The rapid development of cryptocurrencies has led to an increasing severity of money laundering activities. In recent years, leveraging graph neural networks for cryptocurrency fraud detection has yielded promising results. However, many existing methods predominantly focus on node classification, i.e., detecting individual illicit transactions, rather than uncovering behavioral pattern differences among money laundering groups. In this paper, we tackle the challenges presented by the organized, heterogeneous, and noisy nature of Bitcoin money laundering. We propose a novel subgraph-based contrastive learning algorithm for heterogeneous graphs, named Bit-CHetG, to perform money laundering group detection. Specifically, we employ predefined metapaths to construct the homogeneous subgraphs of wallet addresses and transaction records from the address-transaction heterogeneous graph, enhancing our ability to capture heterogeneity. Subsequently, we utilize graph neural networks to separately extract the topological embedding representations of transaction subgraphs and associated address representations of transaction nodes. Lastly, supervised contrastive learning is introduced to reduce the effect of noise, which pulls together the transaction subgraphs with the same class while pushing apart the subgraphs with different classes. By conducting experiments on two real-world datasets with homogeneous and heterogeneous graphs, the Micro F1 Score of our proposed Bit-CHetG is improved by at least 5% compared to others.
The number of money laundering crimes for Ethereum and the amount involved have grown exponentially in recent years. However, previous studies related to anomaly detection for Ethereum usually consider multiple types of financial crimes as a whole, ignoring the apparent differences between money laundering and other malicious activities and lacking a more granular detection targeting money laundering. In this paper, for the first time, we propose an improved graph embedding algorithm specifically for money laundering detection called GTN2vec. By mining Ethereum transaction records, the algorithm comprehensively considers the behavioral patterns of money launderers and structural information of transaction networks and can automatically extract features of money laundering addresses. Specifically, we fuse the gas price and timestamp from the transaction records into a new weight and set appropriate return and exploration parameters to modulate the sampling tendency of random walk to characterize the money laundering nodes. We construct the dataset using real Ethereum data and evaluate the effectiveness of GTN2vec on the dataset by various classifiers such as random forest. The experimental results show that GTN2vec can accurately and effectively extract money laundering account features and significantly outperform other advanced graph embedding methods.
César Sabater, Florian Hahn, Peter Andreas, Jan Ramon
In this paper we study verifiable sampling from probability distributions in the context of multi-party computation. This has various applications in randomized algorithms performed collaboratively by parties not trusting each other. One example is differentially private machine learning where noise should be drawn, typically from a Laplace or Gaussian distribution, and it is desirable that no party can bias this process. In particular, we propose algorithms to draw random numbers from uniform, Laplace, Gaussian and arbitrary probability distributions, and to verify honest execution of the protocols through zero-knowledge proofs. We propose protocols that result in one party knowing the drawn number and protocols that deliver the drawn random number as a shared secret.
Aldren Gonzales, Scott R. Smith, Prashila Dullabh, Lauren Hovey · 7 authors
The scale and severity of the opioid epidemic call for innovative, multipronged solutions. Research and development is key to accelerate the discovery and evaluation of interventions that support pain and substance use disorder management. In parallel, the use and integration of blockchain technology within research networks holds the potential to address some of the unique challenges facing opioid research. This paper discusses the applications of blockchain technology and illustrates potential ways in which it could be applied to strengthen the validity of outcomes research on the opioid epidemic. We reviewed published and gray literature to identify useful applications of blockchain, specifically those that address the challenges faced by opioid research networks and programs. We then convened a panel of experts to discuss the strengths, limitations, and feasibility of each application. Blockchain has the potential to address some of the issues surrounding health data management, including data availability, data sharing and interoperability, and privacy and security. We identified five primary applications of blockchain to opioids: clinical trials and pharmaceutical research, incentivizing data donation and behavior change, secure exchange and management of e-prescriptions, supply chain management, and secondary use of clinical data for research and public health surveillance. The published literature was limited, leading us to rely on gray literature, which was also limited in its discussion of the technical aspects of implementation. The technical expert panel provided additional context and an assessment of feasibility that was lacking in the literature. Research on opioid use and misuse is challenging because of disparate data stored across different systems, data and system interoperability issues, and legal requirements. These areas must be navigated to make data accessible, timely, and useful to researchers. Blockchain technologies have the potential to act as a facilitator in this process, offering a more efficient, secure, and privacy-preserving solution for data exchange. Among the 5 primary applications, we found that clinical trial research, supply chain management, and secondary use of data had the most examples in practice and the potential effectiveness of blockchain. More discussions and studies should focus on addressing technical questions concerning scalability and tackling practical concerns such as cost, standards, and governance around the implementation of blockchain in health care. Policy concerns related to balancing the need for data accessibility that also protects patient privacy and autonomy in revoking consent should also be examined.
