Publications: Infectious Diseases

HCV in prison: targeting elimination (html)

HCV in prison: targeting elimination

In the battle to eliminate HCV as a public health threat by 2030, prison healthcare is at the forefront. This webinar, held live on 24 May 2022, brings together three international experts who lead prison-based HCV elimination programmes to share their in-depth knowledge and first-hand experience. Through four presentations and a panel discussion, the faculty will guide you through the key things to consider when setting up HCV testing and treatment programmes in custodial settings, review international best practice and share inspiring success stories that have yielded real-world results.

Recording of a webinar, which took place on Tuesday 24 May 2022.

The Silenced Epidemic: Why Does Russia Fail to Address HIV? (html)

The Silenced Epidemic: Why Does Russia Fail to Address HIV?

Whereas significant progress has been made in controlling HIV globally, Russia’s epidemic has continued to grow for the past thirty years. Out of a total population of 144 million, about 1.1 million Russians currently live with HIV. This national crisis is largely the result of government failure to support necessary prevention approaches such as harm reduction programs, public information campaigns, and sex education in secondary schools. Instead, Russian government policies marginalize vulnerable groups, restrict the work of civil society organizations in HIV prevention and care, and suppress the dissemination of critical information regarding the scale of the epidemic. By neglecting evidence–based prevention programs, the Russian government misses the opportunity to develop an effective response to one of the country’s most pressing health problems. Because of these realities, international organizations must find new ways to encourage Russia to rethink its HIV/AIDS policies by engaging in dialogue with the Russian government, business organizations, and civil society groups.

Heino Stöver (Frankfurt University of Applied Sciences)

Ingo Ilja Michels (Frankfurt University of Applied Sciences)

What challenges Facing Social Work in the Field of HIV, Other Infectious Diseases and Addictions?

Presentation delivered at THE INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE ON "SOCIAL SERVICE FOR THE ELDERLY AND DISABLED PERSONS IN THE REPUBLIC OF TAJIKISTAN: PROBLEMS AND THEIR SOLUTIONS" - Dushanbe 27 October 2021

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: the Global Burden of Diseases Study 2019 (pdf)

Azizbek Boltaev (Department of Mental Health, Human Research and Development Centre, Bukhara, Uzbekistan)

Babak Moazen (Frankfurt University of Applied Sciences, Institute of Addiction research and University of Heidelberg)

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic.

UNAIDS statement at the Opening Plenary 64th session of the Commission on Narcotic Drugs, 12 April 2021 (pdf)

Ninan Varughese

HIV infections AIDS public health response

UNAIDS statement to the Commission on Narcotic Drugs, 12 April 2021

Our progress towards ending AIDS as a public health threat by 2030 was already off track before the COVID-19 outbreak. Now this crisis has the potential to blow us even further off course.

Decades of experience in responding to HIV are being used in the response to the coronavirus. Community-led service delivery pioneered by the HIV response is helping to overcome the extraordinary impediments created by COVID-19.

Key populations continue to be left behind. Annual HIV infections among people who inject drugs have barely changed. Key populations and their sexual partners accounted for 62% of all new infections worldwide in 2019. To give one example, in eastern Europe and central Asia an estimated 48% of new infections occur among people who inject drugs.

Prisons and COVID-19: Lessons from an ongoing crisis (pdf)

Alexander Söderholm

Prisons and COVID-19: Lessons from an ongoing crisis

A number of countries that have made commitments to decongest prisons have explicitly excluded people detained for drug offences, including two of the case study countries in this brief (Colombia and Indonesia).
Many countries that have implemented decongestion measures have simultaneously failed to prevent or reduce the continued and disproportionate arrest and imprisonment of people for minor drug offences, thus undermining attempts to reduce prison overcrowding.
Due to overcrowding and the lack of adequate drug treatment and harm reduction services, hygiene products and sanitation measures, people in prison, particularly people who use drugs, are at much higher risk of contracting COVID-19 and suffering serious adverse health consequences from the virus than individuals in the general public.
There is already a lack of adequate drug dependence treatment and harm reduction measures inside prisons.6 Where such services do exist, incarcerated people have experienced serious restrictions to accessing them during the COVID-19 pandemic
Community integration programmes have failed to support people released from detention to return to their communities during the COVID-19 pandemic.

