The Asteria Foundation
The Spread of HIV among Female IDUs in Southern
Social and Psychological Factors
And Limited Services
A Report on Research Results
A study conducted with support from the Soros Foundation-Kyrgyzstan
And the International Harm Reduction Development Program,
Open Society Institute, New York
I.D. Dzhalbieva sociologist, author of questionnaires and
I.V. Yermolaeva study director, director of the Asteria Foundation
M.M. Tokombaeva expert on preventing and fighting HIV/AIDS, drug
addiction, and on working with convicts. President of the Harm Reduction
Network in Kyrgyzstan.
M.A. Smelyanskaya Coordinator, International Harm Reduction
Development Program, Open Society Institute, New York.
1.1. Study Description
1.1.1. The Purpose and Goals of the Study
This study was conducted during December 2007 and January 2008 in the
cities of Osh and Jalal-Abad, and in Osh Oblast. The purpose of the
study was to fill an information vacuum regarding female drug users in
Kyrgyzstan. Despite frequent references to the use of Kyrgyz women in
narcotrafficking and reports by international organizations about growth
in the number of women drug users in neighboring Kazakhstan, this
vulnerable group has received remarkably little attention from
international donors and human rights and nongovernmental organizations
on the one hand, and from government bodies that provide medical and
social services on the other. According to reports by the Republic
Center for Narcology (RCN), as of August 2008, 488 women were registered
as drug users in the republic. This would constitute 9 percent of total
drug users in Kyrgyzstan (5356). The RCN also reported that the number
of female drug users is growing beyond what it had been in past years:
the official figure for registered women in 2008 (488) is twice what it
was in 2005 (236). Considering that statistics on registered drug users
do not paint a complete epidemiological picture and that female IDUs in
Kyrgyzstan are a rather closed group, it can be assumed that the real
number of women using narcotics and the percentage they represent of
drug users overall is much greater than official figures would indicate.
The primary goal of the study, which was conducted by investigating
the social, psychological, medical, and legal needs of women drug users,
was to produce specific recommendations on how to improve the conditions
under which women live and create and/or modify prevention, treatment
and care programs specific to the target group.
In order to achieve this goal, the study group assigned itself the
1. To identify the demographic and socioeconomic profile of the
female drug user.
2. To determine the behavioral risks associated with drug use,
including those associated with sex work.
3. To determine the state of health of female drug users; to study
childrearing practices and assess access to prevention and treatment
programs for female IDUs.
4. To identify stigmas affecting female drug users in their
interactions with law enforcement, health workers, and society.
1.1.2. Study Methodology
Study results and recommendations are based on data collected using
qualitative information gathering methods (semi-structured in-depth
interviews using a questionnaire). The financial, human, and time
resources available to the research group, as well as the closed nature
of the group being studied, limited the number of respondents we were
able to survey. Therefore we do not claim that study results permit us
to extrapolate totals (all female drug users; all female drug users with
children; all female sex workers). Instead they reveal trends helpful in
determining the needs and requirements of the studied target group. The
methodology is appropriate to the goals and tasks of the study.
Respondents were reached using a "snow ball" method and members of
the target group were sent out into the field to work with their peers.
Collaboration with the Oblast Narcological Dispensary, the NGOs Parents
Against Drugs, Podruga, and Tais Plius Dva also brought us into contact
Information was collected using questionnaires adapted to each group
1. Questionnaire for semi-structured in-depth interviews with female
2. Questionnaire for semi-structured in-depth interviews with female
drug users with children;
3. Questionnaire for semi-structured in depth interviews with female
drug-using sex workers.
1.1.3. Confidentiality and Safety
Respondents were guaranteed complete confidentiality. Information
identifying respondents, either directly or indirectly, cannot be
disclosed to anyone except the team of researchers, who need these
records to verify interviews, analyze data, etc. All respondents were
given clear assurances of this before the interview. The interview did
not begin without the consent of the respondent. Some respondents agreed
to take part in more detailed telephone and in-person interviews, the
records of which are filed with the research group. Quotations from
these interviews are included in this report. All names have been
changed to ensure confidentiality.
2. Study Overview and Primary Recommendations
Over the course of the study 73 female injecting drug users were
surveyed. All the women (98%) used heroin as their primary drug; 44% had
been users for more than 8 years, and 73% of those surveyed were between
19 and 35. Almost half of those surveyed had been involved in the
criminal justice system and of them, 65% had been charged with drug
possession and use. The primary means of employment among the women
surveyed was sex work 62%.
According to study results, 67% of those surveyed did not always use
condoms and the majority, including those engaged in sex work, did not
clearly understand the importance of using condoms as a means of
protecting against disease. Additionally, the group exhibited a lack of
awareness of harm reduction services and substitution therapy, and
access to these services was extremely limited due to stigma, lack of
awareness, and the low level of self-esteem among those surveyed. Over
the course of the study it was also determined that in the southern
region there are no support groups, 12-step programs, or narcotics
anonymous groups for women.
The survey group had a disproportionately high rate of HIV infection
23% of women surveyed identified themselves as HIV positive. A
comparison of this figure with data from sentinel surveillance conducted
by the Kyrgyz Ministry of Health in 2006 shows that the level of HIV
infection in the survey group is almost twice as high as the average
rate of HIV among drug users in the city of Osh. Only 6% of those
surveyed had been tested for HIV in the past year. One quarter of those
who had ever been tested for HIV stated that they did not receive pre-
or post-test counseling. Among survey subjects, 66% tested positive for
hepatitis C. They also reported frequent instances of violence and
violations of their rights by law enforcement.
The findings make it clear that in order to reduce the risk of
infectious diseases, it is essential that female IDUs be provided better
access to preventive services and drug treatment and that more precise
situational analysis of this group is needed throughout the country. It
must also be noted that widespread stigma and discrimination toward
female drug users on the part of government workers, those close to
them, and the public at large, has served to close off this
exceptionally vulnerable group. Consequently, what is needed first and
foremost is work with the public at large and the nongovernmental sector
to reduce the stigmatization of these women and discrimination against
them. Other major recommendations are summarized below and spelled out
in greater detail in the concluding chapter of the report.
The main recommendations presume collaborative work between NGOs and
government bodies both with the target group and the public at large.
NGOs engaged in harm reduction and providing medical and social
services to sex workers already have access to the target group and are
uniquely positioned to attract large numbers of female IDUs into
prevention programs and develop self-help groups among them.
