Main Article Content
Background. The dissolution of the USSR resulted in independence for constituent republics but left them battling an unstable economic environment and healthcare. Increases in injection drug use, prostitution, and migration were all widespread responses to this transition and have contributed to the emergence of an HIV epidemic in the countries of former Soviet Union. Researchers have begun to identify the risks of HIV infection as well as the barriers to HIV testing and treatment in the former Soviet Union. Significant methodological challenges have arisen and need to be addressed. The objective of this review is to determine common threads in HIV research in the former Soviet Union and provide useful recommendations for future research studies.
Methods. In this systematic review of the literature, Pubmed was searched for English-language studies using the key search terms “HIV”, “AIDS”, “human immunodeficiency virus”, “acquired immune deficiency syndrome”, “Central Asia”, “Kazakhstan”, “Kyrgyzstan”, “Uzbekistan”, “Tajikistan”, “Turkmenistan”, “Russia”, “Ukraine”, “Armenia”, “Azerbaijan”, and “Georgia”. Studies were evaluated against eligibility criteria for inclusion.
Results. Thirty-nine studies were identified across the two main topic areas of HIV risk and barriers to testing and treatment, themes subsequently referred to as “risk” and “barriers”. Study design was predominantly cross-sectional. The most frequently used sampling methods were peer-to-peer and non-probabilistic sampling. The most frequently reported risks were condom misuse, risky intercourse, and unsafe practices among injection drug users. Common barriers to testing included that testing was inconvenient, and that results would not remain confidential. Frequent barriers to treatment were based on a distrust in the treatment system.
Conclusion. The findings of this review reveal methodological limitations that span the existing studies. Small sample size, cross-sectional design, and non-probabilistic sampling methods were frequently reported limitations. Future work is needed to examine barriers to testing and treatment as well as longitudinal studies on HIV risk over time in most-at-risk populations.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Revised 7/16/2018. Revision Description: Removed outdated link.
Donoghoe MC, Lazarus JV, Matic S. HIV/AIDS in the transitional countries of Eastern Europe and Central Asia. Clin Med. 2005;5(5):487-490.
Thorne C, Ferencic N, Malyuta R, Mimica J, Niemiec T. Central Asia: Hotspot in the worldwide HIV epidemic. Lancet Infect Dis. 2010;10(7):479-488.
Parfitt T. Drug addiction and HIV infection on rise in Tajikistan. Lancet. 2003;362(9391):1206.
DeHovitz J, Uuskula A, El-Bassel N. The HIV Epidemic in Eastern Europe and Central Asia. Curr HIV/AIDS Rep. 2014;11(2):168-176.
Atlani L, Caraël M, Brunet JB, Frasca T, Chaika N. Social change and HIV in the former USSR: The making of a new epidemic. Soc Sci Med. 2000;50(11):1547-1556.
Balabanova D, McKee M, Pomerleau J, Rose R, Haerpfer C. Health service utilization in the former soviet union: Evidence from eight countries. Health Serv Res. 2004;39(6 Pt 2):1927-1950.
Walsh N, Maher L. HIV and HCV among people who inject drugs in Central Asia. Drug Alcohol Depend. 2013;132(Suppl 1):S37-S40.
Atun R, Olynik I. Resistance to implementing policy change: The case of Ukraine. Bull World Health Organ. 2008;86(2):147-154.
Terlikbayeva A, Zhussupov B, Primbetova S, et al. Access to HIV counseling and testing among people who inject drugs in Central Asia: Strategies for improving access and linkages to treatment and care. Drug Alcohol Depend. 2013;132(Suppl 1):S61-S64.
Godinho J, Renton A, Vinogradov V, Novotny T, Rivers MJ. Reversing the tide: Priorities for HIV/AIDS prevention in Central Asia. World Bank Working Papers2005.
Rhodes T, Simic M. Transition and the HIV risk environment. BMJ. 2005;331(7510):220-223.
Link BG, Phelan JC. Stigma and its public health implications. Lancet. 2006;367(9509):528-529.
Rechel B, Sikorskaya I, McKee M. Hope for health in Turkmenistan? Lancet. 2009;373(9681):2093-2095.
