HIV incidence and mortality decreased globally, yet increased markedly in the Commonwealth of Independent States (CIS) of Eastern Europe and Central Asia where HIV epidemics remain volatile and fueled primarily by people who inject drugs (PWIDs) with opioid use disorders (OUDs). Regional drug policies favoring incarceration have resulted in 5 CIS countries being among the 10 countries with the highest rate of incarceration. In this region, HIV is concentrated 18- to 50-fold higher than in communities. Our team has several active research projects in this region implementing evidence-based interventions and policies to reduce HIV/HCV transmission and to increase access to care.
The syndemics of addiction, HIV and TB are concentrated in criminal justice settings (CJS). HIV and TB contribute most to mortality among the ~50-60 million people who transition through prisons annually. Malaysia has the highest HIV prevalence among people who inject drugs (PWIDs) in Asia where criminalization of drugs is harsh, resulting in the highest HIV prevalence among prisoners and the second highest incarceration rate in Asia. While mortality decreased 39% in Asia, it has increased in Malaysia where treatment of HIV and TB are inadequately treated among PWIDs, especially in prisoners.