[The UNAIDS strategy in the prevention of HIV/AIDS in the countries of Eastern Europe]. / Strategiia IuNEIDS po profilaktike VICh/SPIDa v stranakh Vostochnoi Evropy.

Grounds for the necessity of the formation of effective approaches to the prevention of HIV epidemic with a view to counteract the rapid spread of infection in East European countries are presented. Attention is specially drawn to fact that the epidemic will not be limited by drug users, but will quickly cross the boundaries of this group. The development of preventive measures must be based on the use of the world experience. New effective approaches to work with vulnerable groups (the strategy of harm reduction, work in communities, consultations, etc.) must be widely used. The program of actions of the UNAIDS European Section, stipulating the strengthening and extension of the potential of the countries in the region for the effective counteraction to the epidemic, is formulated. As priority areas, activities covering vulnerable groups and with young people have been determined. The strategy of UNAIDS is realized through 20 UN theme groups on HIV/AIDS in the countries of Eastern Europe. Special attention is drawn to the creation of methodological networks. The creation of a unified strategic plan for counteraction the epidemic of HIV/AIDS is regarded by UNAIDS as its perspective for the future.

HIV infection associated with drug injecting in the newly independent states, eastern Europe: the social and economic context of epidemics.

AIMS: We review recent trends in HIV associated with injecting drug use (IDU) in the Newly Independent States (NIS) in eastern Europe, including Belarus, Moldova, Russia, Ukraine, and Kazakhstan in central Asia. We aim to draw attention to the social and economic "risk environments" in which rapid HIV spread among IDUs has occurred. METHODS: Findings draw on centrally registered HIV surveillance data, published research studies and assessment reports funded by international development agencies. FINDINGS: Since 1995, there is evidence of rapid HIV spread in Belarus, Kazakhstan, Moldova, Russia and Ukraine, with estimates suggesting between 50% and 90% of new HIV infections among IDUs. At the same time, there have been rapid increases in the incidence of syphilis and declines in health and welfare status, including outbreaks of diphtheria, tuberculosis and cholera. Findings emphasize the potential influence of the social and economic context in creating the "risk environments" conducive to HIV and epidemic spread. Key factors include: rapid diffusions in IDU; population migration and mixing; economic transition and decline; increasing unemployment and impoverishment; the growth of informal economies; modes of drug production, distribution and consumption; declines in public health revenue and infrastructure; and political, ideological and cultural transition. CONCLUSIONS: An understanding of the social and economic contexts mediating HIV spread is a prerequiste to identifying the environmental "pre-conditions" of epidemic outbreaks, and thus also, for predicting and preventing HIV transmission. The "risk environment" may influence the efficacy of individual and community-level HIV prevention and highlights the concomitant urgency for interventions targeting social and environmental change.