Date of Award

January 2013

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Frederick L. Altice

Subject Area(s)



Since 2005 there has been a 24% decrease in global AIDS-related deaths (1). Even still, in 2011 2.5 million people became newly infected with HIV, and 1.7 million people died from AIDS- related causes. Despite drastic global reductions in AIDS-related deaths, the two regions of Eastern Europe and Central Asia, and North Africa and the Middle East reported a 21% and 17% increase in AIDS-related deaths since 2005, respectively (1). Unlike countries in Sub-Saharan Africa, the AIDS epidemic in Eastern Europe, Central Asia, Southeast Asia, and the Middle East is driven primarily by injection drug use and presents the next frontier in the fight against HIV/AIDS. Nearly half (47%) of all HIV-infected people who inject drugs (PWID) are in five countries including China, Vietnam, Russia, Ukraine, and Malaysia (2). Despite the fact that PWID represent 67% of HIV cases in these countries, they represent only 25% of those receiving ART. Significant barriers to effective treatment and prevention remain for HIV-infected PWID and require a new set of knowledge and practices to overcome them.

In this paper, we will focus on Malaysia and Ukraine, two of the five countries with the greatest burden of HIV-infected PWID that are notable for their responses to the challenges posed by injection drug use and HIV. Specifically, we will examine HIV risk behaviors and attitudes towards opioid substitution therapy (OST) in Malaysia, assess the potential of integrated health services in Ukraine, and analyze OST scale-up efforts among HIV-infected PWID in both countries. In doing so, we hope to inform and improve the provision of healthcare services in countries suffering from the twin epidemics of HIV and injection drug use.


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