Overall the HIV/AIDS epidemic in Uzbekistan and Central Asia is believed to be in the beginning stages. While there are more than 5,600 people officially registered in Uzbekistan as living with HIV, WHO/UNAIDS estimates 4,900 – 30,000 people are living with the condition. With indicators pointing to sharp increases in the rate of infection, Uzbekistan could be facing a humanitarian disaster that affects the economic and social well being of millions.

The sharp increase is largely linked to the use of illicit drugs with the majority of Uzbekistan's HIV/AIDS infections caused by intravenous drug use. Unknowingly injecting drug users are contributing to the spread of the disease when they share needles with residual HIV positive blood in them or have unprotected sex.

Trust Points are anonymous rooms in polyclinics that are staffed with trained personnel to facilitate services such as counseling, legal advise, referrals for specialized treatment and rehabilitation, blood and STI testing, syringes and needles exchange, condom distribution, peer-to-peer education for promotion of safe behavior. Trust Points also promote HIV/AIDS, Sexually Transmitted Infections, and drug awareness through mass media campaigns, community outreach activities, and the distribution of IEC material (information, education, communication).

Drug Harm Reduction focuses on introducing immediate precautions and safety measures with a view to eventual behaviour change, which is why we distribute condoms and syringes to injecting drug users, homosexuals and commercial sex workers. Drug Demand Reduction also focuses on peer-to-peer education and on raising public awareness regarding HIV/AIDS issues over a longer period.

The morality of Harm Reduction programs has been under debate for some time at the international level – it has been argued that syringe/needle exchange and condom distribution simply encourage drug use and high-risk behaviour. However as a Christian organisation, we believe that God created all people, loves and values each human life immeasurably, and instructs us to do all we can to preserve and enhance life. Therefore in high-risk situations we encourage safe practice first through condom and clean syringe use as a means to preserve and protect life and reduce the transmission of the HIV virus. At the same time we promote long-term behaviour change through counseling and education.

Rehabilitation is carried out through the State Detoxification Centre. World Vision Uzbekistan has entered an agreement with this Center whereby vouchers are given to injecting drug users in Trust Points. With these vouchers, injecting drug users can then receive detox therapy at the State Detoxification Centre. Additionally, Trust Points provide psychological consultations and organize regular self-help groups to assist injecting drug users in their struggle to overcome addiction.

The challenge that Uzbekistan faces is to reverse the deterioration in health status that followed the collapse of the Soviet Union and to catch up with the lost years of health development. Efforts are needed to ensure that Uzbekistan will reach the Millennium Development Goals, particularly as under-five mortality rate remains high and the Maternal Mortality Ratio (MMR) has shown a rising trend in the last few years. High rates of infectious and non-infectious diseases and poor nutrition, particularly among children and women, are partly due to the effects of the transition on the health and social institutions, income, and access to water and sanitation facilities.

World Vision’s engagement to address health related issues in Uzbekistan is limited to HIV/AIDS prevention. To this end, World Vision signed partnership agreements with the Ministry of Health, the Republican AIDS Centre and the Tashkent City AIDS Center, which creates the overall framework for operations to counter the spread of HIV/AIDS in Uzbekistan.

HIV/AIDS and drug abuse pose new threats to the health of people in Uzbekistan, in particular youth, which makes up over 50% of Uzbekistan’s population. While HIV/AIDS incidence has been concentrated among high-risk groups in Uzbekistan, it is crucial to anticipate an epidemic among the larger population and especially among youth. World Vision’s response is to distribute IEC material (information, education, communication) especially designed for youth. For its distribution, World Vision works with schools, youth networks and communities while engaging youth themselves as peer educators.

A Knowledge Attitude Practice (KAP) survey among youth in Tashkent schools and high schools revealed that more than 65% of youth have a basic understanding of HIV/AIDS. Their most important sources of information on HIV/AIDS are TV shows, public events and schoolteachers. Their main reasons for taking up drugs are curiosity and peer pressure. The KAP results also revealed approximately 44% of young people would like to take an active role in the prevention of drug use and transmission of the HIV virus through peer-to-peer education and participating in social events. Furthermore, around 92.3% of youth in the capital, Tashkent, have a negative attitude to drug use.

The Trust Points, for example, face the challenge of establishing relationships with high risk groups such as injecting drug users, commercial sex-workers and homosexuals, which are driven deep underground by traditional Uzbek social attitudes and an increasingly hard-line approach to prostitution and drug addiction by the police. The stigma attached to the HIV positive status makes advocacy a real challenge in any HIV prevention project. In Uzbekistan there is a widespread myth that HIV/AIDS will “never happen to me.” It is difficult to make people realize that HIV/AIDS is not discriminatory, but infects and kills individuals regardless of their social status or background. We are challenged to take a culturally appropriate approach that gets the message across to the population without alienating people. It is a long process and we are striving to give the right kind of information at the right time.

Yes, there is hope that the HIV/AIDS epidemic in Uzbekistan can be reverted or at least contained. Humanitarian organisations like World Vision are responding urgently and are supporting the government to get the hard messages across. Uzbekistan is making good use of international assistance to enable it to implement a national strategy involving many stakeholders with clear responsibilities and mandates within a legal framework. HIV/AIDS prevention is World Vision’s top priority in Uzbekistan. We are committed to identifying and designing new projects that address the needs of the most vulnerable and marginalised groups and to making the wider population aware of these groups’ rights and responsibilities for the sake of future generations.