Prevention of infectious diseases and treatment of HIV / AIDS and hepatitis among injecting drug users in Central Asia and the contribution of social work to the services for drug using peopl (pdf)

Prevention of infectious diseases and treatment of HIV/AIDS and hepatitis among injecting drug users in Central Asia and the contribution of social work to the services for drug using people

It is clear that the number of new HIV infections is increasing in Kazakhstan, while at the same time the proportion of injecting drug users is decreasing. This trend can also be observed in the other Central Asian countries, but it is difficult to explain it analytically.
Also the number of opioid users treated in narcological clinics is declining, while the number of patients in Opioid Substitution Treatment (OST) is slowly increasing, but still on a very small scale in relation to the total number of opioid users1. Whether these substitution treatments affect HIV prevalence rates is difficult to assess, but their overall range and the retention rates are still far too low / too high respectively to produce epidemiological effects.
One important area that is severely neglected is the risk of hepatitis infections, which, according to too few existing data, is much larger than HIV / AIDS. The prevalence is between 60-80% and there is hardly any treatment available, which is still too expensive and for which there is hardly any practice experience.

Peer to peer communication about hepatitis C treatment amongst people who inject drugs: A longitudinal qualitative study (pdf)

Stelliana Goutzamanis (Burnet Institute, Melbourne)

Joseph S. Doyle (The Alfred and Monash University)

Peer to peer communication about hepatitis C treatment amongst people who inject drugs: A longitudinal qualitative study

Background: Little is known about how information on direct-acting antiviral treatment for hepatitis C circulates through peer networks of people who inject drugs. In this study we aimed to explore what and how treatment-related information is shared between people undergoing treatment and their peers.

Methods: Participants were recruited from two general practice clinics and the community-based hepatitis C Treatment and Prevention Study. Semi-structured interviews were conducted with each participant (N = 20) before, during and following treatment. Interviews explored hepatitis C treatment experiences, key sources of DAA information and the impact of receiving and sharing knowledge. Inductive thematic analysis was conducted. Time sequential matrices were generated to understand thematic change over time.

Results: Fifty-four interviews were conducted with 20 participants across seven field-sites in Melbourne, Australia. Key themes were: ‘peers as a source treatment information’, ‘do it together’ and ‘becoming a treatment advocate’. Peers were a crucial trusted source of information. Positive treatment anecdotes were important for building confidence in and motivation to initiate treatment. Many participants adopted a ‘treatment advocate’ role in their close peer networks, which was described as empowering. Some participants described benefits of undertaking treatment alongside members of their close network.

Conclusion: Findings illustrate the importance of close peers in shaping treatment perceptions and engagement. This will be important in designing health promotion messaging and interventions to increase treatment uptake.

Sustainable Development Outlook 2020 (pdf)

UN, Department of Economic and Social Affairs

Sustainable Development Outlook 2020

Achieving SDGs in the wake of COVID-19: Scenarios for policymakers

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

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.

The HIV Epidemic in Eastern Europe and Central Asia (pdf)

Nabila El-Bassel

The HIV Epidemic in Eastern Europe and Central Asia

ПСИХОСОЦИАЛЬНАЯ ПОДДЕРЖКА детей и подростков, живущих с ВИЧ и другими хроническими заболеваниями. Казахстанская модель. (pdf)

Pedagogical Dialogue N3 / 33 / 2020

ПСИХОСОЦИАЛЬНАЯ ПОДДЕРЖКА детей и подростков, живущих с ВИЧ и другими хроническими заболеваниями. Казахстанская модель.

В статье рассмотрены проблемы психосоциальной поддержки детей и подростков, живущих с ВИЧ и другими хроническими заболеваниями, на примере казахстанской модели. В данной статье авторы утверждают, что своевременное внедрение национальных стандартов психосоциальной поддержки станет важной мерой для обеспечения благополучия детей и подростков при подготовке к дальнейшей полноценной взрослой жизни.

