2021
Ingo Ilja Michels
Heino Stöver
Oleg Aizberg
Azizbek Boltaev
Opioid Agonist Treatment Treatment of Opioid Dependence HIV/Hepatitis prevention and treatment
Opioid Agonist Treatment for Opioid Use Disorder patients in Central Asia

In Central Asia approximately (only) 2,500 of dependent people (approximately 400,000) are in Opioid Agonist Treatment (OAT). In the Kyrgyz Republic 1,450, in Tajikistan 680 and in Kazakhstan 353. OAT in prisons is available in the Kyrgyz Republic or Republic of Tajikistan. Access is very patchy and the number of inmates in treatment is very limited. Nevertheless, OAT might play a substantial part in the health care system provided to drug users in Central Asia in the future, although there is still massive resistance against this evidence-based treatment. OAT can reduce substantially drug-related criminality and infection diseases (HIV, Hep C) and support effective treatment of additional health problems and dependence. The results of research studies and practical experiences clearly indicate that dependent patients benefit substantially from OAT with improvements in physical and psychological health. OAT proves successful in attaining high retention rates (65 % to 85 % in the first years, up to 50 % after more than seven years) and plays a major role in accessing and maintaining ongoing medical treatment for HIV and hepatitis. OAT is also seen as a vital factor in the process of social reintegration and it contributes to the reduction of drug related harms such as mortality and morbidity and to the prevention of infectious diseases. Some 10-20 % of OAT patients in European countries or USA become drug-free in the long run. Methadone is the only prescribed agonist opioid medication in Central Asia, although buprenorphine might attain rising importance (but too expensive, no experiences). In Turkmenistan no OAT is provided. In Uzbekistan OAT had been introduced, but was not continued. Access to OAT in rural areas is very patchy and still constitutes a problem. There are only few employment opportunities for patients participating in OAT, although regular employment is considered unanimously as a positive factor of treatment success.

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2020
Tianzhen Chen
Jiang Du
Na Zhong
et al.
Trajectories of heroin use predict relapse risk among heroin-dependent patients: A 5-year follow-up study

Objectives: The relationship between past drug use trajectory and long-term relapse risk after rehabilitation among heroin-dependent patients remain understudied. The primary objectives were to identify longitudinal heroin use patterns of heroin-dependent patients, to determine the associative factors with trajectories and to investigate the impact of trajectory groups on relapse after finishing compulsory rehabilitation programs.

Materials and methods: A total of 564 heroin-dependent patients were recruited from 4 compulsory rehabilitation facilities in Shanghai, China between 2007 and 2008. The baseline data was linked to participants’ follow-up data on relapse from official records. Group-based trajectory model was used to identify distinctive drug use trajectory groups. The association between the identified group and heroin relapse risk was then analyzed to understand the role of past drug use trajectory on relapse.

Results: Five trajectory groups were identified in this cohort: (1) Rapid Decrease (9.9%); (2) Persistent High (32.0%); (3) Slow Decrease (34.1%); (4) Gradual Increase (4.5%); (5) Persistent Low (19.5%). Gender, age, education, and impulsivity were found to be different between the five groups. During the 5 years after discharged from the compulsory program, 291 (59.0%) individuals relapsed. Multivariate logistic regression analysis showed that the persistent high group (OR: 2.77 [1.46–5.24]), slow decrease group (OR: 2.31 [1.32–4.06]) and gradual increase group (OR: 3.50 [1.18–10.39]) was positively associated with the heroin relapse risk when compared to the persistent low group. Conclusions: Heroin use trajectories vary among heroin-dependent patients in China. The trajectories of heroin use before compulsory rehabilitation are associated with subsequent long-term relapse risk.

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2020
UNODC
Международные стандарты лечения расстройств, связанных с употреблением наркотических средств

Настоящий документ, «Международные стандарты лечения расстройств, связанных с употреблением наркотических средств» (далее Стандарты), является результатом совместной работы УНП ООН и ВОЗ по поддержке государств-членов в их усилиях по разработке и продвижению эффективных, основанных на фактических данных и соответствующих принципам этики методов лечения расстройств, связанных с употреблением наркотических средств.

Стандарты предназначены для всех, кто участвует в формировании политики, планировании, финансировании, осуществлении, мониторинге и оценке вмешательств и услуг по лечению расстройств, связанных с употреблением наркотических средств.

Настоящий документ основан на имеющихся в настоящее время научных данных в отношении лечения расстройств, связанных с употреблением наркотических веществ, и является основой для применения Стандартов в соответствии с принципами общественного здравоохранения. Стандарты определяют основные компоненты и характеристики эффективных систем лечения расстройств, связанных с употреблением наркотических средств. Методы лечения и вмешательства, отвечающие потребностям людей на различных этапах и при разной степени тяжести расстройств, связанных с употреблением наркотических средств, описываются так же, как описывается лечение любого хронического заболевания или нарушения здоровья.