Bitcoin is by far the most popular crypto-currency solution enabling peer-to-peer payments. Despite some studies highlighting the network does not provide full anonymity, it is still being heavily used for a wide variety of dubious financial activities such as money laundering, ponzi schemes, and ransom-ware payments. In this paper, we explore the landscape of potential money laundering activities occurring across the Bitcoin network. Using data collected over three years, we create transaction graphs and provide an in-depth analysis on various graph characteristics to differentiate money laundering transactions from regular transactions. We found that the main difference between laundering and regular transactions lies in their output values and neighbourhood information. Then, we propose and evaluate a set of classifiers based on four types of graph features: immediate neighbours, curated features, deepwalk embeddings, and node2vec embeddings to classify money laundering and regular transactions. Results show that the node2vec-based classifier outperforms other classifiers in binary classification reaching an average accuracy of 92.29% and an F1-measure of 0.93 and high robustness over a 2.5-year time span. Finally, we demonstrate how effective our classifiers are in discovering unknown laundering services. The classifier performance dropped compared to binary classification, however, the prediction can be improved with simple ensemble techniques for some services.
Bitcoin, the world’s first cryptocurrency, was first introduced in 2009, by Satoshi Nakamoto. While many believe the name is a pseudonym, and the true identity of the creator(s) is unknown, it is an undisputed fact that cryptocurrencies have introduced an indelible change to monies worldwide. Consequently, cryptocurrencies have also introduced a plethora of new opportunities for money laundering activity.\nWhile cryptocurrencies follow the same three-step laundering process of placement, layering, and integration, the activity can be more difficult to detect due to the anonymous nature of cryptocurrencies. Moreover, while traditional schemes such as smurfing or gambling at a casino are still used as laundering techniques, more advanced methods such using mixers and tumblers or utilizing unscrupulous cryptocurrency exchanges are also being used to mask the flow of funds. Finally, the rapid increase in initial coin offerings (ICO’s) provides yet another outlet for cryptocurrency money laundering to occur.\nFortunately, advancements are being made on a variety of fronts to address the increase in illicit activity. First, the largest cryptocurrency exchange, Coinbase, has implemented a robust know-your-customer (KYC) program, as evidenced by my own experience of opening an account with the exchange. Secondly, researchers are finding new ways to extract information about certain cryptocurrency transactions which were previously thought to be unidentifiable. Finally, both law enforcement and government agencies, including the SEC and the Financial Crimes Enforcement Network, are using innovative, aggressive, and even clandestine techniques to combat cryptocurrency money laundering activity.
Achieving government’s goals for cannabis regulation requires legal cannabis to be a cheaper, more attractive consumer alternative compared to the illegal market. This goal may be undermined by the costs and disadvantages of traditional regulatory management. A Canada wide, real-time blockchain tracking system appears to be a viable technical solution architecture. A permissioned blockchain network could be tested alongside traditional tracking. This investment, if proven effective, could reduce regulatory costs for government and red tape for business, helping to achieve Governments’ objectives to:Enhance public safety by ensuring quality and monitoring product salesUndermine illegal markets to reduce crime and prevent product diversion
Obinna Ositadimma Oleribe, Olabisi Oladipo, Iheaka Paul Ezieme, Mary Margaret Elizabeth · 5 authors
Access to quality care is essential for improved health outcomes. Decentralization improves access to healthcare services at lower levels of care, but it does not dismantle structural, funding and programming restrictions to access, resulting in inequity and inequality in population health. Unlike decentralization, Commonization Model of care reduces health inequalities and inequity, dismantles structural, funding and other program related obstacles to population health. Excellence and Friends Management Care Center (EFMC) using Commonization Model (CM), fully integrated HIV services into core health services in 121 supported facilities. This initiative improved access to care, treatment, support services, reduced stigmatization/discrimination, and improved uptake of HTC. We call on governments to adequately finance CM for health systems restructuring towards better health outcomes.