Additionally, in cooperation with leaders of local communities, NGOs are
able to launch educational programs aimed at preventing violence against
women and reducing stigmas and discrimination affecting vulnerable
groups of women. NGOs must cooperate with government bodies, such as:
drug treatment centers, AIDS centers, and gynecology clinics to create a
system of referrals and client management for female IDUs. It is evident
that both NGOs and health workers need to be educated in the specific
services needed by female IDUs, and it is therefore recommended that
they be acquainted both with this report and with literature that gives
more extensive examples about providing medical and social services to
female drug users.
Drug treatment services, in collaboration with NGOs, are capable of
improving the conditions under which women undergo short-term
detoxification treatment and of informing women about the methadone
substitution therapy program and recruiting greater numbers of women
into this program. For example, pregnant IDUs and HIV-infected female
IDUs should be accepted into drug substitution programs on a priority
basis. Health workers specializing in gynecology can become better
qualified in the area of drug dependency and study existing treatment
models, and inform patients about them and methods for preventing HIV
3. Main Section
3.1. Demographic and Socioeconomic Profile of Respondents
3.1.1. Basic Information
A total of 73 women were surveyed:
All 73 were injecting drug users
32 had children (44%)
45 were engaged in sex work (62%)
17 were HIV positive (23%)
They had been using drugs for:
from 1 to 3 years 17 (23%)
from 3 to 5 years 4 (5%)
from 5 to 8 years 20 (28%)
from 8 to 12 years 9 (13%)
12 years or longer 23 (31%)
The children of the 32 who were mothers ranged in age from 1 to 25.
Of those respondents, who stated that they engage in sex work, more than
half had children.
Table 1 presents basic socio-demographic information about the
respondents. A large percentage of the women surveyed (48%) were in
their prime years in terms of employment and reproduction between 26
A plurality of the respondents had a secondary school education.
About one-tenth of respondents had only a primary school education, and
it should be mentioned that among them were those who could neither read
nor write. The study sample also included a few college-educated women.
Table 1: Socio-Demographic Data
Some secondary school
Technical secondary education
Other (Tatar, Korean)
Half of the respondents lived with their parents or at least in their
parents' home. The other half, rented housing.
3.1.2. Income Sources.
The vast majority of those surveyed had some source of income (80%).
While a high rate of employment might appear to be something positive,
the incomes of most respondents do not place them within any
economically stable segment of the population.
Of the 18% that have regular employment, 3% had their own business
and engages in commerce. Seven (7) percent worked as outreach workers
for NGOs and earned 2500 som/month. Eleven (11) percent worked in the
service sector and most often performed menial labor (dishwasher,
housekeeper, laundress, scrub women, etc.). Salaries for such jobs
ranged from 1000 to 2500 som per month.
A very large percentage of respondents performed sexual services
along trucking routes, for which they reported payment ranging from 100
to 200 som. In more "elite" establishments, payment can reach 600-700
som. The behavioral risks associated with drug use, sex work in
particular, is described in section 3.2. A certain percentage of
respondents 4.11% - admitted to engaging in crime.
Among sources of income, 5.48% of respondents received child support
(from 500 to 830 som/month) and 1% received compensation for the loss of
a breadwinner (170 som/month).
Table 2: Employment
Technical secondary education
3.1.3. Incarceration Experience
Forty (45) percent of those surveyed reported that they had been
charged with crimes and incarcerated. In most cases they were charged
with possession and use of narcotics (65%). The percentage of those
detained by law enforcement for petty theft was also rather high.
Table 3: Crimes with Which Respondents Were Charged
Crimes with Which Respondents
Engaging in prostitution (in OAE),
infliction of bodily harm, grand larceny.
*Here and elsewhere, when the total percentage is more than 100, this
indicates that respondents were able to give multiple answers.
Despite the fact that the Kyrgyz Ministry of Justice has collaborated
with the nongovernmental sector in recent years and has made qualitative
improvements in the area of HIV prevention in male prison settlements by
introducing syringe exchange programs, social work, and, in August 2008,
through a methadone pilot project, the HIV prophylaxis situation in
incarcerated female populations is much worse, since none of the
above-mentioned programs have been implemented there.
Most of the respondents spent from 3 to 5 years incarcerated. Changes
introduced into Kyrgyz law and reductions in the penalties for
possession of small amounts of drugs, making this an administrative
offense, will have a positive effect on the fate of female IDUs in the
future. Currently, amnesties and retroactive application of the updated
law is leading to the release of a large number of women (according to a
source in the Ministry of Justice, in women's colony No. 2 the number of
prisoners was cut in half over the course of a year, from more than 500
inmates in 2007 to 265 in 2008).
Table 4: Incarceration Terms
7 or more
Having been incarcerated has serious consequences not only for
women's status in society, but also for their psychological state and
health, and it determines the conditions under which children are
raised. The situation is further exacerbated by the fact that the social
support system for those freed from colonies is not working well. As a
rule, this leads to a situation where female ex-convicts are essentially
deprived of all rights in the eyes of civil law. Additionally, even
those governmental and nongovernmental organizations that provide
support to former inmates shelters, drop-in, and rehabilitation
centers often are not equipped to work with female drug users, since
their main contingent is male or women with a more "acceptable"
Here is what Ryskul, a psychologist in the Social Bureau of Women's
Colony No. 2 (village of Stepnoe), had to say about this.
The task of our Social Bureau is to prepare convicts to be released
from incarceration. We discuss a joint plan of action and how they will
solve their problems when they are released and provide information
about NGOs and various governmental offices where women can receive some
help. But as soon as they are released, women confront a number of
problems much more serious than those confronting men. The housing that
NGOs provide is for a maximum of one month, maybe just a bit more, and
beyond that it's unknown what will happen. At best it takes half a year
to receive new [identification] documents, and without documents you
can't get a job. And in order to get a passport you need a residence
permit, and who will give you one? So restoring documents might take
more than a year. If a woman has a child or several children, then there
are even more problems. And many women's centers won't take the women we
they deal with different categories of women. It would be wonderful
if all government offices actively supported the initiatives of the
ex-convicts who turn to them for help. If this were the case it would be
easier to monitor the fates of women who are released. Now there are
some efforts by government bodies, but the problem remains unsolved.
The problem of identity documents was common among respondents. For a
variety of reasons, one quarter of them had no such documents (23.29%).
Diagram 1: Reasons for Lack of Documents
Although having recently been released from incarceration is not the
primary reason respondents did not have documents, this problem still
demands attention, especially since the lack of documents has
consequences not just for the women, but for their children.