Стандарты носят рекомендательный характер, и, следовательно, национальным и местным терапевтическим службам или системам не следует пытаться обеспечить осуществление всех содержащихся в этом документе стандартов и рекомендаций одновременно. Тем не менее, с течением времени и с учетом постоянно улучшающегося качества в целях «научно обоснованной и соответствующей этическим принципам практики» можно и следует ожидать формирования более четко организованных, более эффективных и лучше соответствующих принципам этики систем и служб оказания помощи людям с расстройствами, связанными с употреблением наркотических средств.

УНП ООН и ВОЗ предлагают всем, что отвечает за формирование, планирование, финансирование, осуществление и мониторинг местной и национальной политики, а также тем, кто отвечает за оценку лечения расстройств, связанных с употреблением наркотических средств, сопоставить местные системы и услуги по лечению таких расстройств с положениями Стандартов. Цель состоит в том, чтобы выявить пробелы и области, которые не соответствуют Стандартам, и совместно с соответствующими заинтересованными сторонами провести работу по совершенствованию систем и услуг. Хотя многие принципы и разделы Стандартов могут быть применены к лечению других психических расстройств и расстройств, связанных с употреблением психоактивных веществ (например вызванных употреблением алкоголя или табака), основной приоритетной областью Стандартов являются расстройства, связанные с употреблением наркотических средств.

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2020
Глобальный мониторинг эпидемии СПИДа 2019 Казахстан

I. Общий - по ускорению мер в ответ на ВИЧ

II. Каскад тестирования и лечения ВИЧ - Обеспечить доступ к лечению для 30 миллионов людей с ВИЧ путем достижения целей «90–90–90» к 2020 году

III. Профилактика передачи ВИЧ от матери ребенку - Искоренить новые случаи инфицирования ВИЧ среди детей к 2020 году с обеспечением доступа для 1,6 миллионов детей к лечению от ВИЧ к 2018 году

IV. Профилактика ВИЧ; Ключевые группы населения - Обеспечить доступ к комбинированной профилактике, включая доконтактную профилактику, добровольное медицинское мужское обрезание, снижение вреда и пропаганду использования презервативов, для, как минимум, 90% людей, особенно молодых женщин и девочек-подростков в странах с высоким уровнем распространенности и ключевых групп населения — геев и других мужчин, имеющих половые связи с мужчинами, трансгендеров, работников секс-бизнеса и их клиентов, лиц, употребляющих инъекционные наркотики и заключенных

V. Пол; Стигма и дискриминация - Устранить гендерное неравенство и искоренить все формы насилия и дискриминации в отношении женщин и девочек, лиц, инфицированных ВИЧ, и ключевых групп населения к 2020 году

VI. Знание ВИЧ и доступ к услугам в области сексуального репродуктивного здоровья - Обеспечить 90% молодежи знаниями, умениями и навыками для защиты от ВИЧ и доступом к услугам в сфере полового и репродуктивного здоровья к 2020 году, чтобы снизить число новых ВИЧ-инфекций среди девочек- подростков и молодых женщин до уровня менее 100 000 в год

VII. Социальная защита - Обеспечить социальную защиту с учетом конкретных потребностей в связи с ВИЧ для 75% людей находящихся в группе риска или инфицированных ВИЧ, к 2020 году.

VIII. Услуги, предоставляемые силами сообществ - Довести к 2020 году объем услуг, предоставляемых силами сообществ, до уровня не менее 30 % от общих объемов услуг

IX. Расходы на ВИЧ - Обеспечить увеличение инвестиций в сфере противодействия ВИЧ до 26 млрд. долл. США к 2020 году, с выделением четверти (25 %) средств на комбинированную профилактику ВИЧ-инфекции, и 6 % на регулирование социальных факторов, имеющих решающее значение как для распространения, так и для эффективного противодействия эпидемии

X. Расширение прав и доступ к правосудию - Обеспечить людей, живущих с ВИЧ, находящихся в группе риска или пострадавших от ВИЧ, возможностями по просвещению в сфере имеющихся у них прав и доступом к правосудию и юридическим услугам для профилактики и борьбы с нарушениями прав человека

XI. Oтход от практики изолированного решения вопросов противодействия СПИДу - Обеспечить отход от практики изолированного решения вопросов противодействия СПИДу на основе интеграции в системы предоставления услуг с учетом конкретных нужд и потребностей людей и обеспечения всеобщего охвата услугами здравоохранения, включая лечение туберкулеза, рака шейки матки, вирусных гепатитов В и С

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2020
БЫСТРАЯ ОЦЕНКА ПРОБЛЕМ И ПОТРЕБНОСТЕЙ ЖЕНЩИН, ЖИВУЩИХ С ВИЧ И ЗАТРОНУТЫХ ВИЧ, ПРЕДСТАВИТЕЛЬНИЦ КЛЮЧЕВЫХ ГРУПП НАСЕЛЕНИЯ В ПЕРИОД ПАНДЕМИИ COVID-19 В КАЗАХСТАНЕ

