Abstract

Eastern Europe and Central Asia (EECA) is the only region in the world where annual HIV infection rates continue to grow. According to the Joint United Nations Program on HIV/AIDS (UNAIDS), in 2019 approximately 1.4 million people in the region were living with HIV. The main factors that have contributed to the spread of the epidemic over the past two decades include injecting drug use, the stigmatization and marginalization of vulnerable groups, the increasing spread of HIV into the general population, and the lack of evidence-based prevention and treatment programs necessary for controlling the epidemic. Limited access to life-saving antiretroviral treatment has intensified the impact of the epidemic in EECA and increased mortality rates among people living with HIV (PLWH).

In the post-Soviet space, Russia is experiencing by far the biggest HIV/AIDS epidemic. This can be attributed largely to the government’s failure to introduce evidence-based prevention measures for vulnerable groups, e.g., harm reduction programs, which are recommended by international health organizations. Other countries in the region have been more pragmatic in their approach and introduced harm reductions programs on a broader scale. In Ukraine, the efforts to combat HIV, which led to an initial stabilization of the epidemic in 2012, have been endangered by the military conflict in the eastern part of the country and subsequent internal displacement, which has increased HIV vulnerability. In comparison with Russia and Ukraine, the countries of the South Caucasus and Central Asia are less affected by HIV. However, labor migration to Russia constitutes a persistent risk factor for HIV transmission from higher-prevalence Russia to lower-prevalence South Caucasus and Central Asia.

Although initially the HIV/AIDS epidemic has been mainly driven by injecting drug use, it is also clearly linked to lesbian, gay, bisexual, and transgender (LGBT) politics and policies in EECA. Because of widespread stigmatization and marginalization, the spread of HIV within LGBT communities remains underreported and is barely visible in official HIV statistics. This makes it difficult for prevention programs to reach out to vulnerable groups. In all countries in the region, prevention efforts among LGBT communities remain inadequate and largely depend on local civil society organizations (CSOs), which lack the capacities to provide nationwide information campaigns and other prevention programs for the LGBT community. In addition, the work of CSOs that advocate for HIV prevention among LGBT groups is further undermined by repressive laws, e.g., the 2013 “gay propaganda law” in Russia, which has increased the stigmatization of LGBT people and has made prevention outreach more difficult. Research has contributed to our understanding of HIV vulnerability and its impact in EECA. Further research is needed, however, into the social and political factors that explain the persistent failure of regional decision-makers to adequately address the growing HIV epidemic.