The countries that comprise the Central Asia region have diverse economies, ethnicities and geographies, but they share in a rapidly expanding HIV epidemic – fueled by injecting drug use. In Tajikistan 13.5 percent of people who inject drugs (PWIDs) are infected with HIV. Similarly high numbers are seen in other Central Asia countries, with 12.3 percent of PWIDs in Kyrgyzstan, 8.4 percent in Uzbekistan and 4.8 percent in Kazakhstan testing positive for the disease. High rates of HIV infection are also seen in other at-risk populations including prisoners, female sex workers, men who have sex with men and migrants. 
These key populations, especially PLHIV, migrants and prisoners are also at high-risk for TB. Although overall mortality and morbidity due to TB has been decreasing in the CAR , all five countries have TB rates that are considered to be at epidemic levels (TB incidence rates higher than 50 new cases per 100,000 of population).
PSI/Central Asia began implementing HIV prevention and drug reduction programs in 2002 for Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan. Under these programs, PSI has promoted healthier behaviors to more than 217,000 at-risk youth and thousands of IDUs and SWs in high-risk sites along major opiate trafficking routes. PSI expanded its work in the region in 2007 to include family planning projects in vulnerable areas of Tajikistan and Kyrgyzstan. PSI left Uzbekistan in 2008, but continues to work in the country through NGO partners.
In 2009, PSI/Central Asia embarked on a new five year project to reduce the burden of HIV and TB in all five Central Asian Countries. The Project works with most-at-risk populations including people who inject drugs, sex workers, men who have sex with men, prisoners and migrants and has reached more 143,146 key populations. This impact will continue to reverberate in the region for years to come in the form of improved public health and a population more engaged with the health system. Thus far, 25,225 individuals have redeemed referral vouchers to receive medical services including HIV or TB testing and treatment and more than 5,400 people who inject drugs were specifically referred to drug treatment services. Rising rates of TB transmission were targeted through outreach and education, reaching an upwards of 100,000 people. Over 16,700 vouchers have been redeemed for TB testing, which has led to the detection of 776 new cases of TB. Of the TB positive individuals reached by the Project, nearly 1,180 have been enrolled in case management and treatment adherence programs developed by Project staff. Throughout Project implementation, PSI/Central Asia has established close working relationships with national health and government structures at all levels and strengthened local capacity through numerous trainings, ensuring maximum Project sustainability.
 Kazakhstan: Data for general population (15-49 years old) from MoH, 2013; data for PWID, SWs, MSM, and Prisoners from MoH, 2013; data for Migrants from Republican AIDS Center, 2008. Kyrgyzstan: Data on general population (15-49 ages) from UNAIDS, 2012; data on PWID, SWs, MSM, and Prisoners from Preliminary Sentinel Surveillance, 2013; data on migrants not available. Tajikistan: general population (15-49 ages), SWs, MSM, Prisoners from UNAIDS, 2012; data for PWID from Preliminary Sentinel Surveillance, 2011; data for migrants from Sentinel Surveillance, 2008; Uzbekistan: Data for general population (15-49 ages), from UNAIDS, 2012; data on PWID, SWs, and MSM from Sentinel Surveillance, 2011; data on migrants and prisoners not available.
 “Global Tuberculosis Report 2013,” Geneva: WHO, (2013): 161-162. (accessed August 5, 2014).
The USAID Dialogue on HIV and TB Project, formerly the Health Outreach Program, is a five-year program aimed at reducing the spread of HIV and tuberculosis (TB) in Central Asia by improving health behaviors among most-at-risk populations (MARPs).
Project goals include:
- Reduction in risk behaviors associated with HIV transmission.
- Increased use of evidence-based HIV prevention and TB treatment services by MARPs.
- Improved TB case detection among selected MARPs.
- Improved adherence to and decreased default rate from TB treatment among MARPs.
USAID Dialogue on HIV and TB Project is implemented by a consortium of partners led by PSI and includes Project HOPE, AIDS Foundation East-West (AFEW), and the Kazakh Union of People Living with HIV. Implemented in Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan and Turkmenistan, the project targets people who are most at risk of contracting HIV and TB:
- People who inject drugs.
- Sex workers.
- Men who have sex with men.
- People living with HIV & AIDS.
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria
- ABT Associates
- Project Hope
- KNCV Tuberculosis Foundation
- Local NGOs
- National TB Centers (Kazakhstan, Kyrgyzstan, Tajikistan)
- Republican AIDS Centers (Kazakhstan, Kyrgyzstan, Tajikistan)
- The Effectiveness of PSI Outreach Activities Among MSM Regarding Condom Use and HIV HTC in Central Asia
The goal of this project is to use social networking and education to create a social norm that promotes safe sexual practices among men who have sex with men (MSM). This presentation was created for 2014 International AIDS Conference in Melbourne, Australia.
- Using Data Stored in Management Information System (MIS) to Improve Tuberculosis Treatment Adherence Among People Living with HIV (PLHIV) in Central Asia
PSI/Central Asia implements the USAID Dialogue on HIV and TB Project to improve TB treatment adherence among people living with HIV (PLWH) through comprehensive case management and social support. We use a management information system (MIS) to evaluate the effectiveness of adherence support. The MIS tracks referrals to TB testing and new cases detected through the use of vouchers. Clients are assigned a unique identifier, and social workers track client activities, including treatment completion and reasons for default. Unlike past systems that just tracked number of visits or people reached, this MIS enables follow-up of individual clients over time and identification of treatment defaults. After one year, MIS data showed 43.8% of defaulters (48) lost contact with the project in the last month – highlighting the need for improved PLWH retention strategies. The project is reviewing PLWH records and meeting with clients to identify steps to improve retention.
- Central asia (2008): Knowledge, Attitudes and Practices of At-Risk Youth Relating to Injecting Drug Use and Sexual Behavior in Four Countries of Central asia. Third Round
- Youth Perspectives on Drug Use, Heroin, and Risk for HIV/AIDS in Tajikistan and Uzbekistan, Central Asia
This study of youth in Tajikistan and Uzbekistan identifies factors that render them vulnerable to drug use. It explores youth’s definitions of and attitudes toward drug use and examines how substances other than heroin and opiates influence higher risk behaviors, especially injecting drug use.