Общественными фондами «Реванш» и «Фонд женщин, живущих с ВИЧ» при поддержке UNFPA было инициировано социологическое исследование в виде быстрой оценки с целью выявить ключевые проблемы и потребности отдельных групп женщин в период пандемии COVID-19, а также изучить ситуацию с сексуальным и репродуктивным здоровьем. Объектом исследования стали женщины, обращающиеся во время пандемии за помощью в кризисные центры и общественные фонды, в частности: женщины, живущие с ВИЧ; женщины, затронутые ВИЧ; представительницы ключевых групп населения, а также женщины, находящихся в сложной жизненной ситуации. В данном исследовании были выделены 4 ключевые группы лиц, которые по определению ЮНЭЙДС особенно уязвимы к ВИЧ и зачастую не имеют адекватного доступа к услугам: люди, употребляющие инъекционные наркотики (ЛУИН), трансгендерные женщины, секс-работницы, а также заключенные (в том числе бывшие заключенные) и лица, содержащиеся под стражей.

По сообщениям многих экспертов в связи с изоляцией людей, вызванной с пандемией COVID-19, во всем мире помимо резкого снижения социально-экономических условий жизни населения вырос уровень бытового насилия в отношении женщин. Директор-исполнитель Структуры «ООН-женщины» Фумзиле Мламбо-Нгкуки даже считает, что речь идет о своего рода «теневой пандемии». Эта проблема стала характерной и для Казахстана. Так, по сообщению начальника управления ювенальной полиции и защиты женщин от насилия комитета административной полиции МВД РК А.Оспанова, в стране за время пандемии количество семейно-бытовых преступлений выросло на 21%. С начала карантина к административной ответственности за противоправные деяния в сфере семейно-бытовых отношений были привлечены 8 тысяч человек2.

Также по данным МВД, в 2020 году в кризисные центры были направлены более 500 жертв бытового насилия. В на данный момент Казахстане функционирует 41 кризисный центр, в 29 из них есть приюты, где оказывается помощь пострадавшим лицам, а в некоторых регионах и самим правонарушителям.

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2019
Tianzhen Chen
Na Zhong
Jiang Du
et al
Polydrug use patterns and their impact on relapse among heroin-dependent patients in Shanghai, China

Aims To describe the polysubstance use patterns of heroin-dependent patients and to understand the impact of polysubstance use patterns on relapse during the 5 years after completing compulsory rehabilitation programmes. Design In this secondary analysis, the baseline data of 503 heroin-dependent patients were linked with their 5-year follow-up data from official records. Setting Four compulsory rehabilitation centres in Shanghai, China.

Participants A total of 564 heroin-dependent patients who were discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008 were recruited. Among these, 503 patients with available follow-up records were included in this analysis. 

Measurements The baseline measurements included the Addiction Severity Index, the Temperament and Character Inventory and the Medical Outcomes Study Social Support Scale. Relapses after discharge from the compulsory rehabilitation centres were extracted monthly from the official electronic record system. Latent class analysis was used to identify different polysubstance use patterns. Associations between the identified latent classes and heroin use and the factors related to relapse during the 5-year follow-up were analysed with the Cox regression model.

Findings Three latent classes were identified in this cohort: (1) alcohol polydrug users (APU; 13.7%), (2) low polydrug users (LPU; 76.5%) and (3) amphetamine-type stimulant polydrug users (ASPU; 9.7%). During the 5-year follow-up, 298 heroin patients relapsed, and the three groups showed different relapse rates (ASPU 69.4 versus LPU 60.5 versus APU 44.9%, P = 0.02). The average durations of abstinence for the three groups differed (ASPU 31.27 ± 3.41 months versus LPU 36.77 ± 1.19 months versus APU 42.46 ± 2.81months, P = 0.02). Multivariate Cox regression analyses found that the LPU [hazard ratio (HR) = 1.63, 1.06–2.51] and ASPU (HR = 2.10, 1.24–3.56) classes were positively associated with the risk of heroin relapse. Conclusion Polydrug use patterns differ among heroin-dependent patients in compulsory rehabilitation programmes in China. A history of polydrug use may predict heroin relapse risk among patients in those compulsory rehabilitation programmes.

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2019
Tianzhen Chen
Min Zhao
China methadone opioid agonist treatment opioid dependence
Meeting the challenges of opioid dependence in China: experience of opioid agonist treatment

Purpose of review 

This article reviews the role of methadone maintenance treatment (MMT) clinics in minimizing the harms caused by opioid dependence, as well as China’s current challenges in this area. In addition, we aim to discuss the treatment strategies for opioid dependence within the international community in the current global situation of serious abuse of opioids.