Rechel B, McKee M. The effects of dictatorship on health: The case of Turkmenistan. BMC Med. 2007;5:21.
Boltaev AA, El-Bassel N, Deryabina AP, et al. Scaling up HIV prevention efforts targeting people who inject drugs in Central Asia: A review of key challenges and ways forward. Drug Alcohol Depend. 2013;132(Suppl 1):S41-S47.
Gupta GR, Parkhurst JO, Ogden JA, Aggleton P, Mahal A. Structural approaches to HIV prevention. Lancet. 2008;372(9640):764-775.
Markosyan KM, Babikian T, DiClemente RJ, Hirsch JS, Grigoryan S, del Rio C. Correlates of HIV risk and preventive behaviors in Armenian female sex workers. AIDS Behav. 2007;11(2):325-334.
Lang DL, Salazar LF, DiClemente RJ, Markosyan K. Gender based violence as a risk factor for HIV-associated risk behaviors among female sex workers in Armenia. AIDS Behav. 2013;17(2):551-558.
Johnston L, Grigoryan S, Papoyan A, Grigoryan T, Balayan T, Zohrabyan L. High HIV and HCV and the unmet needs of people who inject drugs in Yerevan, Armenia. Int J Drug Policy. 2014;25(4):740-743.
Nassibov R, Abdukkayev A. Rapid assessment on spread of injection drug use related HIV/AIDS in Azerbaijan. Int J Drug Policy. 2005;16(6):432-435.
Botros BA, Aliyev QM, Saad MD, et al. HIV infection and associated risk factors among long-distance truck drivers travelling through Azerbaijan. Int J STD AIDS. 2009;20(7):477-482.
Otiashvili D, Kirtadze I, O'Grady KE, et al. Access to treatment for substance-using women in the Republic of Georgia: Socio-cultural and structural barriers. Int J Drug Policy. 2013;24(6):566-572.
Tsereteli N, Chikovani I, Chkhaidze N, Goguadze K, Shengelia N, Rukhadze N. HIV testing uptake among female sex workers and men who have sex with men in Tbilisi, Georgia. HIV Med. 2013;14(Suppl 3):29-32.
Viale BN. How perceived barriers to voluntary counseling & testing impact actual HIV testing among injection drug users in Kazakhstan. 2010; http://hdl.handle.net/10211.10/624.
El-Bassel N, Gilbert L, Terlikbayeva A, et al. HIV risks among injecting and non-injecting female partners of men who inject drugs in Almaty, Kazakhstan: Implications for HIV prevention, research, and policy. Int J Drug Policy. 2014;25(6):1195-1203.
El-Bassel N, Gilbert L, Terlikbayeva A, et al. Implications of mobility patterns and HIV risks for HIV prevention among migrant market vendors in Kazakhstan. Am J Public Health. 2011;101(6):1075-1081.
El-Bassel N, Gilbert L, Terlikbayeva A, et al. HIV among injection drug users and their intimate partners in Almaty, Kazakhstan. AIDS Behav. 2013;17(7):2490-2500.
Berry M, Wirtz AL, Janayeva A, et al. Risk factors for HIV and unprotected anal intercourse among men who have sex with men (MSM) in Almaty, Kazakhstan. PLoS One. 2012;7(8):e43071.
Boltaev AA, Deryabina AP, Kusainov A, Howard AA. Evaluation of a pilot medication-assisted therapy program in Kazakhstan: successes, challenges, and opportunities for scaleup. Adv Prev Med. 2012:308793.
Deryabina A. Mapping of key HIV services, assessment of their quality, and analysis of gaps and needs of most-at-risk populations in Chui Oblast and Bishkek City, Kyrgyzstan. 2011; http://pdf.usaid.gov/pdf_docs/pnaea608.pdf. Accessed Oct. 20, 2015.
Messner L, Kazantseva T. Gender assessment: Access to HIV services by key populationis in Kyrgyzstan. 2013; https://www.encompassworld.com/sites/default/files/aidstarone_report_gender_assessment_web.pdf. Accessed Oct. 20, 2015.
