Central Asia is one of the few regions in the world where the HIV epidemic is still on the rise. While HIV incidence is declining globally, WHO estimated in 2011 that the number of people newly diagnosed with HIV in the Central Asia Region (CAR) increased 14-fold between 2000 and 2011 (WHO European Action Plan for HIV/AIDS for 2012-2015, 2011). HIV transmission in CAR is driven by people who inject drugs (PWID) located in urban centers and along drug transport corridors from Afghanistan through Tajikistan (TJ), Turkmenistan (TK), Uzbekistan (UZ) Kyrgyzstan (KG) and Kazakhstan (KZ). The United Nations Office on Drugs and Crime (UNODC) estimates that 20% of heroin shipped from Afghanistan passes through CAR and approximately 11 metric tons per year are consumed in the region, where PWID constitute up to 1% of the adult population. In towns on the Afghan border of TJ, the cost of an average dose of heroin is reported to be less than a bottle of beer, although the cost rises each time the contraband crosses a border on its way north to KZ, Russia and beyond. In TJ, the cost of sterile injection supplies compared to the cost of heroin is significant, and the reported prevalence of HIV infection among PWID is 17-23%. In KG, the cost of a syringe at a pharmacy is four times higher than the cost of a dose of heroin, and the Republican AIDS Center reports that as of February 1, 2013, 2,635 PWID, or 59.7% of all registered PWID, were infected with HIV. In KZ, where the per capita GDP is considerably higher, the additional cost of a clean syringe is less significant, and HIV prevalence among PWID is 3-4%. While the primary driver of HIV transmission has been the use of contaminated injection supplies, there are indications that the epidemic is expanding, primarily through sexual transmission from PWID to their sex partners. The proportion of newly registered HIV cases in Kazakhstan attributable to sexual transmission increased from 20% in 2006 to 51% in 2011, and in Kyrgyzstan, from 30% in 2006 to 33% in 2010, and mirrors the general trend in the neighboring countries of TJ and UZ. (Triangulation of the data from Kazakhstan suggests that the proportion of sexually-transmitted infections may be overstated, but the trend is genuine.) The overlap between unsafe injecting practices and unsafe sexual practices is manifested in high HIV infection rates in CAR's key populations: approximately 8% of UZ sex workers inject drugs, 50% of female PWID in TJ have provided sex services in exchange for drugs, money or food, and less than 50% of TJ PWID reported use of a condom during intercourse with sex workers. In KG, syphilis prevalence, another marker for unsafe sexual practices, was 32% among SW, 16% among prisoners, and 13% among MSM and PWID. High prevalence of HIV among prisoners and detainees is related to high rates of incarceration of PWID, as well as unsafe injecting and sexual practices during incarceration. In 2010, 3% (KZ) to 9% (TJ) of all registered HIV cases were among prison populations.