Recent findings 

Like other countries facing the opioid crisis, China is actively working on revising policy, improving the addiction treatment system and promotion of MMT clinics to cope with the risks of opioid abuse. As they provide one of the most effective opioid agonist treatments for opioid dependence, MMT clinics play an extremely important role in this campaign. The MMT programme in China has had a significant beneficial effect on reduction of opioid use and the prevalence rate of HIV/AIDS.

Summary 

The efficacy of MMT for patients with opioid dependence in China is confirmed by the present review. However, several important challenges still need to be resolved. China’s treatment experience also provides a reference for other countries facing the danger of opioid dependence.

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2019
UNICEF / KSCDID - Almaty
Training Manual: Psychosocial Supervision for Children and Adolescents Living with HIV or Other Chronic Disease

Kazakhstan is part of the youngest epidemic of HIV. The HIV incidence among the general population are 1.82 per 1000, among 15-19 age group - 0.92 per 1000. In 2018, 532 children (under 18 years of age) were registered as having HIV infection. The breakdown of adolescents is unevenly distributed with half living in South Kazakhstan; one fifth in Almaty and Almaty Region, and the rest across the other regions. The experience of working with children and adolescents among professionals differs greatly. The main focus has been medical provision with counseling provided for caregivers and concentrating on HIV treatment. The psychosocial support needs have, until now, been neglected.

For quality psychosocial support, professionals working with children with HIV need a thorough understanding on child-centred, child-rights approaches and how to implement them into their practice. Professionals working with HIV-positive children should be able to locate possible barriers and challenges and find solutions to address these and ensure all children have optimum physical and emotional care provided for them.

Psychosocial support needs to be focused on, and offered to the whole family. It is a way to nurture acceptance and positive parenting in care-givers and support the young person to develop the skills and resilience to lead a full and healthy life.

Children and young people living with HIV are not unique in their need for psychosocial support in managing a chronic health condition. This Training Manual is universal and applicable in different conditions such as hepatitis, diabetes and those children living with disabilities.

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2019
International Journal of Drug Policy
Stigma Harm Reduction HIV PWID
Attitudes towards people living with HIV and people who inject drugs: A mixed method study of stigmas within harm reduction programs in Kazakhstan

Background: High levels of stigma towards people who inject drugs (PWID) and people living with HIV (PLWH) exist in Kazakhstan, yet little is known about the role of stigma in harm reduction service settings. In this paper, we use a mixed method design to explore and describe the actionable drivers and facilitators of stigma among harm reduction service providers. Additionally, we describe the manifestations of stigma among PWID who are living with HIV (PWID/LWH), and the impact that stigma has on harm reduction and healthcare service utilization.

Methods: Eight focus groups with 57 PWID/LWH were convened between March 2016 and July 2016 to describe manifestations of stigma from the perspective of syringe exchange program (SEP) clients. Additionally, we surveyed 80 nurses, social workers, outreach workers, and providers of HIV care at SEPs between January 2017 and July 2017 to assess stigmatizing attitudes among staff within the SEP environment. Joint displays were used to integrate quantitative and qualitative data.

Results: The actionable drivers of stigma identified in this study include negative opinions and moral judgements towards PWID/LWH. Facilitators identified included stigmatization as a social norm within the service provision environment, a lack of awareness of anti-discrimination policies, and lack of enforcement of antidiscrimination policies. Qualitative findings highlight manifestations of stigma in which PWID/LWH experienced denial of services, perceived negative attitudes, and avoidance from service provision staff. PWID/LWH also described segregation in healthcare settings, the use of unnecessary precautions by providers, and unauthorized disclosure of HIV status.

Conclusions: This paper highlights the urgent need to address stigma in the harm reduction and HIV service settings in Kazakhstan. These findings have implications for informing an actionable model for stigma reduction for providers who deliver services to PWID/LWH in Kazakhstan. Drivers, facilitators, and manifestations of stigma are multifaceted and addressing them will require a multilevel approach.

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2018
International Journal of Drug Policy
Injection drug use People who inject drugs HIV Criminal justice Kazakhstan
Differences by sex in associations between injection drug risks and drug crime conviction among people who inject drugs in Almaty, Kazakhstan

Background: The criminalization of drug use leads to high rates of drug crime convictions for engaging in injection drug use behaviors, introducing barriers to HIV prevention and drug treatment for PWID. Females (FWID) face unique vulnerabilities to HIV compared to males (MWID) in Kazakhstan. This study examined sex differences in associations between HIV/HCV infection, HIV knowledge, injection drug risk behaviors, and conviction for a drug crime in a sample of people who inject drugs (PWID) in Almaty, Kazakhstan.

Methods: Analyses were performed on baseline data from 510 PWID and stratified by males (MWID) (329) and females (FWID) (181) from Kazakhstan in a couples-focused HIV prevention intervention. Logistic regression analyses using mixed effects (AOR) examined associations between HIV/HCV infection, HIV knowledge, injection drug risk behaviors, drug use severity, drug treatment history and conviction for a drug crime.