A woman named Irina had the following to say about her situation:
In general, I'm a Russian citizen, and the first time I was
imprisoned I still was. By the time I was released I didn't have
documents anymore and the certificate of release listed me as a Kyrgyz
citizen. So the second time I was imprisoned it was as a citizen of the
KR. Now it's not clear what country I'm a citizen of, and I have no
documents. And I have no idea what to do to get them, where to start.
In Tanya's case, the inability to obtain documents in time may have
an impact on her parental rights:
I was released from prison with a baby. I'm from Kochkor-Aty (Jalal-Abad
Oblast) that's where I lived with my husband. While I was in prison he
sold the house and left for some unknown destination. I don't have any
parents either, so I have nowhere to go. I wanted to give the baby to an
orphanage until I could find work, housing, and obtain documents. But I
heard that it would be hard to get my child back. Now I'm afraid to give
up my child, but I have no idea where to go.
3.2. Behavioral Risks Associated with Drug Use, Including Those
Associated with Sexual Services
3.2.1. Duration and Context of Drug Use and Associated Risks
For the most part, the drugs of choice used by respondents were
heroin and hanka. In addition, some respondents also smoked cannabis.
Table 5: Drugs of Choice
Practically all respondents use heroin as their main narcotic. If
heroin was not available, they used hanka (39%), and also substituted
alcohol (98%) or psychotropic pills (34%) for heroin. To complement
heroin they used dimedrol, a sedative.
As Diagram 2 shows, most respondents had been using drugs for a
rather long time. Approximately one-third of those surveyed indicated
that they had used drugs for 12 years or more.
Diagram 2: Duration of Drug Use
If we consider that most respondents were between 26 and 35 years of
age (48%) and that they had been using drugs for 8 years or more (44%),
it becomes apparent that most of those surveyed were first given drugs
when they were adolescents or were aged 20 to 25, or when they married.
This is consistent with the findings of international research
indicating that women often first use drugs within the context of a
Below are some of the most commonly repeated responses in answer to a
question about the first experience using drugs.
It was interesting, all my friends were using
Curiosity, then I got used to it
It was popular
I wanted to be like everyone else
To fit in with a group
Interest, I thought it was cool
I saw other people doing it and I wanted to try, I got drawn in
Everyone in my crowd was using
My boyfriend said that I would like it, it became interesting
When my joints were hurting, my husband injected me, said it would
He talked me into it and I liked it
My husband and his friends are addicts
Under pressure from my husband
It seemed interesting, then I didn't notice how much I craved getting
With my husband and his friends
My older sister was shooting up and she got me into it
My husband got me into it
My husband pressured me
Most responses involve three repeating themes interest associated
with imitating friends and peers; the search for an escape from a
difficult situation or a means of dealing with difficult circumstances;
and the influence or a husband or loved one.
It should be noted that using drugs with a partner or in a group of
friends entails a heightened risk of HIV/AIDS infection for female IDUs.
Twenty (20) percent of those surveyed were married or had a stable
partner. As they expressed it, they had no need to hide their drug use
from their husband or partner since he also was a user. The trust that
women tend to place in their intimate partners often leads to the joint
usage of injection equipment. For example, research in three regions of
Russia revealed that 25% of female IDUs shared injection equipment with
their partners. Similar research conducted by the nongovernmental
organization Clean World that studied female drug users in five cities
of Azerbaijan showed that 76% of them used shared syringes and only
one-third of them injected themselves first, while the remaining
two-thirds used injection equipment that their partner or friends had
used. Additionally, a 2006 study conducted in Kyrgyzstan, Tajikistan,
and Uzbekistan by the UN Office on Drugs and Crime (UNODC) found that of
the three countries, drug users in Kyrgyzstan cleaned their injection
equipment less often than in the other countries. Furthermore, 90% of
female drug users surveyed stated that they never clean injection
equipment before using it.
Women (female IDUs in particular) are often unable to persuade their
husbands or partners to use condoms during sexual activity. Despite the
fact that essentially all those surveyed (96%) know about
contraceptives, 67% do not always use a condom. More than half of women
who reported not using a condom were not involved in sex work and,
consequently, relied entirely on the faithfulness of their partners. In
a region where informal polygamy is still practiced, such trust can have
very unpredictable results. It was evident from comments by those
surveyed that even those women who have a steady partner are inclined to
random sexual encounters, which further exacerbates the risk of HIV and
3.2.2. Sex Work
Sixty-two (62) percent of respondents were sex workers. This
statistic is consistent with figures from neighboring Tajikistan, where
sentinel surveillance conducted in 2005 showed that 58% of women drug
users were drawn into sex work. When asked what had compelled them to
earn money this way, the main factor cited by respondents was lack of
money, including money to buy drugs.
Not enough money for a dose and for food
Ran out of money for drugs
Because they pay
Earn a bit extra this way, but don't do it regularly
Got onto "otrava" [heroin or opium], didn't have enough money, had to
go out on the trassa [streets, i.e., enter prostitution]
At first I wound up in a group where everything was nice, expensive,
beautiful things, seemed really cool, then drugs, lack of money
Didn't have anything to live on
Came from Talas, my sister didn't have money for an operation
Because of money, had to pay for housing, food, drugs
Didn't have a job, needed money for a dose and to pay for housing
Need money for my dose, for my son, to live on
The stories of two respondents are given in greater detail below. It
should be noted that these are the stories of individuals, but they are
not unique among the survey group and point to the limited options and
other social factors that impact the women's lives.
Here is how 22-year-old Zukhra from Jalal-Abad tells her story.
I have been working in the sauna since I was 16, as a prostitute in
other words. My husband stole me when I was 14, I gave birth to a son,
and ran away. I don't want to see my husband or the child I had with
him. I came here, met a guy who was an addict, and he got me into drugs
and, after 2 months he sold me to the sauna so I could earn money for
him. Then he died of an overdose.
And here is the story of 18-year-old Adina from the city of Osh:
I've been shooting up for three years and my younger sister has been
for one year. She started with me. There are six of us sisters, living
together renting a little house. We had a brother who helped, but he
died of an overdose recently and we needed some way of living and
getting food. So we went out onto the trassa [streets]; I'm too old to
sell my body, but my little sisters are in demand.
International experience confirms that the economic situation and the
need for the means to support a family or a child, as well as for drugs
for themselves and their partners often compels female drug users to get
involved in sex work. Female drug users do not always get opportunities
to work in more prestigious establishments and the main source of income
for them becomes street sex work, with all the risks to life and health
that this entails, such as frequent episodes of violence and persecution
by law enforcement. Furthermore, when riskier sexual services are
provided, clients usually demand that no condom be used. Female drug
users also sometimes engage in so-called "barter" sex, offering
themselves in exchange for drugs, shelter, or food.
