Central Asian Republics (2010): HIV and TB TRaC study evaluating risk behaviours associated with HIV transmission and utilization of HIV prevention services and HIV/TB co-infection prevention among SWs

The region is primarily driven by injecting drug use, with high rates of HIV infection observed among Most at-Risk Populations (MARPs) along the drug trafficking routes. The overlap between sex work and injecting drug use facilitates the spread of HIV in the region. The number of sex workers in Eastern Europe and Central Asia countries has increased dramatically in recent history, with levels of sexually transmitted infections being high, suggesting that few sex workers are practicing safer sex. The four countries of Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan report epidemic levels of TB among their general populations, with above 110 cases per 100,000. Multidrug-resistant TB (MDR-TB) has become a serious problem, with Tajikistan and Kyrgyzstan having the third and sixth highest proportions of MDR-TB cases in the world. Almost all Central Asian countries are below the World Health Organization (WHO) targets for case detection rates and treatment success rates. A 5-year USAID Dialogue on HIV and TB Project is being implemented by Population Services International (PSI) in the four countries of Central Asia to reduce risk behaviors associated with HIV transmission and to increase the utilization of HIV and TB treatment services among MARPs. The project aims to increase access to and availability of condoms as well as TB treatment through high-targeted quality outreach to vulnerable groups. A total of 881 sex workers were surveyed using Time-Location Sampling in four cities and two oblasts in Kazakhstan, Kyrgyzstan, and Tajikistan. The survey used 2-stage cluster sampling and probability proportionate to size. Analysis was performed with SPSS 16, and the segmentation table produced was based on logistic regression analyses. Explanatory variables that significantly contribute to the explanation of the variance in the behavior of interest were identified. The monitoring table on drug use highlights that over 70% of sex workers in Kazakhstan and Kyrgyzstan and more than 86% in Tajikistan reported having consumed alcohol during the last month. However, drug injection rates seem not so high across all three countries. Sharing needles/syringes is found to be very high in Tajikistan compared to Kazakhstan and Kyrgyzstan. A high proportion of drug-using sex workers in Tajikistan and Kyrgyzstan said that they provide sexual services in exchange for drugs. The monitoring table on consistent condom use and STI highlights that in Kazakhstan and Kyrgyzstan, the percentage of respondents who consistently used condoms at vaginal and anal sexual intercourse was highest with commercial partners, lower with casual partners, and lowest with regular partners. Among respondents in Tajikistan, consistent condom use was quite low with all types of partners. However, the mean numbers of casual and commercial partners per year in Tajikistan were much higher than the means in Kazakhstan and Kyrgyzstan. The proportion of those who practiced self-treatment is comparably high in all three countries, although the most sex workers are aware of the location of specialized STI services. The availability of condoms was reported to be quite high across all three countries. Knowledge of correct HIV transmission routes was high in the three countries, but there were notable misconceptions on incorrect ways of HIV transmission.