Conclusion: High-risk behaviors, HCV infection and more severe substance use disorders are associated with drug crime conviction for PWID, particularly FWID. Structural interventions are necessary to increase the engagement of PWID with drug crime convictions in HIV prevention and substance abuse treatment.

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2018
International Journal of Drug Policy
Opioid overdose HIV HCV Injection drug use
Reducing opioid overdose in Kazakhstan: A randomized controlled trial of a couple-based integrated HIV/HCV and overdose prevention intervention “Renaissance”

Objectives: To evaluate the efficacy of a couple-based integrated HIV/HCV and overdose prevention intervention on non-fatal and fatal overdose and overdose prevention behaviors among people who use heroin or other opioids in Almaty, Kazakhstan.

Methods: We selected 479 participants who reported lifetime heroin or opioid use from a sample of 600 participants (300 couples) enrolled in a randomized controlled trial (RCT) conducted between May 2009 and February 2013. Participants were randomized to either (1) a 5-session couple-based HIV/HCV and overdose prevention intervention condition or (2) a 5-session Wellness Promotion and overdose prevention comparison condition. We used multilevel mixed-effects model with modified Poisson regression to estimate effects of the intervention as risk ratios (RR) and the corresponding 95% CIs.

Results: About one-fifth (21.9%) of the sample reported that they had experienced an opioid overdose in the past 6 months at baseline. At the 12-month follow-up, both the intervention and comparison conditions reported significant reductions in non-fatal overdose and injection heroin/opioid use and significant increases in drug treatment attendance and naloxone use to prevent death from overdose. However, we found no differences between the study arms on any of these outcomes. There were three intervention condition participants (1.3%), compared to seven comparison condition participants (2.9%) who died from opioid overdose during the 12-month follow up period although this difference was not significant.

Discussion: There were no significant conditions on any outcomes: both conditions showed promising effects of reducing non-fatal overdose and overdose risks. Integrating overdose prevention into a couplebased HIV/HCV intervention may be an efficient strategy to target the syndemic of opioid overdose, HIV and HCV in Kazakhstan.

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2018
Journal of Adolescent Health
Drug use Prevention Computerized interventions Central Asia Post-Soviet
Building Competencies to Prevent Youth Substance Use in Kazakhstan: Mixed Methods Findings from a Pilot Family-Focused Multimedia Trial

Purpose: The knowledge-based approach to substance use and HIV prevention, commonly used in Central Asia, does not equip at-risk adolescents with risk reduction skills. This pilot study aims to adapt and test the feasibility and estimate the effect size parameters of a skill-based and family-focused intervention for at-risk adolescents from communities affected by heroin trade and use in Kazakhstan, located on the major drug trafficking route from Afghanistan.

Methods: This National Institute on Drug Abuse-funded pilot trial used a mixed-methods approach and included 181 adolescents (ages 14¡17) that reported at least one risk factor (e.g., substance-using family members or friends and parental criminal history). In addition to the school-based health education program, intervention-arm adolescent-caregiver dyads received three computerized pilot sessions focusing on risk reduction self-efficacy, resistance to peer pressure, and strengthening of family relationships. Adolescents completed baseline, 3- and 6-month Audio Computer-Assisted Self-Interview surveys in Russian and treatment group adolescents (n = 12) also participated in postintervention focus groups.

Results: Small size effects were observed for youth-level theoretical mediators associated with lower substance use. Compared to the control group, intervention-arm adolescents showed improvement in personal and social competencies such as assertiveness (Cohen’s d = .21) and self-esteem (d = .22) at 3 months and increased engagement in prosocial activities at 6 months (d = .41). Adolescents from the intervention group also reported improved self-control skills helping alleviate emotional distress (an increase in anger and tension management d = .30 at 3 months and a reduction in temper d = ¡.27 at 6 months) along with a lower likelihood of binge drinking at 6 months (odds ratio = .18, p = .023).

Conclusions: In middle-income countries like Kazakhstan, an intervention that utilizes interactive technologies and combines an empirically tested skills-based approach with family involvement may be an engaging, acceptable, and culturally appropriate tool for preventing substance use among at-risk youth.

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2017
Министерство здравоохранения Республики Казахстан
HIV/AIDS infectious diseases
Национальный доклад о достигнутом прогрессе в осуществлении глобальных мер в ответ на СПИД Отчетный период: 2017 год

Прекращение эпидемии СПИДа к 2030 году - одна из задач в списке целей устойчивого развития (ЦУР), которая была единогласно принята странами-членами ООН. Полученный опыт в решении проблем ВИЧ-инфекции будет играть определяющую роль в успешном достижении многих ЦУР, в частности, ЦУР 3 («Хорошее здоровье и благополучие»), а также целей касательно вопросов гендерного равенства и расширения прав и возможностей женщин, устранения неравенства между полами, глобального сотрудничества, а также установления принципов справедливости, мира и равноправия в обществе.