The results of this survey showed that among sex workers there is no
clear understanding of the need to use a condom as a means of protecting
against disease. The reason for not using a condom is often the client's
desire to have sex without one. Below are some responses explaining why
those surveyed have unprotected sex.
When the client doesn't have one
With a partner I trust
He asks or demands
The client will pay more if
Sometimes the client doesn't want to
When I don't have one
Sometimes I don't have one, sometimes I just want to save money
A drunk client didn't want to
Many respondents who, one way or another, did use condoms, often got
them for free. As the women indicated, there is access to free condoms,
in other words cost should not be an issue, but lack of awareness may
be, along with such factors as work schedules, location of distribution
points, and the inability to convince partners to use condoms or
formulate a refusal to have sex without one.
The experience of violence is both a psychological motive behind
self-destructive actions and a consequence of the lifestyle of female
IDUs. A rather high percentage of respondents 38% - have been victims
of violence, both physical and sexual. The circumstances, locations, and
times vary. Violence experienced at any age, but especially in
adolescence, has been linked in the foreign and Russian literature with
a subsequent propensity to use psychoactive substances and engage in
risky sexual behavior. The responses listed below indicate that in
general, within the survey sample, violence was experienced either in
the form of rape or physical violence associated with sex work, or as
rape or physical violence by a partner or acquaintances. It might be
assumed that many of those surveyed were victims of violence before they
became sex workers and before they began to use drugs.
At work, in other words on the trassa [streets], you'd run into
people who want a lot and want it for free
They hit me over the head with a bottle on the street, made fun of
me, and raped me
My husband beat me and demeaned me
They raped me and beat me on the street
From men, they beat me and raped me
My husband beats me
On the trassa, as a sex worker
Emotionally, by acquaintances
I was in Kazakhstan illegally, as a sex slave
My husband demeaned me
Most often when I was working as a sex worker, clients would beat me,
make fun of me, trick me
At work drunk clients beat and demean me
Drunk, insolent clients
In the sauna: clients would make fun of me, I was subjected to rape
My acquaintance raped me, my live-in boyfriend beat me
My live-in boyfriend beat me
When I was "bumming around" in the park, several times teenagers beat
me and raped me
Clients sometimes beat me
I was beaten by my live-in boyfriend, raped by an acquaintance
I was beaten by my live-in boyfriend, other IDUs..
I was gang raped
I was beaten in the bazaar by homeless people, merchants
Drunk clients beat me, demeaned me
My guy beat me
3.3. Determining the Health of Female Drug Users: Studying
Childrearing Practices and Assessing Prevention and Treatment
3.3.1. Overall Health
A high percentage of respondents (59%) report that their health is
"not good." This is reflected in the rather high instance of medical
visits 80% had sought medical treatment within the past year. Table 6
shows how recently respondents had sought such treatment.
Table 6: Time Elapsed since Last Seeking Medical Care
Time since Last Visit to Health Care Provider
Had not sought health care
3 years or more
Special attention should also be focused on those who had not sought
health care at all during the past year 20% of respondents. Among the
20% that had not sought health care during the past year, 18% said there
was no need, but the majority (82%) had given a lack of funds as the
reason. This last category, which totals 16% of the survey group, while
having a heightened risk of HIV infection, had no access to health care.
The reasons for seeking health care were varied, but common among
them, in addition to getting general tests, were reasons associated with
gynecological diseases. Only a small percentage of those surveyed noted
that they had sought medical care to be tested for HIV during the past
year. This indicates a glaring lack of awareness and points to the fact
that women in the survey group either do not seek or, due to
stigmatization, actively avoid undergoing regular testing for HIV and
Table 7: Reasons for Seeking Health Care
Refused to answer
3.3.2. Infectious Diseases
According to a 2006 assessment of the HIV rate among injecting drug
users compiled by the Ministry of Health, in the city of Osh this figure
was 14% and in Bishkek it was 0.8%. The overall HIV rate among injecting
drug users throughout the country is cited as 7.4% by the Ministry of
Health. This same assessment gives the HIV rate among sex workers in two
major cities of Kyrgyzstan as 1-1.5%.
In contrast, the survey group exhibited a very high rate of infection
23% of respondents indicated that they were HIV positive. Considering
that the majority of the 17 women who admitted being HIV positive did so
during personal interviews, perhaps an even greater number of women in
the sample are HIV positive but did not want to admit their status. The
group selected for study is not sufficiently representative to draw any
solid epidemiological conclusions. Nevertheless, this high percentage of
HIV positives in the survey group points to the need to conduct more
precise assessments of the HIV rate in the country, as well as the even
more urgent task of winning the confidence of female IDUs and conducting
purposeful prevention intervention.
One quarter of the surveyed population that did test for HIV, did not
receive counseling either before or after testing. Pre- and post-test
counseling is an integral part of the successful prevention and
treatment of HIV infection. The absence of this service, in addition to
increasing psychological trauma, also often leads to a low rate of
patients returning to get their test results and to an overall lack of
trust among clients toward health care workers. This can lead to the
development of HIV and associated diseases.
The survey group also displayed a high rate of hepatitis C infection
66% of respondents said they had tested positive.
Diagram 3: HIV Rate in Survey Population Group
3.3.2. Reproductive Health and Childrearing Practices
Forty (40) percent of those surveyed had had abortions (between 1 and
5 times). The only resource we have for comparison is a study conducted
by the Kyrgyz Ministry of Health in the late 1990s, which noted that 30%
of Kyrgyz women of reproductive age had had at least one abortion.
Since the late 1990s, the number of abortions per 1000 women continues
to decline from 26.0 in 1997 to 14.0 in 2004, from which it can be
presumed that the figure for respondents, which exceeds the old figure
by 10%, exceeds the current figure even more dramatically.
Historically, Kyrgyzstan has had high rates of abortion and of using
abortion as a primary form of family planning. So this is a problem
affecting all Kyrgyz women, not only female IDUs. In their case,
however, this problem is exacerbated by the fact that doctors often
force them to have abortions or do not pay sufficient attention to
"problem" patients, which can led to a higher rate of abortions and a
general worsening of female IDUs' reproductive health. Many doctors also
tend to view pregnancy in a female IDU as something negative, basing
this attitude in the belief that a women who uses drugs is not capable
of giving birth to and raising a healthy child.
