AIDS 2024: HIV Epidemic in Eastern Europe and Central Asia Worsens

By Aisuluu Bolotbaeva and Diederik Lohman

Last month’s International AIDS Conference, held in Munich, had a strong focus on Eastern Europe and Central Asia (EECA), and for good reasons. While in every other region the epidemic has slowed and mortality decreased, in the EECA region the epidemic is growing—rapidly. In 2021, an estimated 160,000 people were newly infected with HIV and 44,000 people died of AIDS-related causes, increases of 48% and 32% respectively since 2010. In dozens of sessions, policy makers, program implementers, scientists, donors, and community actors examined this worrying trend and debated how to reverse it.

One important session, a ministerial roundtable organized by the World Health Organization, brought together high level officials from many countries in the region as well as experts from international public health agencies and donors. Unfortunately, the session did not leave us optimistic for a turnaround in the epidemic anytime soon. While officials reported some progress toward the 95-95-95 targets, most countries remain far off pace, especially for key populations and young people. But it was the failure of many of the high level officials to adequately address the biggest obstacle to ending HIV in the region that was most disconcerting.

In the EECA region, the HIV epidemic is driven by injecting drug use and unprotected sex, predominantly among population groups such as men-who-have-sex-with-men and sex workers. Yet, as Christine Stegling, deputy director of UNAIDS, noted in her remarks, HIV prevention services reach only half of key populations in the region. Possession of drugs for personal use remains harshly criminalized in EECA, deterring many people who use drugs from accessing harm reduction and HIV services. Indeed, Stegling said, 35% of people who use drugs do not utilize any available services. Various countries, including Kyrgyzstan, have adopted laws that prohibit promotion of “non-traditional” relationships—meaning same-sex relationships—following Russia’s example. In Uzbekistan, same-sex relations are punishable by imprisonment.

To end HIV in EECA, it is essential that the criminalization of people who use drugs and the criminalization of same-sex relationships end, along with an end of stigma and discrimination against key populations more broadly. This was a recurring theme in the presentations of the international agencies. But, with a few notable exceptions, it barely registers in many of the national strategies. Moreover, many countries in the region—Georgia, Kazakhstan, and Kyrgyzstan—have adopted Russian-style foreign agent laws that will make it hard—or even impossible—for community and other civil society organizations to implement stigma and discrimination reduction programs and advocate for an end to criminalization of key populations.

The ministerial session at the AIDS conference was an opportunity for high level EECA officials to show that they mean business when it comes to their 2030 commitment to end HIV as a public health threat. Most of them failed. There’s little chance for an “end of AIDS” in the region until these issues are put at the center of the HIV response.

Aisuluu Bolotbaeva is a public health and human rights advocate with over two decades of experience working across Eastern Europe and Central Asia. She currently works as a consultant for the Global Fund to Fight AIDS, TB and Malaria on the implementation of human rights programs.

Diederik Lohman is a health and human rights researcher and advocate. He currently works as a consultant for, among others, the Global Fund to Fight AIDS, TB and Malaria on the implementation of human rights programs.