More evidence on men who have sex with men in Central Asia needed

Uncovering the epidemic of HIV among men who have sex with men in Central Asia.

Wirtz AL, Kirey A, Peryskina A, Houdart F, Beyrer C. Drug Alcohol Depend. 2013 Nov;132 Suppl 1:S17-24. doi: 10.1016/j.drugalcdep.2013.06.031. Epub 2013 Jul 29.

Background: Research among people who inject drugs (PWID) in Central Asia has described same sex behavior among male PWID and may be associated with HIV and other infections. Little is known about the population of men who have sex with men (MSM) and the burden of HIV among MSM in Central Asian countries.

Methods: We conducted a comprehensive search of peer-reviewed publications and gray literature on MSM and HIV in the region. Search strategies included terms for MSM combined with five Central Asian countries and neighbors, including Mongolia, Afghanistan, and Xinjiang Province, China.

Results: 230 sources were identified with 43 eligible for inclusion: 12 provided HIV prevalence and population size estimates for MSM, none provided incidence estimates, and no publications for Turkmenistan were identified. National reports estimate HIV prevalence among MSM to range from 1 to 2% in Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan, Xinjiang, to 10% in Mongolia. Biobehavioral studies estimated HIV prevalence at 0.4% in Afghanistan and 20.2% in Kazakhstan. Sexual identities and behaviors vary across countries. Injection drug use was relatively low among MSM (<5% for most). Non-injection drugs, alcohol use prior to sex, and binge drinking were more common and potentially associated with violence. Criminalization of homosexuality (Afghanistan, Uzbekistan, and Turkmenistan) and stigma has limited research and HIV prevention.

Conclusion: Improved understanding of risks, including potential linkages between sexual exposures and substance use, among MSM are important for response. The little known about HIV among MSM in Central Asia speaks to the urgency of improvements in HIV research, prevention, and care.

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Editor’s notes: In Central Asia, the HIV epidemic has historically been characterised as primarily being driven by injecting drug use. However, this is an over-simplification, and research with people who inject drugs is starting to show that some men who inject drugs, also have sex with men. This review compiled existing evidence about HIV among men who have sex with men (MSM) in the region, from both the academic and grey literature. The paper is important, both because of the insights that the findings provide, as well as because of the large gaps in data that it illustrates. Currently there is extremely limited data that can be used to characterise the burden of HIV and risk factors for HIV acquisition and transmission among MSM, including men who use drugs. This provides an incomplete picture of the HIV epidemic in the region. Stronger evidence about the broader range of vulnerable populations, and the interactions and overlapping of risk behaviours, is needed.  This is necessary to better understand and characterise the epidemic in each country in the region; and to help shape a more effective response.  

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