It should be noted that methadone substitution therapy (MST), which
can be prescribed during pregnancy and is not dangerous either for the
mother or the fetus, is also the most effective method for treating
heroin dependency. MST allows patients to stop the risky injection of
narcotics and thus decreases the probability of HIV infection. Methadone
also helps adherence to antiretroviral therapy, which in turn reduces to
a minimum the likelihood that HIV will be passed from mother to child.
As of January 2007, there were two instances of pregnant women being
admitted to MST programs in Osh Oblast. Both pregnancies were successful
and both mothers are still on methadone. The level of knowledge
among women surveyed about drug treatment services, including MST, is
examined in detail in the following section.
Of all those surveyed, 32 women had children, ranging in number from
one to three.
Table 7: Number of Children
Number of Children
A small percentage of respondents (14%) are raising their children
themselves. Most leave their children either with their parents or their
husband's relatives, their own relatives, or resort to the services of
state institutions. The reasons given for this include a lack of trust
by relatives, being confined as an inmate, or insufficiently available
Because my child is in Russia
I work, but I don't have housing
I was in prison, and when I was shooting up, I wasn't attentive
At first we all lived together, and when I started to shoot up, my
parents took them in
I have to work to make money to live on
I cannot give my child a normal upbringing
I'm working, I often disappear, my mother-in-law doesn't trust me
Because I shoot up
Exactly half of the respondents had children who attend school. Many
respondents were not informed about how often their children are ill,
evidently because they are not raising them themselves.
Among respondents with children, 9% of them had school-aged children
who did not attend school. The reasons for this failure to attend school
is: no funds (11.12%) and they are ill (6.67%). In 13.34% of cases
respondents encountered discrimination (they were not accepted into
school or kindergarten, or they were not admitted to a hospital for
treatment) because their mother was a drug user.
Half of respondents replied that their children observe their mothers
using drugs. A quarter of the overall total with children sent their
children to buy drugs in cases when:
When I'm in withdrawal
When I was sick
I was afraid of the cops I called the pusher and she gave it to my
It was right next door
When I was being tailed by the police
Half of the respondents replied that their children had enough food,
clothing, school supplies, and toys. Almost all respondents stated that
they had trusting relationships with their children. With the exception
of one respondent who "abandoned" her child in the care of her parents,
nobody in the group had been deprived of parental rights.
The following were among the problems that came up in association
with raising children:
I'm not around
My mother doesn't give me access to them
I would like to pay more attention to them; I think I will after all
give up drugs and everything will be fine, but for now I'm up to my ears
in this swamp
Generally don't have enough money to support them
I don't always have enough time to take care of them better
I don't have an opportunity to continue my education
I would like to send them to kindergarten; I don't have any
opportunity to bring up my younger daughter, since if I look after her,
then there's nobody to earn money to live on
I would like to raise my daughter myself, but until I get off drugs
My child has cerebral palsy, so I have a lot of problems
I don't have my own housing
Not enough money
While mothers who are drug users do confront negative attitudes,
having children can be the main impetus to changing behavior among
female IDUs. Caring for a child is an important responsibility that can
motivate a woman to find employment, a place to live, and can cause her
to limit or completely cease the use of psychoactive substances. Since
female IDUs often are the only guardians for their child, such
traditional methods as long-term rehabilitation are hard to manage for
mothers, and therefore more progressive methods are needed, such as MST,
short-term rehabilitation, and support groups.
3.3.3. Drug Treatment Services
Half the respondents stated that they had been treated with drugs
(detoxification) in a drug treatment center or a psychiatric clinic.
Some respondents had been through treatment four times, but most had
only been treated once or twice. It should also be noted that a study
conducted by UNODC in 2005 indicated that women in Kyrgyzstan were much
less likely to undergo a course rehabilitation than men: at the time the
study was conducted, 97% of the patients who had gone through a course
of treatment in Osh were men, with the percentage being 92% in
Bishkek. Those surveyed were not aware that there is a long-term
course of rehabilitation available in the Republic Narcological
Dispensary in Bishkek that includes psychological support and social
adaptation. As the respondents mistakenly understood it,
"rehabilitation" is a 10-day course of treatment that consists of
short-term detoxification. As they put it, when a person is registered
as a drug user, they can go through a course of detoxification if they
pay 1900 som, while anonymous treatment (without registering with the
narcological dispensary) costs 5000 som. A course of detoxification,
in addition to having practically no effect from the perspective of
long-term remission, is expensive. It was also learned that there are no
support groups or narcotics anonymous groups whatsoever for women, which
truly limits opportunities for women in terms of behavioral change,
rehabilitation, and socialization.
Essentially all respondents had attempted to give up drugs several
times. Remission had extended for from several months to three or more
years. Ninety-three (93) percent had attempted to give up drugs on their
own. Among those who were not incarcerated, the average length of
remission was 2-3 months. Among those who had been in the penal system,
remission lasted between one and three years. During remission, 38% of
respondents substituted drugs with alcohol, cannabis, pills, or
methadone, and 7% took only methadone.
Almost all those we surveyed knew about the existence of MST. But
most of them had catastrophic misconceptions about methadone. Rather
than understanding methadone as a medication that could help overcome
the obstacle of heroin dependence, they viewed methadone as a free
heroin substitute. Many described methadone as a medicine against
A medical substitute for heroin
A free substitute for heroin
If you don't abuse it, it helps against heroin dependency
It helps against withdrawal
A synthetic drug substitute
It's a synthetic product
I don't know anything just that it's free
There is such a drug, it's legal, and it's at the narcological
There is such a program
It's synthetic heroin, you take tablets regularly, there's such a
program at the narcological dispensary
You take it in pill form instead of heroin
it's at the drug treatment
People take it so they won't shoot up heroin, you have to go to the
drug treatment center
People take methadone so they won't spread HIV/AIDS
It's a medical narcotic, safe and better than heroin, you don't have
to worry about the cops
The fact that female drug users are unaware of how widespread and
accessible MST is can be seen in the official statistics showing who
takes part in the program. Since 2002, 518 patients have managed to
undergo treatment with methadone therapy in Osh and only 35 of them
(6.8%) have been female. As of August 2008 there were 150 participants
in the Osh program and only 10 (6.7%) of them were women.
Ten respondents had participated in MST programs in the past. The
reason they are no longer participants in MST is that they were
incarcerated or they moved. This testifies to the need to introduce
programs within the penitentiary system and expand it in the civilian
sector, and to bring treatment up to international standards, which
allows patients to undergo a course of treatment for some time in their
3.3.4. Harm Reduction Programs
Among respondents, 86.37% knew what services the AIDS Center and the
syringe exchange program (SEP) offer. They had received information
about SEP from volunteers, friends, acquaintances, and outreach workers.