In 2010, the fourth decade of the HIV pandemic arrived during a time of unprecedented success in HIV prevention. Globally, UNAIDS estimated that new HIV infections fell by 33% between 2001 and 2011; new infections among adults and adolescents fell by 50% or more in 26 countries (more than half of these countries were in sub-Saharan Africa), and new infections among children worldwide dropped by 52% [1,2]. The declines in new HIV infections are particularly evident in countries with sustained and more strategic investments, which take into account the specifics of local epidemics, increased political leadership and community engagement in response to the HIV epidemic, and scale up of HIV prevention and treatment programmes [2]. The rapidly growing delivery of antiretrovirals to women and infant feeding–based prevention programmes has resulted in a sharp decline in new HIV diagnoses among children. The encouraging declines in HIV infections can also be attributed to the improved effectiveness of combination antiretroviral treatment (cART), an expanded range of improved medications, the declining prices that make cART more accessible to people in low-income countries, growing coverage with HIV testing, and improved access to prevention and treatment services (particularly for women and young people in low-income countries). Global investment in the AIDS response jumped from US$3.8 billion in 2002 to US$18.9 billion in 2012. The new decade also saw a revolution in HIV prevention with ground-breaking scientific advances in HIV biomedical prevention, and specifically, proof that microbicides containing an antiretroviral agent can reduce sexual transmission of HIV to women by 39% [3], that earlier start of treatment by HIV-positive people (treatment as prevention or TasP) can reduce the risk of onward transmission by as much as 96% [4], and that consistent, correct use of a daily antiretroviral tablet by men who have sex with men (MSM) can achieve substantial reductions in HIV infections (pre-exposure prophylaxis or PrEP) [5]. In response to the excitement and optimism surrounding the preventative effects of antiretroviral medications, the UN member states considered and unanimously approved the new Political Declaration on HIV/AIDS at a special session of the General Assembly in New York in 2011 [6]. At the core of the 2011 UN Political Declaration are ambitious new HIV prevention targets calling on governments to commit to reducing sexual transmission of HIV by 50%, reducing HIV transmission though injecting drug use by 50% and eliminating mother-to-child transmission of HIV by 2015. These targets are aimed at reinvigorating the commitment towards achieving the Millennium Development Goal #6 to combat HIV/AIDS [7]. In the past two years, research on HIV biomedical prevention has focused on adapting the new prevention strategies to the context of local HIV epidemics [8]. There have been equal measures of optimism and pessimism expressed about the ability of new prevention strategies to halt the HIV pandemic. Based on the evidence that starting treatment earlier can increase health benefits and extend life for people with HIV [9,10], many clinicians are already recommending early treatment for both medical and TasP purposes. Regarding PrEP, the widespread reaction is caution in recommending this strategy. Such reluctance is based on concerns about the common adherence issues in the studies of PrEP [11], the obvious relationship between level of adherence to daily medication schedule and its preventative effect [12] and side effects and drug-resistant HIV [13], among others. Despite little evidence that PrEP use can affect behaviour, many concerns have been voiced about the future of safe sex practices, particularly condom use among MSM, if new biomedical prevention strategies are introduced. More research is needed to investigate this issue using appropriate study designs. In its current form, daily PrEP may benefit only a small number of people with very high and ongoing risk for HIV infection, and other PrEP regimens must be explored. The overarching concern about new prevention strategies, particularly PrEP, is that the cost and burden of providing them are currently unacceptable for most, even high-income, countries. As a result, there have been calls for more evidence and a very slow progress in implementing these two new exciting HIV prevention developments. Regarding PrEP, only two countries to date have prescription guidelines for people at high risk of HIV infection [14,15]. We now have the knowledge and new tools to revolutionize HIV prevention, and we have the bold new Political Declaration with ambitious targets. It must be acknowledged that the task of bringing HIV infections down to zero seems daunting from where we stand now in late 2013. Despite the global success in lowering the HIV infection rates by 33% [1], sub-Saharan Africa has seen only a 25% decline [16]. Some regions have seen increases (8% in Eastern Europe and central Asia [17], 19% in East Asia [18] and 37% in the Middle East and North Africa [19]). This lack of progress has been associated with insufficient resources, inadequate coverage of women with antiretroviral treatment and HIV testing programmes not reaching the population groups at high risk for HIV infection. While sexual behaviour has changed to become safer in some countries and populations, sexual risk taking has increased in other settings. This is the case in most high-income countries in North America, western and central Europe and Australasia, where MSM are central to local HIV epidemics. In these countries, both high-risk sexual practices among MSM and HIV infections have been on the rise [20,21]. Condom use has increased in some