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It estimates that between 28% and 55% of all new HIV infections over the next 15 years in the region will be attributable to heightened HIV transmission risk among currently or previously incarcerated people who inject drugs.37 When reported, HIV prevalence in prisons exceeds 10% in Latvia (20.4%), Ukraine (19.4%), Estonia (14.1%), and Kyrgyzstan (11.3%)38 A number of prison surveillance studies have found HIV prevalence to be 22 times, 19 times, and 34 times higher in prisons than in surrounding communities in Ukraine, Azerbaijan and Kyrgyzstan, respectively.39 In 2010, the most recent data available, 55,000 of Russia's 846,000 inmates were thought to be living with HIV.40 Between 20, HIV prevalence doubled among young people (aged 15–24) in Eastern Europe and Central Asia.41 In 2017, it was estimated that 0.2% of 15-24 year olds in the region were living with HIV, with an equal prevalence level between young men and women.42 Exposure to alcohol and drugs, peer pressure, gender-based violence and inequality, intensive labour migration and displacement, human trafficking, marginalisation and involvement in sexual exploitation all conspire to increase the vulnerability of young people in the region, especially girls, to HIV.43 The average age people in the region begin injecting drugs is low and in some countries the age of first use is decreasing further.

For example, in 2016 Armenia and Belarus eliminated mother-to-child transmission of HIV.

According to country progress reports in eight countries, from 2.0% (in Tajikistan) to 11% (in Kyrgyzstan) of surveyed young people (aged 15–24) had sex before the age of 15.45 Among the 1.4 million people living with HIV in the region at the end of 2017, 73% were aware of their HIV status, an increase from 69% in 2016.46 However, while the overall number of annual HIV tests continues to increase, the proportion of tests among key populations is shrinking, declining from 4.5% of all HIV tests conducted annually in 2010 to 3.2% in 2016.47 Testing coverage is generally higher among sex workers and men who have sex with men, and lower among people who inject drugs, although it is still below advised levels across all key affected populations.

When reported, in 2017 HIV status awareness among HIV positive sex workers ranges from 31.7% in Moldova to 93.7% in Kazakhstan.

Outside of Russia, the rate of new HIV infections is stable.5 The region’s epidemic is concentrated predominantly among key affected populations – in particular, people who inject drugs (sometimes referred to as PWID) – yet there is low coverage of harm reduction and other HIV prevention programmes in key countries within the region.6 Unprotected sex is causing an increasing number of HIV infections and is now the leading cause of transmission in some countries.

The sexual partners of key affected populations, in particular sex workers and people who inject drugs, are at elevated risk of HIV infection and accounted for 33% of new infections across the region in 2014.7 Indeed, the number of new HIV infections acquired through heterosexual sex increased by 150% between 20.8 In addition, growing HIV epidemics among transgender people, gay men and other men who have sex with men are understudied and unrecognised by several national HIV responses.9 Stigma and discrimination towards people living with HIV and key populations remain high.

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