Prevention of HIV/AIDS among injecting drug users in Russia: Opportunities and barriers to scaling-up of harm reduction programmes

Tkatchenko-Schmidt, Elena; Renton, Adrian; Gevorgyan, Ruzanna; Давыденко, Л А; Atun, Rifat

doi:10.1016/j.healthpol.2007.07.005

Cited by 47 publications

(54 citation statements)

References 28 publications

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“…These suggestions took many forms: providing general explanations of MMT, working with community leaders, and linking MMT to other services. Other studies have found levels of awareness and understanding among IDUs regarding the availability and benefits of harm reduction as a strong determinant of participation (Philbin et al, 2008;Tkatchenko-Schmidt et al, 2008;Yang et al, 2008). Some drug users and NGO members stated support for total abstinence.…”

Section: Discussionmentioning

confidence: 98%

“…Studies report concerns among IDUs that utilizing harm reduction services would lead to the discovery of their status, resulting in increased stigma and prosecution by local police (Hammett et al, 2005b;Lu, Zhao, Bao, & Shi, 2008;Tkatchenko-Schmidt et al, 2008;Yang et al, 2008). Specific numbers of arrests are difficult to determine, but reports suggest that 10Á30% of IDUs spend time in a detoxification center each year (Reid & Costigan, 2002).…”

Section: Discussionmentioning

confidence: 99%

“…Harm reduction is a strategy to reduce the negative health, social, and economic effects of drug use, without requiring abstinence from drugs (Joseph, Stancliff, & Langrod, 2000;Tkatchenko-Schmidt, Renton, Gevorgyna, Kavydenko, & Atun, 2008). Methadone maintenance treatment (MMT) is an effective and safe substitution therapy for opioid dependence (Pang & Hao, 2007) that reduces injection-related risk behaviors, blood-borne infections, and can help IDUs recover various social functions (Drucker, Lurie, Wodak, & Alcabes, 1998).…”

Section: Introductionmentioning

confidence: 99%

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Exploring stakeholder perceptions of facilitators and barriers to accessing methadone maintenance clinics in Yunnan Province, China

Philbin

Zhang²

2010

AIDS Care

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Injection drug use is an ongoing public health crisis in China and one of the largest contributors to the transmission of HIV/AIDS. Though the government has rapidly scaled up methadone maintenance treatment clinics, they have not been extensively evaluated to analyze factors influencing rates of attendance. We explored the facilitators and barriers to accessing methadone maintenance clinics in Kunming City, Yunnan Province, China. Using in-depth qualitative interviews conducted from February 2008 to June 2008 with 35 informants - injection drug users (IDUs) and key stakeholders - we explored factors that determine whether drug users decide to present at methadone clinics. Interviews were digitally recorded with consent, transcribed verbatim, and translated. Content analysis was conducted to identify themes which included general attitudes toward methadone treatment, barriers and challenges to access, and suggestions for improvement. Within these, topics included responses to methadone, its side effects, and fear of discrimination, loss of privacy, and police interference. Respondents also listed numerous suggestions for improvement including raising awareness of harm reduction both among drug users and the community, providing additional support in the form of psychological counseling, job training and behavioral therapy, and increasing communication between police, government, and public health officials. High rates of HIV infection among IDUs in China have prompted public health responses including the scale up of methadone maintenance clinics. Our results may inform policy strategists in implementing social-structural changes to create enabling environments that facilitate an increase in access to methadone clinics among IDUs in Kunming.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exploring stakeholder perceptions of facilitators and barriers to accessing methadone maintenance clinics in Yunnan Province, China

Philbin

Zhang²

2010

AIDS Care

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“…35,36 In Russia and Turkmenistan substitution treatment remains prohibited by law. 22,30,35,37 As of 2007, it remained unavailable in Armenia, Kazakhstan, and Tajikistan. 30 Powerful interest groups combine against the introduction of substitution treatment, including narcologists, law enforcement officers, and, in some countries, drug dealers.…”

Section: Findings Tuberculosismentioning

confidence: 99%

The Soviet legacy in diagnosis and treatment: Implications for population health

Rechel

Kennedy

McKee

et al. 2011

J Public Health Pol

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This article reviews diagnosis and treatment in the Commonwealth of Independent States in three clinical areas: tuberculosis, substance misuse, and neurological disorders in children. While the specific problems in each of these areas differ greatly, commonalities emerge, pointing to the continued influence of the Soviet past. Although progress in developing evidence-based medicine is being made, the isolation of Soviet science from Western developments has resulted in the widespread use of outdated diagnostic procedures and treatment protocols, while finance mechanisms still encourage unnecessary hospitalizations and treatments. A hierarchical medical system, as well as underdeveloped patient rights and medical ethics, mean that patients have little information and ability to participate in decision-making. The continued use of outdated approaches to diagnosis and treatment contributes to poor population health outcomes in the region.

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“…The impact of HIV/AIDS epidemic on marginalized IDUs and MSN populations has been well documented. In CEE with higher HIV prevalence among IDUs governments are often least accountable and human rights and legal frameworks remain non existence and politicians are uncommitted in decriminalization of proven treatment modalities such as opioid substitution therapy, clean needle and syringe exchange program [38][39][40]. Additional obstacle is the often mistrustful relationships that exist between civil society and often corrupt and inefficient governments hindering health and prevention programs particularly connected to HIV/AIDS, TB initiatives [41].…”

Section: Prevention Strategies Among Risk Groups and Risk Environmentsmentioning

confidence: 99%

The quest for multi-sectoral HIV/AIDS prevention in Central and Eastern Europe and why it matters

Vadiee

2011

HIV & AIDS Review

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a b s t r a c tBackground: The HIV/AIDS epidemic is continuing to expand in Central and Eastern Europe against a background of transition and disparities in welfare. In absence of a multi-sectoral HIV/AIDS prevention strategy among the risk groups in Eastern and central Europe obstacles in reaching the key prevention targets will continue to remain. Method and search strategy: We performed a systematic literature search using key terms such as; HIV/AIDS, Central and Eastern Europe (CEE), multi-sectoral prevention to review studies that reported on extent of multi-sectoral implementation in CEE. Results: The mobilization and capacity building among the communities remains a challenge in CEE. The prevention strategies aimed at IDUs, CSWs and adolescent young women should be formulated with a real understanding of their risk environments. The civil society and the involvements of the broader political system is crucial in decriminalization of harm reduction programs among IDUs. HIV prevention among women and adolescent should be strategized in the context of broader sexual and reproductive health rights. Conclusion: A multidisciplinary and multi-sectoral HIV/AIDS prevention in CEE needed in order to efficiently and effectively address the growing East-West Epidemiological divide.

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Prevention of HIV/AIDS among injecting drug users in Russia: Opportunities and barriers to scaling-up of harm reduction programmes

Cited by 47 publications

References 28 publications

Exploring stakeholder perceptions of facilitators and barriers to accessing methadone maintenance clinics in Yunnan Province, China

Exploring stakeholder perceptions of facilitators and barriers to accessing methadone maintenance clinics in Yunnan Province, China

The Soviet legacy in diagnosis and treatment: Implications for population health

The quest for multi-sectoral HIV/AIDS prevention in Central and Eastern Europe and why it matters

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