countries, but declined in others. Proven effective interventions (e.g., prevention of mother-to-child transmission (PMTCT) and needle- and syringe-exchange programmes) have not achieved sufficiently high coverage in many countries [1]. Although trends in risky sexual practices have been linked to the trends in HIV incidence [22] and population-level behaviour change to the reduction in HIV prevalence, there are still challenges in linking behaviour-change programmes to specific HIV outcomes on the population level [2]. While new expectations have been raised about the role of antiretrovirals for HIV prevention, mixed progress was observed in access to cART, and only 61% of people eligible for treatment under the 2010 WHO guidelines received it (this is as little as 34% under the 2013 WHO guidelines). The Political Declaration has for the first time named and acknowledged the importance of such population groups as MSM, people who inject drugs and sex workers for HIV prevention, but in many settings, stigma and access to treatment and prevention services for these groups are still important challenges. Many low- and middle-income countries have stepped up their local investments in HIV prevention [2], but, regrettably, the lack of resources has remained a major issue: only US$18.9 billion was available from all sources for the AIDS response in 2012, and this was estimated to be 16–26% short of annual need [1]. It is at this time of some successes in HIV prevention and challenges in how to optimize the available resources and tools that the aspirational Political Declaration of commitment to fight the pandemic is necessary. This year's International AIDS Day marks the midpoint towards the deadline set by the Political Declaration in 2011. It is an opportunity for governments and each of us to revisit and reinvigorate the universal commitment to bring HIV infections to zero. Like never before, we have good cause to expect the next generation to be AIDS-free and new HIV infections to move towards zero. In the face of the 75 million people who have suffered from HIV/AIDS and the many more affected, the international community should keep the promise and bring this HIV pandemic to an end. None were declared. The Kirby Institute receives project funding from the Australian Government Department of Health and Ageing. The views expressed in this publication do not necessarily represent the position of the Australian Government. IZ has prepared the manuscript and approved its final version.
In the last decade, gay men and other men who have sex with men (MSM) have come to the fore of policy debates about AIDS prevention. In stark contrast to global AIDS policy during the first two decades of the epidemic which excluded MSM from policy outside the West, UNAIDS now identifies MSM as "marginalized but not marginal" to the global AIDS epidemic. This dissertation provides an account of this controversial reversal of global AIDS policy and uses it as a point of departure for understanding the role of intergovernmental organizations (IGOs) like UNAIDS in the formation of global health priorities.In contrast to the emergence of other health and social policy issues, various studies observe that efforts to establish a global agenda for addressing HIV and AIDS have been highly concentrated within intergovernmental organizations. How and in whose interests do new priorities emerge within AIDS IGOs? Health policy researchers argue that IGOs have considerable influence in the formation and dissemination of health policies around the world. However, there is a particularly rich debate among sociologists and political scientists about whether and how IGOs can act autonomously and pursue policy priorities that are not supported by states. Because these organizations generally lack enforcement power and are dependent on states for financial resources and legitimacy, IGOs have traditionally been conceived as lacking autonomy to pursue their own policy interests independent of the interests of states. Yet, recent interventions by sociologists have shown how IGOs strategically navigate the demands of states and even attempt to reconfigure the external environment to promote alignment with the policy interests of the IGO. Nonetheless, concerns about resources continue to plague IGOs and often constrain their agency. In this dissertation I argue that a key limitation of existing studies on the autonomy and influence of IGOs is their narrow focus on the decision-making and agenda-setting stages of policy making. I extend sociological research on the influence and autonomy of IGOs by addressing how concerns about implementation shape the particular structures and strategies that AIDS IGOs adopt in order to pursue their own policy interests. Many of these strategies are not easily understood by existing theories of IGO behavior which argue that as bureaucracies, IGOs will seek to expand their autonomy and influence in a sector. In contrast, I argue that IGOs with limited power to enforce policy implementation by states are highly sensitive to an implementation-autonomy trade off and may actually give up some autonomy in decision-making in order to facilitate broader implementation by states. IGOs also face additional barriers to implementation due to decentralization of the organization at the regional- and country-level and competition from other IGOs, nongovernmental organizations, and bilateral and private donors. Using archival data from World Health Organization's Global Programme on AIDS and its successor, the Joint United Nations Programme on HIV/AIDS (UNAIDS), two IGOs mandated by the United Nations to coordinate a global response to AIDS epidemic, I show in Chapter 1 how concerns about