Представители от Республики Казахстан приняли активное участие в Совещании высокого уровня Генеральной Ассамблеи ООН по вопросам борьбы со СПИД, которое прошло в Нью-Йорке 8-10 июня 2016 года. Благодаря консолидированной позиции международного сообщества, на совещании высокого уровня, была одобрена Политическая декларация по ВИЧ/СПИДу: ускоренными темпами к активизации борьбы с ВИЧ и прекращению эпидемии СПИДа к 2030 году. Декларация была принята всеми странами-членами ООН, включая Республику Казахстан.

Для достижения целей политической декларации, Объединенная Программа ООН по ВИЧ/СПИД (ЮНЭЙДС) разработала глобальную стратегию «Ускорение: прекращение эпидемии СПИДа к 2030 году», включая достижение целей 909090 к 2020 году.

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2016
Journal of Substance Use
HIV testing and treatment injection drug use Kazakhstan
HIV testing and access to HIV medical care among people who inject drugs and their intimate partners in Kazakhstan

Background: Growing rates of HIV and high rates of injection drug use in Kazakhstan call for examining access to testing and treatment among people who inject drugs and their intimate partners.

Objectives: We examine how access to health and drug treatment services as well as risk environment factors are associated with ever being tested for HIV and ever receiving any general HIV medical care among 728 male and female intimate partners, where at least one partner injects drugs. Methods: Multivariate random effects logistic regression with random effects for couple were conducted to examine associations between access to health and drug treatment services, risk environment factors, and HIV testing and HIV medical care outcomes.

Results: Analyses indicate that accessing needle exchange services and having a regular physician were associated with access to both HIV testing and HIV medical care. Receiving drug treatment was associated with accessing HIV testing but not HIV medical care. Being arrested and charged with a criminal offense was also associated with accessing HIV testing but not HIV medical care.

Conclusions/Importance: Study findings highlight the need for increased scale-up of HIV testing efforts, as well as integrated HIV treatment and care in Kazakhstan.

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2015
Jiang Haifeng
Liang Di
Du Jiang
Gender differences in recovery consequences among heroin dependent patients after compulsory treatment programs

Studies on recovery patterns and how baseline factors influence recovery consequences among heroin dependent patients have shown mixed results. This study is aimed at describing the gender differences in long-term recovery patterns and exploring the predictors of negative recovery consequences by gender among heroin dependent patients in Shanghai, China. At baseline, this study recruited 503 heroin dependent patients discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008. In this cohort study, the baseline data was then linked with participants’ 5-year follow-up data from official records. Generalized Estimating Equations (GEE) were used to compare males with females in terms of the presence of negative consequences (incarceration, or readmission to compulsory treatment, or both), in the subsequent 5-years after their discharge from compulsory treatment. Ordinary least squares (OLS) regression was used to explore factors associated to the time length of negative consequences in 5 years after the discharge for males and females separately. Our findings indicate that female heroin dependent patients tend to have less negative recovery outcomes than male patients. Male patients with a life-time history of poly drug use and female patients with borderline personality disorder are especially at risk of incarceration and readmission into compulsory treatment programs.

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2015
Migration Central Asia Sexual risk HIV Masculinity
Masculinities and Social Contexts of HIV Risk Practices Among Central Asian Male Migrant Workers

Background: Migrant workers worldwide are at high risk of acquiring and transmitting HIV and sexually transmitted infections. Over the past decade Central Asia has experienced an increase in new HIV infections and migration and mobility within the region. These trends call for mixed methods research to explore the environmental and mobility contexts in which HIV risk behaviors occur among Central Asian migrants, particularly those in Kazakhstan, a common destination country.

Methods: This study took place in Almaty’s Baraholka Market, which employs 30,000 workers including many migrant workers from Central Asian countries. We used a convenience sampling approach to recruit 48 male migrant workers from Uzbekistan, Tajikistan, Kyrgyzstan, and Kazakhstan. Through in-depth interviews, we examined both their engagement in a number of sexual HIV risk behaviors (including having outside partners, sex trading, and condom use) as well as the meaning they attributed to such behaviors. We also address micro-social contexts (employment, types of relationships, infidelity, and access to resources), macro-contexts (gender roles and power dynamics) and structural contexts (mobility and policing) to examine how environmental influences influenced HIV risks.

Results: Findings suggest that men in this study attributed sex with extramarital partners to sexual desires when wives are unable to have sex, mobility and separation, need for variety, and lack of satisfaction in marriage. Factors influencing condom use included trust, sexual pleasure, intention to protect one’s health, and alcohol use. Participants had low levels of knowledge about HIV/AIDS; believed HIV did not affect their community or social networks, and had limited access to health care.

Conclusions: Study findings call for a combination of contextually sustainable HIV/STI prevention strategies that target migrant workers in Central Asia.