The overwhelming majority of women we surveyed had received some kind of
services offered by the syringe exchange program
Most respondents saw the work of harm reduction programs as something
needed. Assessments of how well these programs were working ranged from
average to high praise, but there were cases where some flaws were
It's necessary work, it helps us
They didn't want to give me syringes
I don't like it, they don't offer medicines
They are doing much needed work
We need more such programs
Useful, something IDUs need
It's good when its free and anonymous
We need more SEP
Not very they don't often bring the syringes
I don't like it
3.4. Identifying Problems Associated with Stigmas Affecting Female
Drug Users in Their Interactions with Law Enforcement, Health Workers,
3.4.1. Discrimination by Those Close to IDUs
A rather higher percentage of respondents 18% hide their drug use
from relatives; 23% hide it from acquaintances and neighbors; and 16%
from their children.
The attitude of those closest to drug users toward their drug usage
ranged from attempts to talk them out of it and demonstrations of
compassion and pity on the one hand, and aggression and threats on the
other. There were some respondents who were not able to formulate or
explain the attitude of those close to them.
I don't know
They feel sorry for me, don't trust me
It varies some feel sorry, others are angry
My mother cried, tried to persuade me, swore at me
Mama is fighting it, lectures me, cries, makes scenes, pays for
They don't trust me, they know that I might steal something from the
My mother took my daughter from me
They're sick of it
They kicked me out of the house before
They kicked me out
They're trying to help
The attitude of acquaintances and neighbors is somewhat different
from the attitude of those closest to the respondents. Here, one often
encounters an indifferent or neutral attitude. Of course, here there is
also benevolence, pity, attempts to help, advice, but there is also
avoidance, mistrust, and even condemnation, insults, and aggression.
It varies some feel pity, others are afraid, curse, don't trust me
They curse and insult me
Some curse, some feel pity
They were afraid
They feel pity, are angry, they worry
They keep their distance, are afraid, don't trust me
I didn't notice any particular changes
Worse, they don't trust me
They don't trust me, they don't talk to me, don't borrow money
They scorn me
It got worse
They try not to talk to me
They don't trust me and don't talk to me as much
They don't talk to me
Same as before
3.4.2 Stigma Impacting Health Care
In the case of half of all respondents, health care providers had
determined that they use drugs. In response to a question about whether
or not there had been cases where health care had been withheld due to
drug use, 6 respondents said it had: "they didn't come when I had a drug
", "they wouldn't give me a certificate from the drug treatment
", "they sent me to one doctor after another
", "my doctor was a
neighbor, and when I lived at home she didn't want to see me
Seventy (70) percent of those surveyed had noticed a change in the
attitude of health care providers toward them when they determined that
the patient was a drug user. Most often this took the form of
Table 9: Health Care Provider Attitudes Associated with Drug Use
Attitudes Demonstrated by
Health Care Providers Associated with Drug Use
Refused to provide care
3.4.3. Stigmas Impacting Employment
In half of cases, employers had refused to hire respondents because
of drug use. Thirty-four (34) percent of respondents replied that their
drug use was the reason they lost their jobs, but half acknowledged that
they were fired for objective reasons associated with their drug use
that they had not been fit to work when they used.
They were turned down for jobs from 1 to 10 times, but in many cases
there were only 1 or 2 such instances. Reasons given for a refusal to
hire amounted to a reluctance to work with drug users or simply that
they had found someone more suitable for the job.
At first they were going to hire me, but then they said they found
Because I was an addict
That they'd already found someone
Because they didn't want problems with the cops because of me
They spoke openly about the fact that I'm an addict
They said they couldn't trust me
Lack of trust toward an addict
They didn't explain, they just refused
They hired someone more suitable
They didn't say, they just refused
They knew I was an IDU and came up with various excuses
They fired me because I missed work because of drug use
An addict can't perform normally, will steal
Respondents who had been turned down for jobs often did not do
anything to change the situation; there were a few cases where they
attempted to explain and convince the employers that they would perform
their jobs as needed, but this initiative did not yield any positive
results. Many simply swallowed their feelings and tried to keep their
failures "on the inside."
3.4.4. Rights Violations by Law Enforcement
The majority of respondents 66% - had at one time or another been
detained by the police. These detentions occurred rather regularly, and
some respondents had been detained 50 or more times over the course of
their drug use. The circumstances were almost always the same: drug
possession, most often at a yama [place where drugs are sold].
They grabbed me, searched me, took me to a gynecologist, found drugs,
I was coming from the bazaar and they stopped me, searched me, and
At my pusher's place, at yamas
When I was leaving my pusher
1 I was set up; 2 times when I was leaving my pusher's place
Near the yama, near my house
They stopped me and searched me
Arrest, frisk, I was set up, they caught me by yamas
They kept watch, caught me, searched me, and jailed me
They stopped me, searched me, detained me
by the yama
When I was leaving my pusher; when I had picked up a packet from
another person; when I had the packet
They broke into the apartment when we were shooting up; they found a
dose when they searched the apartment; when I was leaving my pusher's
place; when another addict set me up
They found it at home during a search
Other IDUs set me up; they brought me a dose and then Drug Control
Bureau agents came bursting in
We were drinking near the yama, other IDUs set us up
We came out of the yama, we had a syringe with solution with us
We were drinking at the yama; they set us up; I was leaving my pusher
with a dose
They detained me when I had a dose with me
Coming from my pusher; they took me from the drug treatment center
Respondents most often solved the problem of being detained by the
police in the following manner:
Trickery or money
Pay or jail
Sometimes I paid, sometimes I provided sexual services
Sometimes I paid what they wanted and sometimes I negotiated the
My mother paid
My live-in boyfriend took it on himself
Paid whatever they asked
With money, but if I didn't have it, I'd stay in jail
My relatives paid (daughter and son-in-law, sister, mother)
I paid, provided information
Money, sex, information
From this list of responses it is evident that the most common means
of getting out of detention for drugs is bribery, providing sexual
services, or providing information.