implementation have shaped decisions about the organizational structure of these IGOs. In addition, I show how implementation concerns have promoted the adoption of particular strategies - organizational inreach, interorganizational cooperation, evidence-based advocacy, and bidirectional pressure - to align policy preferences among states, other organizations, and even their own staff. The use of these strategies by AIDS IGOs has had consequences beyond the decision-making phase of policy development. Drawing on a novel dataset compiled from five waves of UN Country Progress Reports on HIV/AIDS (2003, 2006, 2008, 2010, and 2012), I show in Chapter 2 that the use of these strategies has promoted the alignment of national AIDS programs with UNAIDS policies on MSM over time. On the ground, IGO interest in HIV among MSM has also provided new technologies for seeing MSM in hostile political contexts. As I show in a country-case study presented in Chapter 3, claims for the recognition of same-sex sexualities in Malawi have had the most institutional success within the national AIDS programs which increasingly identifies MSM as a key target for public health intervention. Additionally, links between Malawian organizations and transnational research and advocacy networks have provided a context in which (male) same-sex sexualities have become statistically visible and institutionalized, providing a basis for future grassroots mobilization. At the same time, however, IGO interest in MSM has reinvigorated opposition to homosexuality among Malawian political elites and ordinary citizens. In Chapter 4 I introduce original household survey data collected in Malawi in 2012 (N=1491). Building on qualitative findings from Chapter 3, I use these data to quantitatively examine the effects of variation in aid allocations across Malawi's administrative districts on attitudes toward homosexuality. Results show that in districts with higher levels of annual aid per capita, individuals hold more negative views of homosexuality. Thus while IGOs have had a substantial effect on state-level and donor-level adoption of policy priorities, they have had much less success in changing public views toward homosexuality on the ground. These results suggest that models of global diffusion that utilize policy change as an indicator for cultural change may be greatly overestimating cultural change on contentious issues like homosexuality.In sum, IGOs have become central actors in the formation, diffusion, and implementation of AIDS policy concerning same-sex sexualities. They develop new policy ideas and set priorities that may diverge substantially from the interests of member states, both rich and poor. However, IGOs also face considerable barriers to implementing their policy priorities: from reluctant states to the decentralization of staff across dozens of country offices to competition from other organizations and private donors. In this dissertation I show how barriers to implementation shape the structures and strategies of IGOs. As such, this work contends that IGOs are not simply disinterested forums in which states pursue their own interests or passive collections of rules and norms, but autonomous, influential, and self-interested actors that shape the policymaking process and the world around them, sometimes in unexpected and undesirable ways.
Serge‐Paul Eholié, François Eba Aoussi, Ismael Songda Ouattara, E. Bissagnené · 5 authors
Many successes have been achieved in HIV care in low- and middle-income countries (LMIC): increased number of HIV-infected individuals receiving antiretroviral treatment (ART), wide decentralization, reduction in morbidity and mortality and accessibility to cheapest drugs. However, these successes should not hide existing failures and difficulties. In this paper, we underline several key challenges. First, ensure long-term financing, increase available resources, in order to meet the increasing needs, and redistribute the overall budget in a concerted way amongst donors. Second, increase ART coverage and treat the many eligible patients who have not yet started ART. Competition amongst countries is expected to become a strong driving force in encouraging the least efficient to join better performing countries. Third, decrease early mortality on ART, by improving access to prevention, case-finding and treatment of tuberculosis and invasive bacterial diseases and by getting people to start ART much earlier. Fourth, move on from WHO 2006 to WHO 2010 guidelines. Raising the cut-off point for starting ART to 350 CD4/mm(3) needs changing paradigm, adopting opt-out approach, facilitating pro-active testing, facilitating task shifting and increasing staff recruitments. Phasing out stavudine needs acting for a drastic reduction in the costs of other drugs. Scaling up routine viral load needs a mobilization for lower prices of reagents and equipments, as well as efforts in relation to point-of-care automation and to maintenance. The latter is a key step to boost the utilization of second-line regimens, which are currently dramatically under prescribed. Finally, other challenges are to reduce lost-to-follow-up rates; manage lifelong treatment and care for long-term morbidity, including drug toxicity, residual AIDS and HIV-non-AIDS morbidity and aging-related morbidity; and be able to face unforeseen events such as socio-political and military crisis. An old African proverb states that the growth of a deep-rooted tree cannot be stopped. Our tree is well rooted in existing field experience and is, therefore, expected to grow. In order for us to let it grow, long-term cost-effectiveness approach and life-saving evidence-based programming should replace short-term budgeting approach.