Spicer N, Bogdan D, Brugha R, Harmer A, Murzalieva G, Semigina T. 'It's risky to walk in the city with syringes': understanding access to HIV/AIDS services for injecting drug users in the former Soviet Union countries of Ukraine and Kyrgyzstan. Global Health. 2011;7:22.
Tkatchenko-Schmidt E, Renton A, Gevorgyan R, Davydenko L, Atun R. Prevention of HIV/AIDS among injecting drug users in Russia: opportunities and barriers to scaling-up of harm reduction programmes. Health Policy. 2008;85(2):162-171.
Bobrova N, Rhodes T, Power R, et al. Barriers to accessing drug treatment in Russia: A qualitative study among injecting drug users in two cities. Drug Alcohol Depend. 2006;82(Suppl 1):S57-S63.
Sarang A, Rhodes T, Platt L. Access to syringes in three Russian cities: Implications for syringe distribution and coverage. Int J Drug Policy. 2008;19(Suppl 1):S25-S36.
King EJ, Maman S. Structural barriers to receiving health care services for female sex workers in Russia. Qual Health Res. 2013;23(8):1079-1088.
King EJ, Maman S, Bowling JM, Moracco KE, Dudina V. The influence of stigma and discrimination on female sex workers' access to HIV services in St. Petersburg, Russia. AIDS Behav. 2013;17(8):2597-2603.
Vasquez C, Lioznov D, Nikolaenko S, et al. Gender disparities in HIV risk behavior and access to health care in St. Petersburg, Russia. AIDS Patient Care STDS. 2013;27(5):304-310.
Sarang A, Rhodes T, Sheon N. Systemic barriers accessing HIV treatment among people who inject drugs in Russia: A qualitative study. Health Policy Plan. 2013;28(7):681-691.
Zabrocki C, Weine S, Chen S, et al. Socio-structural barriers, Protective factors, and HIV risk among Central-Asian female migrants in Moscow. Cent Asian J Glob Health. 2013;2(1).
Niccolai LM, Toussova OV, Verevochkin SV, Barbour R, Heimer R, Kozlov AP. High HIV prevalence, suboptimal HIV testing, and low knowledge of HIV-positive serostatus among injection drug users in St. Petersburg, Russia. AIDS Behav. 2010;14(4):932-941.
Kruse GR, Barbour R, Heimer R, et al. Drug choice, spatial distribution, HIV risk, and HIV prevalence among injection drug users in St. Petersburg, Russia. Harm Reduct J. 2009;6:22.
Amirkhanian YA, Kelly JA, McAuliffe TL. Psychosocial needs, mental health, and HIV transmission risk behavior among people living with HIV/AIDS in St Petersburg, Russia. AIDS. 2003;17(16):2367-2374.
Amirkhanian YA, Kuznetsova AV, Kelly JA, et al. Male labor migrants in Russia: HIV risk behavior levels, contextual factors, and prevention needs. J Immigr Minor Health. 2011;13(5):919-928.
Weine S, Bahromov M, Mirzoev A. Unprotected Tajik male migrant workers in Moscow at risk for HIV/AIDS. J Immigr Minor Health. 2008;10(5):461-468.
Stachowiak JA, Tishkova FK, Strathdee SA, et al. Marked ethnic differences in HIV prevalence and risk behaviors among injection drug users in Dushanbe, Tajikistan, 2004. Drug Alcohol Depend. 2006;82(Suppl 1):S7-S14.
Beyrer C, Patel Z, Stachowiak JA, et al. Characterization of the emerging HIV type 1 and HCV epidemics among injecting drug users in Dushanbe, Tajikistan. AIDS Res Hum Retroviruses. 2009;25(9):853-860.
Weine S, Bahromov M, Loue S, Owens L. Trauma exposure, PTSD, and HIV sexual risk behaviors among labor migrants from Tajikistan. AIDS Behav. 2012;16(6):1659-1669.
Golobof A, Weine S, Bahromov M, Luo J. The roles of labor migrants' wives in HIV/AIDS risk and prevention in Tajikistan. AIDS Care. 2011;23(1):91-97.
Jing L, Weine S, Bahromov M, Golobof A. Does powerlessness explain elevated HIV risk amongst Tajik labor migrants? An ethnographic study. J HIV AIDS Soc Serv. 2012;11(2):105-124.
