The economic and political factors of the current decade of the XXI century are shaping the new environment for health and social policies in the region of Central and Eastern Europe and Central Asia (CEECA). A clear tendency is being observed of decrease in funding, available from international and bilateral donors for middle-income countries on the health related responses, including for HIV, hepatitis C and tuberculosis. Though, at the same time, the economies of the region are growing, countries are not yet well prepared for ensuring sustainable transition from donor support to national funding of health programs, especially those targeted at key affected populations (KAPs), and face serious challenges.

The new environment, identified first of all by transition from external support to domestic resources, dictates new approaches in addressing health and social problems of KAPs and clearly assessing the transition consequences for the region, governments, communities, and donors on the one hand, and for sustainability of harm reduction services on the other.

Harm reduction services in CEECA during last years were seen mainly as HIV prevention, but in the new environment they are playing the role of a vehicle, which allows people using drugs to access all continuum of services from prevention information to testing for HIV and tuberculosis, STI and hepatitis treatment, and development of adherence to ARV treatment. In the new circumstances, harm reduction has to be integrated into health and social care systems and needs to be recognized by governments and local communities as essential for achieving social changes.

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