Internet and digital technologies have been discussed recently by Addiction contributors in relation to the delivery of efficient computer-delivered brief interventions [1,2], online methodologies for recruiting and surveying illicit drug users [3] and the internet's role in facilitating the spread of information and sale of emerging drugs such as mephedrone [4] and synthetic cannabinoids [5]. Here, I introduce readers to a novel use of the internet in the drugs field. The anonymous online drug market-place Silk Road was first revealed in June 2011 [6]. Silk Road is accessible only to people who are using Tor anonymizing software [7]. Tor uses encryption to make it impossible for anyone to trace IP addresses (the electronic code assigned to each computer on the internet). The front page of Silk Road looks a great deal like the front page of eBay. Goods and services for sale are categorized and all manner of drugs are available under the following categories: ecstasy, cannabis, dissociatives, psychedelics, opioids, stimulants, benzodiazepines and other. Sellers receive ratings from buyers and comments about the quality of their products, how fast they ship and the level of professionalism and discretion of the transaction. Trust in sellers is built on reputation. Silk Road traders use the anonymous currency Bitcoin [8]. This decentralized international currency operates through peer-to-peer technologies. At the time of writing (October 2011), Silk Road is still online and continuing to expand. Facilitated by a combination of the internet and encryption technologies, buying and selling illegal products is now possible and may increase dramatically in the future. What may stop an exponential increase in the use of anonymous online drug market-places is the hurdle of delivery. At the end of the transaction, the physical product still needs to be sent to the buyer. Sending products between countries allows law enforcement the opportunity to intercept packages and potentially attempt to arrest the would-be importer. Sending products within the same country may make arrest less likely. There are also numerous barriers to entry for people who might want to use Silk Road. Installing and using Tor, buying and using Bitcoins in a secure way and taking the risk of fraud or arrest upon delivery may deter the majority of would-be users. Nevertheless, for the minority who master these concerns and are willing to take the risk, Silk Road has revolutionized how the internet can be used to source drugs. After all, buying drugs in the real world also involves considerable risk. For some, the online equivalent may prove more convenient and secure than arranging a standard deal. There are many unanswered questions about Silk Road. The extent to which law enforcement can stop and disband a site such as this is yet to be seen. The extent to which drug users will use this new technology is also unknown. Needless to say, if anonymous online drug markets do end up expanding into mainstream drug markets, they will pose a real challenge to existing drug laws and policies. We should definitely watch this space. None.
Rifat Atun, Martin McKee, Francis Drobniewski, Richard Coker
OBJECTIVE: To develop a methodology and an instrument that allow the simultaneous rapid and systematic examination of the broad public health context, the health care systems, and the features of disease-specific programmes. METHODS: Drawing on methodologies used for rapid situational assessments of vertical programmes for tackling communicable disease, we analysed programmes for the control human of immunodeficiency virus (HIV) and their health systems context in three regions in the Russian Federation. The analysis was conducted in three phases: first, analysis of published literature, documents and routine data from the regions; second, interviews with key informants, and third, further data collection and analysis. Synthesis of findings through exploration of emergent themes, with iteration, resulted in the identification of the key systems issues that influenced programme delivery. FINDINGS: We observed a complex political economy within which efforts to control HIV sit, an intricate legal environment, and a high degree of decentralization of financing and operational responsibility. Although each region displays some commonalities arising from the Soviet traditions of public health control, there are considerable variations in the epidemiological trajectories, cultural responses, the political environment, financing, organization and service delivery, and the extent of multisectoral work in response to HIV epidemics. CONCLUSION: Within a centralized, post-Soviet health system, centrally directed measures to enhance HIV control may have varying degrees of impact at the regional level. Although the central tenets of effective vertical HIV programmes may be present, local imperatives substantially influence their interpretation, operationalization and effectiveness. Systematic analysis of the context within which vertical programmes are embedded is necessary to enhance understanding of how the relevant policies are prioritized and translated to action.