Thirty-two (32) percent of all respondents experienced violence at
the hands of the police. Reasons included:
Did not want to admit the crime
Because of drugs
To get information out of me
They just wanted to
Because of prostitution
Drug addict, sex worker
Police attitudes due to drug use:
Emotional and physical humiliation
They tried to catch me with drugs
They tried to use my services for free
Took money, insulted me
Tried to manipulate, extort money
The attitude got worse, disparaging, they tried to humiliate me
They tried to force me into sex
40% of those surveyed who said they were involved in sex work stated
that they had been subjected to active violence by the police:
"Subbotniki" [volunteer work, in this case sexual], physical
They said that if I didn't work for them, I couldn't go to the trassa
They are insulting, extort money, use intimidation
They offer that if I provide services they'll let me go
They intimidated me, said that if you don't give it, you'll wind up
So as not to pay, but have it for free
They extort money, force sex
I provided sexual services for free
It should be noted that among the respondents there was an
exceptionally poor knowledge of the law. Many respondents said that they
did not know anything about what rights they have. Among the others a
small portion said that they knew their rights, but this knowledge
amounted to specific aspects associated with the quantity of drugs they
could possess, or that there was no article concerning sexual services.
You can carry up to one gram
I have the right to work and go to school
They don't incarcerate you for sex work
I know the entire criminal code
I know the constitution
They get information, as many women stated, from places of
incarceration, from acquaintances, from volunteers, and from leaflets
Eighty-two (82) percent did not know that it was possible to receive
free legal assistance. Out of the small percentage that stated they did
know this, 9% "just heard that it exists." The nonprofit Parents Against
Drugs and the NGO Podruga [female friend] were mentioned by 9% of
respondents as sources of free legal assistance.
Out of all respondents, only 5 had actually obtained free legal
This study uncovered problems that confront female drug users in
Kyrgyzstan. As consequence of the closed nature of the group, female
drug users are a group most subject to risk and are beyond the reach of
prevention programs. The following recommendations are directed at NGOs
working in HIV/AIDS prevention and harm reduction and at government
bodies. We hope that improved interaction between all parties will draw
a larger number of female IDUs into prevention and treatment programs.
1. Educate women drug users, health care providers, and the
population at large in the area of HIV transmission, safe sex, and
Conduct a series of educational seminars for female IDUs and sex
workers about condom use. The seminars should include information about
the importance of using a condom not just as a contraceptive, but as a
means of protecting against STIs, HIV, and hepatitis. It is important to
cover the question of how to convince clients or partners to use condoms
and to identify ways to overcome barriers and prejudices women face when
they try to justify condom use. It is also important to shed light on
the use of disposable syringes and to provide arguments for using their
own injection equipment among friends and with their partner.
With help from community leaders, a series of educational seminars
should be held for men explaining the dangers of sexual promiscuity and
risky behaviors such as injecting drugs and having sex without condoms.
It is also recommended that the seminars identify the main barriers and
prejudices preventing men from using condoms and discuss how
inconsequential they are when compared with the risk of HIV infection.
The negative consequences of violence against women for the family,
children, and society overall should also be discussed.
In cooperation with specialists from the narcological dispensary and
doctors from friendly clinics, conduct a series of educational seminars
for gynecologists explaining the need to support such difficult-to-reach
groups as female IDUs and sex workers and the effectiveness of
substitution therapy during pregnancy.
At the conclusion of educational seminars with gynecologists, create
multidisciplinary teams consisting of gynecologists and NGO social
workers that will be capable of doing "on site" checkups, i.e., at
syringe exchange points and in places where sex workers congregate.
Where such teams are financially untenable, arrange a system for
accompanying or referring clients to friendly gynecologists, other NGOs,
For head doctors of gynecology departments:
In cooperation with regional drug treatment centers and local NGOs,
improve the knowledge of senior and junior medical personnel regarding
drug dependency and treatment models, such as substitution therapy.
Increase the quantity of Friendly Offices, where in addition to an
examination clients can be given medicines to treat acute illnesses,
since the study shows a high rate of gynecological disease despite
2. Expand access to medical and social services and to harm reduction
and drug treatment programs:
Use leaders identified over the course of the study to improve the
flow of information between NGOs and the community of female IDUs. What
is first needed is an elementary system to inform female IDUs about
existing organizations. A series of handouts should be developed aimed
at female IDUs that lists services offered by existing medical and
social assistance programs, harm reduction programs, clinics, and AIDS
centers; that describe how to protect oneself against hepatitis and
HIV/AIDS; and that provide reliable information about substitution
therapy programs and the positive attributes of this therapy, especially
during pregnancy. This last task should be carried out with the staff of
the Osh Narcological Dispensary and friendly gynecology clinics
throughout the area.
The next step will be development of a self-help group and mutual
assistance group for female IDUs through existing organizations. Since
there are no narcotics anonymous groups or 12-step programs for female
IDUs, efforts should be launched to found such groups through existing
organizations and in cooperation with the narcological dispensary.
In cooperation with the district AIDS center, more female IDUs should
be convinced to come in for HIV testing. Pre- and post-test counseling
should definitely be provided as well as subsequent motivational and
For Republic and District Drug Treatment Services:
Through cooperation with NGOs working in the area of harm reduction,
a greater number of women should be brought into Substitution Therapy in
Osh and this therapy program should be expanded to Jalal-Abad. Perhaps
it will be necessary to re-examine the existing program and think
through how to provide access to substitution theory while maintaining
maximal confidentiality. For example, the opening of an additional site
at the district clinic will permit female IDUs to receive substitution
therapy without disclosing their status as drug users by making regular
visits to a drug treatment center.
Improve efforts to bring women into short-term detoxification
programs by allowing them to undergo treatment in wards separate from
the men's wards.
In order to improve the effectiveness of short-term detoxification,
provide a place for narcotics anonymous groups and 12-step program
groups conducted in cooperation with the staff of local NGOs.
Provide information and access to substitution therapy to pregnant
IDUs in cooperation with district clinics and gynecologists.
For the District AIDS Center
1. Improve cooperation with the district narcological dispensary and
NGOs providing harm reduction services in order to provide pre- and
post-test counseling as well as to ensure adherence to ART for female
IDUs either by bringing them into substitution therapy programs or by
providing quality social accompaniment services.
3. Expand access to legal services and ensure tolerance on the part
of law enforcement:
1. Establish contact with district police stations through
broad-based social work.
2. Conduct a series of educational trainings with district police
stations about the spread of HIV infection, ways to protect against HIV,
and how to prevent the spread of the epidemic through cooperation with
harm reduction programs.
Bringing in existing resources such as lawyers, conduct a series of
educational seminars for female IDUs/sex workers on fundamental legal
questions. Based on the results of the seminars, create booklets listing
women's basic rights in "pocket" format so that female IDUs could carry
one with them.
