Risk Environments of Postsocialism. Sex Work, Drug Policy, and HIV in Eastern and Southeastern Europe Between War, Criminalisation, and External Defunding. A Theoretical Synthesis

This paper develops a theoretical synthesis of sex work, drug policy and HIV in Eastern and Southeastern Europe - a region that fits neither the governance typology of the Global North nor the self-organisation typology of the Global South developed in two companion papers. The region's defining feature is the intersection of sex work with injecting drug use under double criminalisation, governed in much of the post-Soviet space not by criminal law in the strict sense but by a distinct administrative-offence regime inherited from the late Soviet period. Eastern Europe and Central Asia is, alongside the Middle East/North Africa and Latin America, one of three world regions where new HIV infections have risen rather than fallen since 2010. Two axes structure the analysis. The first traces the postsocialist legal-epidemiological complex from its administrative-law foundations through Tim Rhodes' risk environment framework - developed in this region - to the catastrophic 2014 Crimean methadone ban and the contrasting resilience of Ukraine's wartime opioid agonist treatment system. The second traces an inverted extraterritorial axis: where the Northern paper found US power exercised through platform law and the Southern paper through the PEPFAR pledge, this region experiences the abrupt 2025 withdrawal of PEPFAR/USAID funding colliding with an indigenous Russian counter-power - 'traditional values' politics and foreign-agent legislation that actively suppresses sex worker self-organisation (SWAN, Silver Rose, Legalife-Ukraine) rather than merely leaving it unfunded. A cross-cutting axis examines Southeastern Europe and intra-EU mobility, where Romania's collapse from Global Fund eligibility to antiretroviral supply crises shows treatment access becoming a function of residency and funding status rather than medical need - a pattern this paper extends to the underexamined situation of HIV-positive sex workers who return from Western Europe to Romania or Bulgaria. The paper argues that the postsocialist risk environment constitutes a fourth, structurally distinct case: neither self-built protective infrastructure as in the South nor institutionalised labour-law normalisation as in the North, but a terrain where both state and self-organised protection remain precarious against external shocks - war, funding withdrawal, and authoritarian repression alike. Companion Papers: DE https://doi.org/10.31235/osf.io/df43j_v1 https://doi.org/10.31235/osf.io/ckru6_v1 EN https://doi.org/10.31235/osf.io/uc57b_v1 https://doi.org/10.31235/osf.io/tysjx_v1