Accelerating harm reduction interventions to confront the HIV epidemic in the Western Pacific and Asia: the role of WHO (WPRO)

Mesquita, Fábio; Jacka, David; Ricard, Dominique; Shaw, Graham P.; Han, Tie-Ru; Hu, Yifei; Poundstone, Katharine; Salva, Madeline; Fujita, Masami; Singh, Nirmal

doi:10.1186/1477-7517-5-26

Cited by 24 publications

(19 citation statements)

References 12 publications

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“…Initially (up to the1990s), outbreaks of HIV in PWID were limited to North and South America and Europe. However, since the early 2000s, HIV has spread rapidly among PWID in Eastern Europe and in many countries of South, Central and South-East Asia [8]. A large PWID population is cause for concern due to the potential for HIV transmission to the general population through risky sexual behaviors and mother-to-child transmission.…”

Section: Trends Of Dual Epidemics Of Injecting Drug Use and Hiv Infecmentioning

confidence: 99%

“…In Asia, national HIV epidemics in China, Malaysia, and Vietnam have been driven by injecting drug use [8]. Due to the large population sizes of many Asian countries, relatively low HIV prevalence rates still represent infections numbering in the millions.…”

Section: Trends Of Dual Epidemics Of Injecting Drug Use and Hiv Infecmentioning

confidence: 99%

“…In the last decade, the countries of Eastern Europe and Asia have experienced gradual shifts toward political acceptance and implementation of HIV prevention and harm reduction services, often through civil society advocacy [8,23,24,27,28]. Harm reduction activities include opioid substitution treatment (OST) (e.g., methadone, buprenorphine) and clean needle and syringe exchange programs (NSPs).…”

Section: Harm Reduction Policy and Implementationmentioning

confidence: 99%

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Addressing Injecting Drug Use in Asia and Eastern Europe

Wu¹,

Shi

Detels

2013

Curr HIV/AIDS Rep

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While the global HIV incidence dropped about 20% in the past 10 years, HIV incidences among people who inject drugs (PWID) in Asia and Europe continue to increase and to account for high proportions of new HIV infections among PWID globally. Great changes have been observed in this region, such as progressing from rejection to acceptance of harm reduction strategies in Asian countries, but no such change has occurred in Eastern European countries. China has quickly scaled up harm reduction activities nationwide, resulting in the decline of HIV incidence and HIV prevalence among PWID since 2006. However, insufficient scaling up of harm reduction programs in other countries has failed to slow down their HIV epidemics. In Eastern European countries where the spread of HIV among PWID is the most severe, only about 15% of funding for harm reduction programs are from domestic sources. Strong political and financial commitment from countries in this region is urgently needed to quickly scale up evidence-based harm reduction strategies in order to prevent the HIV epidemic from spreading rapidly from PWID to the heterosexual general population.

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Section: Trends Of Dual Epidemics Of Injecting Drug Use and Hiv Infecmentioning

confidence: 99%

Section: Trends Of Dual Epidemics Of Injecting Drug Use and Hiv Infecmentioning

confidence: 99%

Section: Harm Reduction Policy and Implementationmentioning

confidence: 99%

See 1 more Smart Citation

Addressing Injecting Drug Use in Asia and Eastern Europe

Wu¹,

Shi

Detels

2013

Curr HIV/AIDS Rep

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“…The high relapse rates following detention in CDDCs and other non-evidence-based approaches and a high HIV prevalence among PWID led the Malaysian government in 2005 to introduce evidence-based HIV prevention strategies that included both needle/syringe exchange programs (NSEPs) and opioid maintenance therapy (OMT) (Mesquita, et al, 2008; Reid, et al., 2007). Buprenorphine maintenance therapy (BMT) was introduced in 2006; however, this was followed by problems with diversion and misuse via injection, leading to its withdrawal from the market and replacement with co-formulated buprenorphine/naloxone in 2007 (R.…”

Section: Introductionmentioning

confidence: 99%

Treatment Readiness, Attitudes Toward, and Experiences with Methadone and Buprenorphine Maintenance Therapy Among People Who Inject Drugs in Malaysia

Vijay

Bazazi

Yee

et al. 2015

Journal of Substance Abuse Treatment

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Background Little is known about attitudes toward and experiences with opioid maintenance therapy (OMT) among people who inject drugs in Malaysia, a country where people who inject drugs comprise 1.3% of the adult population. Methods In 2010, 460 people who inject drugs in Greater Kuala Lumpur, Malaysia were surveyed to evaluate attitudes toward and experience with OMT and treatment readiness. Attitudes towards OMT with both methadone and buprenorphine were assessed using an opinions scale. Multivariable linear regression was used to assess correlates of treatment readiness, measured with the 19-item Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Results All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Few had had previous experience with methadone (9.3%) or buprenorphine (12.6%) maintenance therapy, yet many had used methadone (55.2%) or buprenorphine (51.7%) outside of treatment settings. Fifteen percent had injected buprenorphine in the past month, and of the few that were currently receiving buprenorphine maintenance therapy, almost all were injecting it. The majority of subjects exhibited a moderate level of treatment readiness and a preference for methadone over buprenorphine. Those with low treatment readiness scores were more likely to have previous experience with compulsory drug detention centers (p<0.01), needle/syringe exchange programs (p<0.005), or be of Indian ethnicity (p<0.001). Past use of methadone (p<0.01), older age (p<0.001), stress symptom severity (p<0.001), and sharing of needles or syringes (p<0.05) were associated with higher treatment readiness scores. Conclusion There are suboptimal levels of OMT experience among people who inject drugs that may be improved by addressing factors that influence patient attitudes. Those individuals with moderate treatment readiness may be targeted by brief motivational and cognitive interventions in primary care, prisons or OMT clinics aimed at improving entry into and retention in treatment.

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“…9 Unfortunately however, this affordable and effective treatment for opioid dependence remains unavailable in most other lowand middle-income countries, as they still face many challenges in expanding methadone maintenance treatment programmes. 10 As a result, both drug use and drug-related HIV epidemics are continuing to have devastating effects in these countries.…”

mentioning

confidence: 99%