Identify interested lawyers. Where necessary, approach existing
national and regional organizations that are already engaged in
providing assistance to IDUs and sex worker and that are interested in
sharing experiences. With the help of interested lawyers, create a
system for tracking cases where the rights of female IDUs and sex
workers have been violated and bringing them to trial.
An Expression of Gratitude
The Asteria research team wishes to express its gratitude to everyone
who participated in the study for providing the information, showing the
understanding, and investing the time needed to prepare this report on
the needs and requirements of female drug users. We would like to
express particular gratitude to Asteria's partners for their assistance:
field workers; the director of the Oblast Narcological Dispensary, U.
Shadiev; director of the NGO Parents against Drugs, M. Burkhanov; T.
Abdiraimova, director of the Podruga NGO; B. Ermatov, director of the
NGO Tais Plius Dva; as well as to the social and outreach workers. We
would also like to extend our special thanks to all the members of the
Asteria research team: the volunteers and social workers D. Khaitov and
E. Khalipova, whose dedication and enthusiasm were the engine that drove
the study toward attaining its goals.
||Injection drug user
||People living with HIV
||Human immunodeficiency virus
||Acquired immune deficiency
||Syringe exchange program
||Narcotics anonymous (12 step
||Alcoholics anonymous (12 step
||Pharmaceutical treatment for
Notes on respondent slang:
Yama a place where narcotics are sold.
Baryga a pusher, someone who sells drugs.
Hanka raw opium.
Anasha marijuana, cannabis.
Lomka the physical pain experienced during withdrawal from
Peredoz A narcotics overdose.
Kumarit' To be ill due to withdrawal from narcotics.
Otrava Heroin, opium.
Trassa Street, road, or sauna: anyplace sex workers work.
Questions for drug users:
How do you earn money to live on?
Does anybody give you financial help?
Do you have your own place to live?
Have you sought medical care?
How would you assess your health at present?
Have you been tested for HIV/AIDS and hepatitis C?
Do you have identity documents?
How long have you been using drugs?
What kinds of drugs are you currently using?
Who were you with when you first tried drugs?
Why did you start using drugs?
Are you married?
If yes, does your spouse know that you use drugs?
Does your spouse use drugs?
Have you gotten any of your friends involved in using drugs?
Have you been charged with any crimes?
Have you had any abortions since you've been a drug user?
Do you know about contraceptives?
Did health care providers determine that you use drugs?
Have there been instances when you were refused medical care because
of your drug use?
Have there been instances when you were turned down for a job because
of your drug use?
Have you been detained by the police because drugs?
How did you resolve the situation of being detained for drugs?
How did the police treat you once they learned that you use drugs?
Have you been subjected to violence by the police?
Have you been a victim of violence in general?
Do your relatives know that you use drugs?
Do your acquaintances and neighbors know that you use drugs?
What do you know about your rights?
If you do, what is your source of information about your rights?
Have you been through detox in a drug treatment center?
Have you been through rehabilitation (ambulatory treatment)?
Have you attempted to give up drugs?
Do you know about methadone substitution therapy?
Are you interested in being given methadone?
Do you know about any services for the drug dependent?
Are there any services that you need?
Do you know about free legal assistance?
Do you know about free syringe exchange points?
If you went to these organizations for services, tell us what you
think of their work?
What kind of help do you need?
Questions for female drug users with children:
How many children do you have?
What are their ages?
Do they attend kindergarten?
Do they attend school?
Are your children involved in any other activities (special interest
or educational clubs, sports
How many times per year are your children sick?
Do your children visit a doctor?
Have your children experienced discrimination because of your drug
use (they were not accepted into school or kindergarten, they were
refused treatment in a hospital)?
Do your children see you or your friends using drugs?
Have you ever sent your child to the drug dealer for a dose?
Do your children work?
Do your children have enough:
c. school supplies
What is your relationship with your children (difficult, trusting,
Have you been deprived of parental rights due to drug use?
What other problems do you have associated with raising children?
Questions for sex workers:
Why did you become a sex worker?
Do you always use a condom?
While working (as a sex worker), have you experienced bad treatment
on the part of the police?
How did the police treat you once they found out that you use drugs?
Have you been subjected to violence by the police because you work as
a sex worker?
Have you gotten any of your friends involved in working in the sexual
How old are these people?
What help or services do you need?
 The questions used in the questionnaires can be found in the
Appendix to this report.
 At the time the study was being conducted, these sums equaled
US$26 and US$66 respectively.
 From US$2.50 to US$5.00 and from $US16 to US$18 respectively.
 From US$13 to US$22 and US$4.50 respectively.
 Doherty, MC, Garfein, RS, Monterroso, E, Latkin, C, Vlahov, D
(2000). "Gender difference in the initiation of injecting drug use among
young adults," Journal of Urban Health, 77(3), 397. Sherman, S, Latkin,
C, Gielen, A (2001). "Social factors related to syringe sharing among
injecting partners: A focus on gender," Substance Use & Misuse, 36(21),
 Berezhnova I, Platt L, Rhodes T, Kamaletdinova N, Webster E.
Bobkov Ye (2005). "HIV/AIDS, sex work and injecting drug use:
comparative analysis of behavioral risk factors amongst representatives
from vulnerable groups in three Russian regions" (in Russian).
Presentation before the 14th International Conference on AIDS, Cancer
and Public Health.
 Regional Study on Drug Use and HIV/AIDS, Regional Summary
Kyrgyzstan, Tajikistan and Uzbekistan. UNODC. Regional Office for
Central Asia, Tashkent. 2007.
 Program for Countering the HIV/AIDS Epidemic in the Republic of
 The Republic of Kyrgyzstan Ministry of Health information portal:
 Kyrgyz Republic Demographic and Health Survey, 1997, compiled by
the Kyrgyzstan. Ministry of Health. Research Institute of Obstetrics and
Pediatrics, and Macro International. Demographic and Health Surveys
[DHS]. Bishkek, Kyrgyzstan, Ministry of Health, Research Institute of
Obstetrics and Pediatrics, 1998 Aug.:63-71. http://www.popline.org/docs/1284/137654.html
 Historical abortion statistics, Kyrgyzstan http://www.johnstonsarchive.net/policy/abortion/ab-kyrgyzstan.html
 Electronic correspondence with the head doctor at the Republic
Drug Center, Ainura Tursunbekova Esenamanova.
 Drug Abuse in Central Asia: Trends in Treatment Demand
2003-2005. UNODC 2006.
 US$50 and US$112 respectively.