Mimiaga MJ, Safren SA, Dvoryak S, Reisner SL, Needle R, Woody G. "We fear the police, and the police fear us": Structural and individual barriers and facilitators to HIV medication adherence among injection drug users in Kiev, Ukraine. AIDS Care. 2010;22(11):1305-1313.
Booth RE, Dvoryak S, Sung-Joon M, et al. Law enforcement practices associated with HIV infection among injection drug users in Odessa, Ukraine. AIDS Behav. 2013;17(8):2604-2614.
Todd CS, Alibayeva G, Khakimov MM, Sanchez JL, Bautista CT, Earhart KC. Prevalence and correlates of condom use and HIV testing among female sex workers in Tashkent, Uzbekistan: Implications for HIV transmission. AIDS Behav. 2007;11(3):435-442.
Sanchez JL, Todd CS, Bautista CT, et al. High HIV prevalence and risk factors among injection drug users in Tashkent, Uzbekistan, 2003-2004. Drug Alcohol Depend. 2006;82(Suppl 1):S15-S22.
Rechel B. HIV/AIDS in the countries of the former Soviet Union: Societal and attitudinal challenges. Cent Eur J Public Health. 2010;18(2):110-115.
Smolak A. Contextual factors influencing HIV risk behaviour in Central Asia. Cult Health Sex. 2010;12(5):515-527.
Todrys KW, Amon JJ. Within but without: Human rights and access to HIV prevention and treatment for internal migrants. Global Health. 2009;5:17.
Dershem L, Tabatadze M, Sirbiladze T, Tavzarashvili L, Tsagareli T, Todadze K. Characteristics, high‐risk behaviors and knowledge of STI/HIV/AIDS, and prevalence of HIV, syphilis and hepatitis among injecting drug users in Batumi, Georgia: 2004 – 2006. 2007; http://pdf.usaid.gov/pdf_docs/Pnadk406.pdf.
Renton A, Gzirishvilli D, Gotsadze G, Godinho J. Epidemics of HIV and sexually transmitted infections in Central Asia: Trends, drivers and priorities for control. Int J Drug Policy. 2006;17(6):494-503.
Zabransky T, Mravcik V, Talu A, Jasaitis E. Post-Soviet Central Asia: A summary of the drug situation. Int J Drug Policy. 2014;25(6):1186-1194.
Bobrova N, Sarang A, Stuikyte R, Lezhentsev K. Obstacles in provision of anti-retroviral treatment to drug users in Central and Eastern Europe and Central Asia: A regional overview. Int J Drug Policy. 2007;18(4):313-318.
El-Bassel N, Strathdee SA, El Sadr WM. HIV and people who use drugs in central Asia: Confronting the perfect storm. Drug Alcohol Depend. 2013;132(Suppl 1):S2-S6.
Estcourt CS, Marks C, Rohrsheim R, Johnson AM, Donovan B, Mindel A. HIV, sexually transmitted infections, and risk behaviours in male commercial sex workers in Sydney. Sex Transm Infect. 2000;76(4):294-298.
Kilmarx PH, Limpakarnjanarat K, Mastro TD, et al. HIV-1 seroconversion in a prospective study of female sex workers in northern Thailand: Continued high incidence among brothel-based women. AIDS. 1998;12(14):1889-1898.
Hamama L, Tartakovsky E, Eroshina K, et al. Nurses' job satisfaction and attitudes towards people living with HIV/AIDS in Russia. Int Nurs Rev. 2014;61(1):131-139.
Smolak A, El-Bassel N. Multilevel stigma as a barrier to HIV testing in Central Asia: A context quantified. AIDS Behav. 2013;17(8):2742-2755.
Wolfe D, Carrieri MP, Shepard D. Treatment and care for injecting drug users with HIV infection: A review of barriers and ways forward. Lancet. 2010;376(9738):355-366.
Wolfe D. Paradoxes in antiretroviral treatment for injecting drug users: access, adherence and structural barriers in Asia and the former Soviet Union. Int J Drug Policy. 2007;18(4):246-254.