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2014
International Journal of Drug Policy
HIV risks among injecting and non-injecting female partners of men who inject drugs in Almaty, Kazakhstan: Implications for HIV prevention, research, and policy

Background: Kazakhstan and other countries in Central Asia are experiencing a rapidly growing HIVepidemic, which has historically been driven by injection drug use, but is more recently being fueled byheterosexual transmission.

Methods: This paper examines HIV and HCV infection, as well as sexual and drug-related risks amongfemale partners of men who inject drugs (MWID), comparing females who inject drugs (FWID) to non-injecting female partners on socio-demographic, relationship context, and structural characteristics.

Results: The prevalence rate of HIV was 30.1% among FWID and 10.4% among non-IDU female partnersof MWID. The prevalence rate of HCV was 89.8% among FWID and 14.8% among female non-IDUs. Lessthan one-fifth of all female participants had access to HIV education and services or harm reductionprograms. Although high rates of non-injection drug use and sexual risk behaviors were found amongboth FWID and non-injecting female partners of MWID, we found that FWID were more likely to be HIVseropositive (aRR = 3.03; 95% CI = 1.78, 5.18) and HCV seropositive than non-IDU females (aRR = 6.05; 95%CI = 4.05, 9.04), were more likely to have used alcohol or drugs before sex (aRR = 1.67; 95% CI = 1.40, 2.00),and were more likely to have used sedatives, barbiturates, tranquilizers, sleeping pills, or painkillers thatwere not prescribed by a physician (aRR = 17.45; 95% CI = 8.01, 38.01).

Conclusion: Given the spread of the HIV epidemic to heterosexual partners in Kazakhstan, more attentionis needed in research, prevention, and policies regarding female partners of male injection drug users.

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2014
Journal of Therapy and Management in HIV Infection
HCV among Male Injection Drug Users and their Female Partners in Almaty, Kazakhstan: Implications for HCV Treatment and Prevention

HCV infection is a serious concern among people who inject drugs. Despite imposing a major disease burden in countries with high rates of injection drug use such as Kazakhstan, other Central Asian and East Asian countries, Eastern Europe, and Russia, HCV remains an understudied issue. This study includes 728 individuals (364 couples) from Almaty, Kazakhstan, where at least one member of the dyad reported recent injection drug use. Participants were recruited to participate in a couple-based HIV prevention study. We examine the prevalence of HCV and co-infections between HCV and HIV, correlates of HCV, and the association between HCV prevalence and sexual behaviors after adjusting for non-injection illicit drug use, unsafe injection behaviors, and socio-demographic characteristics. Of the total sample, 90.2% of people who had ever injected drugs were diagnosed HCV positive and 15.5% of those who did not report injecting drugs were HCV positive. The prevalence of HIV and HCV co-infection among the total sample was 20.7%. In the multivariate analysis, having sex while high on alcohol and/or drugs was associated with HCV after adjusting for unsafe injection practices, non-injection drug use, and socio-demographic characteristics (PR=1.20; 95% CI=1.04, 1.39). The high rates of HCV and co-infection of HIV and HCV found in the study underscore the need for attention to HCV testing and treatment among people who inject drugs in Kazakhstan and their sex partners.

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2013
Drug and Alcohol Dependence
Redressing the epidemics of opioid overdose and HIV among people who inject drugs in Central Asia: The need for a syndemic approach

Background: Accumulating evidence suggests that opioid overdose and HIV infection are burgeoning intertwined epidemics among people who inject drugs (PWID) in Central Asia. To date, however, research on overdose and its associations with HIV risks among PWID in Central Asia remains virtually absent. This paper aims to provide a regional overview of the hidden epidemic of overdose and how it is linked to HIV among PWID in Central Asia, using a syndemic framework that is guided by risk environment research.

Methods: We conducted a comprehensive literature search of peer-reviewed publications and gray literature on opioid overdose and its associations with HIV in five countries of Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) as well as on policies and programs that address these co-occurring epidemics.

Results: Regional data indicate high rates of fatal and non-fatal overdose among PWID. Evidence suggests mortality rates from overdose exceed HIV/AIDS as the leading cause of death among PWID. The syndemic framework suggests multiple macro-level and micro-level environmental risk factors that drive the cooccurring epidemics of HIV and overdose. This framework identifies several interacting biological and behavioral risks that result in additive effects for HIV and overdose.

Conclusion: The high rates of overdose and its associations with HIV underscore the need for a syndemic approach that considers overdose on parity with HIV. Such an approach should focus on the biological, behavioral and structural interactions between these epidemics to reduce social suffering, morbidity and mortality among PWID in Central Asia.

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2013
Drug and Alcohol Dependence
Tuberculosis, drug use and HIV infection in Central Asia: An urgent need for attention

Introduction: Rates of tuberculosis in Central Asia are extremely high, and even more alarming are the very high rates of multidrug-resistant tuberculosis (MDR-TB) in Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan. In addition, rates of HIV infection related to injection drug use seems to be rising as well, thus creating conditions for a potentially devastating co-epidemic of TB/HIV and MDR-TB/HIV which would have terrible consequences for public health in these countries.

