 65% of PLWH in some Central Asian countries have been tested for HIV in the last 12 months. The rates have been increasing in the recent years but still are relatively low. Stigma, discrimination, human rights violations, and repressive legislation are barriers to HTC for people who inject drugs (PWID)., Conclusion: The use of innovative evidence-based HTC models, such as community mobile-vans, self-testing at home, and rapid HIV testing among PWID in Central Asia are discussed and recommendations given regarding amendments in legislation and scaling up of existing community-based pilot projects to support HIV testing among PWID in CA., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

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., Conclusion: 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., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)