CONCEPT PAPER

Date: October 14-16, 2002

Location: Dushanbe, Tajikistan

Sponsored by: Open Society Institute (OSI), through its International Harm Reduction Development (IHRD) program and Central Eurasia Project, and in cooperation with the Open Society Institute Assistance Foundation-Tajikistan and the Netherlands Ministry of Foreign Affairs

Conference Information
The conference will focus primarily on Central Asia's rapidly expanding HIV epidemic, to date fueled largely by injecting drug use. The conference will address the problems of drug use and trafficking and attendant health and social consequences by highlighting effective public policies, best-practice public health interventions, and protection of human rights. By bringing together leaders and experts in government, health and medicine, security, and other areas, the conference aims to create an open dialogue in which numerous stakeholder groups share information and experience and seek to develop concrete and comprehensive objectives.

The conference will focus on the five Central Asian countries that were once part of the Soviet Union: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan.

Background Information
Over the last 10 years, the countries of Central Asia have witnessed the exponential growth of drug use and HIV infection in their societies. What little foreign aid has been directed at these problems has tended to focus on counter-narcotics programs, which have uniformly failed to have a substantial impact on trafficking.

All the countries in the region share characteristics that make their populations vulnerable to HIV and other blood-borne infections, including:

• All have experienced social and economic instability;
• Access to health care and social services is poor, health expenditure is generally declining, and health systems cannot meet the demands placed on them;
• The poor economic and educational situations of women that have contributed to their involvement in drug trafficking, as well as a growing commercial sex industry that further increases vulnerability to HIV;
• World experience has shown that drug use and injection-often followed by HIV-are most prevalent in drug cultivation areas, or on drug trafficking routes. All of the Central Asian countries either produce drugs, are close to drug cultivation areas or are on trafficking routes;
• Migration and displacement increase the potential for HIV transmission but also create difficulties in sustaining community-based health programs;
• Education levels among women in particular are falling; and
• There is a virtual absence of an independent judiciary or rule of law that would help curb the arbitrary arrest and mistreatment of drug users.

To date, public health interventions in response to these crises have been ineffective or small in scale, contributing to the current situation: hundreds of thousands of drug injectors and a skyrocketing, grossly underestimated HIV epidemic. Unless far-reaching public health efforts and effective drug policies are implemented immediately, these trends will cause increased political destabilization, economic decline, and needless human suffering.

There is currently considerable potential for positive development. The war in Afghanistan, combined with Eastern Europe and the former Soviet Union's newly acknowledged status as the region with the world's highest rate of new HIV infections, has forced governments and international agencies to take the threat of an AIDS explosion in Central Asia more seriously. Bilateral and multilateral donors have increased their investments in monitoring and healthcare delivery programs. Diplomatic links have been strengthened. Most important, governments in the region have shown willingness to engage on HIV/AIDS prevention issues.

But while carefully planned, comprehensive, coordinated public policies, security measures, and development in the health sector may promote democratization and cooperation in Central Asia, poor policies can (and have) resulted in the opposite. Counter-narcotics programs can serve as a cover for human rights abuses. Disproportionately harsh sentencing, including the death penalty, is common for drug-related crimes. The stigmatization of drug users and people living with AIDS fuels the epidemic by restricting access both to information about HIV prevention, and to life-saving treatments. It is time to take stock of the situation in order to focus local, national and regional efforts toward the most positive and cost-effective solutions while a window of opportunity still exists to contain this social and health crisis.