Current status: In many countries of Central Asia, diagnosis of tuberculosis still rests on clinical grounds or simple technologies such as chest radiograph and sputum smear examination. Modern molecular techniques such as GenExpert are being introduced in Kazakhstan and Uzbekistan, and perhaps soon in Kyrgyzstan. Treatment of TB is still often centered around prolonged inpatient stay at TB hospitals. Only a minority of patients with HIV infection are receiving ART, and TB and HIV services are not well integrated. Needle exchange programs are becoming increasingly available, but opioid substitution therapy is rarely used in Central Asia. TB, drug treatment and HIV services are generally not well-integrated.

Conclusions: To combat this developing storm, integration of TB services, HIV care, and substance abuse treatment programs is needed urgently to allow efficient and effective diagnosis and treatment of these conditions in a coordinated manner.

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2013
Drug and Alcohol Dependence
Access to HIV counseling and testing among people who inject drugs in Central Asia: Strategies for improving access and linkages to treatment and care

Introduction: As a population profoundly affected by the HIV epidemic and in critical need of linkages to HIV treatment and care, PWID in Central Asia remain largely underserved. This paper provides an overview of the current state of HIV testing and counseling in Central Asia for PWID, identifies main barriers leading to gaps in service delivery, and discusses implications for improving strategies that promote HIV testing for PWID.

Methods: We reviewed a number of sources for this paper including unpublished government reports, published papers, and Ministries of Health of Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan country progress reports to the UN General Assembly Special Session on HIV/AIDS (UNGASS) for 2012.

Results: Between 29 and 65% of PLWH in some Central Asian countries have been tested for HIV in the last 12 months. The rates have been increasing in the recent years but still are relatively low. Stigma, discrimination, human rights violations, and repressive legislation are barriers to HTC for people who inject drugs (PWID).

Conclusion: The use of innovative evidence-based HTC models, such as community mobile-vans, selftesting at home, and rapid HIV testing among PWID in Central Asia are discussed and recommendations given regarding amendments in legislation and scaling up of existing community-based pilot projects to support HIV testing among PWID in CA.

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2012
Assel Terlikbayeva
Sabrina Hermosilla
Sandro Galea
Tuberculosis Case notification rate (CNR) Prevalence Risk factors MDR-TB Kazakhstan Spatial distribution Surveillance National tuberculosis program (NTP) Oblast
Tuberculosis in Kazakhstan: analysis of risk determinants in national surveillance data

Background: Development of tuberculosis (TB) is determined by various risk factors and the interactions of temporal and spatial distributions. The aim of this study was to identify the most salient risk factors for TB disease as well as multidrug resistant TB (MDR-TB) at the oblast (provincial) level in Kazakhstan. 

Methods: Correlational and descriptive analyses were conducted at the oblast and national level using data provided by the country’s National Institute of Geography (NIG) and the National Tuberculosis Program (NTP).  Reported incident case notification rates (CNRs) and prevalence vary by oblast, thus the study investigated which determinants contributed to this regional variation and compared burdens among oblasts.

Results: The results showed that while tuberculosis CNRs decreased over the study period, MDR-TB conversely increased. Two oblasts -Atyrauskaya and Mangystauskaya - presented especially significant anomalies with large
decreases in TB incident CNRs coupled with comparatively large increases in MDR-TB incident CNRs.

Conclusion: Understanding the distribution of TB and MDR-TB cases and associated risk factors, especially the “unknown risk factor” categorization points to the need for future research.

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2007
Ingo Ilja Michels
Min Zhao
Lin Lu
Drug abuse and its treatment in China

Background: There has been opiate abuse in China for several centuries. When the People’s Republic of China was founded in 1949, there were more than 20 million opiate abusers (5 % of the population). In the early 1950s, the new Chinese government took a series of dramatic steps to combat the widespread opium abuse, carrying out a nation-wide anti-drug campaign, sometimes combined with harsh methods. China was recognized as a drug-free nation during the three decades from the 1950s to the 1980s. Drug abuse spread quickly following its re-emergence as a national problem in China in the late 1980s. Current situation: The number of registered drug abusers increased from 70,000 in 1990 to more than one million by the end of 2006. One major drug-related problem has been the spread of HIV. There are now more than 650,000 cases of HIV infection, about half of whom are injecting drug users. Since 2003, China has implemented harm-reduction measures such as needle-and-syringe programmes and methadone maintenance treatment for controlling the spread of HIV/AIDS. Although compulsory treatment options are still mostly used, voluntary treatment facilities are growing rapidly, and psychotherapeutic treatment options are being implemented. 

Conclusions: The rapid expansion of methadone maintenance programmes has given many intravenous drug users a new, relatively affordable treatment option, and there are ambitious plans to expand these programmes.

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