Глобальный мониторинг эпидемии СПИДа 2019 Казахстан (pdf)

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

Проект по интегрированному оказанию услуг по ВИЧ и туберкулезу в пунктах поддерживающей терапии метадоном: результаты и извлеченные уроки (pdf)

ICAP, Центральна Азия

Проект по интегрированному оказанию услуг по ВИЧ и туберкулезу в пунктах поддерживающей терапии метадоном: результаты и извлеченные уроки

Prevention HIV, HC dual epdemic HIV-TB in Prisons (pdf)

Prevention HIV, HC dual epdemic HIV-TB in Prisons

1) Как могут сотрудники тюрем и медицинские сотрудники, работающие в тюрьмах, защищать себя от инфицирования ВИЧ и/ или гепатитами B/C?

2) Основываясь на вашем опыте, какие образовательные и обучающие (тренинги) техники для заключённых и сотрудников тюрем наиболее эффективны и почему?

3) Объясните непрофессионалу каковы основные особенности ТБ и ВИЧ, СПИД и каковы различия.

Training Manual: Psychosocial Supervision for Children and Adolescents Living with HIV or Other Chronic Disease (pdf)

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.

HIV/AIDS in Eastern Europe and Central Asia (pdf)

Ulla Pape (Freie Universität Berlin)

HIV/AIDS in Eastern Europe and Central Asia

Eastern Europe and Central Asia (EECA) is the only region in the world where annual HIV infection rates continue to grow. According to the Joint United Nations Program on HIV/AIDS (UNAIDS), in 2019 approximately 1.4 million people in the region were living with HIV. The main factors that have contributed to the spread of the epidemic over the past two decades include injecting drug use, the stigmatization and marginalization of vulnerable groups, the increasing spread of HIV into the general population, and the lack of evidence-based prevention and treatment programs necessary for controlling the epidemic. Limited access to life-saving antiretroviral treatment has intensified the impact of the epidemic in EECA and increased mortality rates among people living with HIV (PLWH).

HIV/AIDS in Eastern Europe and Central Asia (pdf)

HIV/AIDS in Eastern Europe and Central Asia

Eastern Europe and Central Asia (EECA) is the only region in the world where annual HIV infection rates continue to grow. According to the Joint United Nations Program on HIV/AIDS (UNAIDS), in 2019 approximately 1.4 million people in the region were living with HIV. The main factors that have contributed to the spread of the epidemic over the past two decades include injecting drug use, the stigmatization and marginalization of vulnerable groups, the increasing spread of HIV into the general population, and the lack of evidence-based prevention and treatment programs necessary for controlling the epidemic. Limited access to life-saving antiretroviral treatment has intensified the impact of the epidemic in EECA and increased mortality rates among people living with HIV (PLWH).

Improving HIV service delivery for people who inject drugs in Kazakhstan: study protocol for the Bridge stepped-wedge trial (pdf)

HIV Harm reduction People who inject drugs (PWID)

Improving HIV service delivery for people who inject drugs in Kazakhstan: study protocol for the Bridge stepped-wedge trial

Background: People who inject drugs (PWID) in Kazakhstan face many barriers to HIV testing as well as to accessing HIV care, to retention in HIV care, and to initiating and adhering to anti-retroviral treatment (ART). Needle and syringe programs (NSPs) are an opportune setting for integrated interventions to link PWID to HIV care.

Methods: This Hybrid Type II study employs a stepped-wedge design to evaluate both effectiveness and implementation outcomes of Bridge, an intervention to identify, test, and link HIV-positive PWID to HIV care. The study is conducted at 24 NSPs in three different regions of Kazakhstan, to assess outcomes on the individual, organizational, and policy levels.

Discussion: This trial responds to an identified need for new models of HIV service delivery for PWID through harm reduction settings.

Introducing hepatitis C virus healthcare pathways in addiction care in the Netherlands with a Breakthrough project: a mixed method study (pdf)

Patricia Kracht

Elisabeth de Gee

Agnes van der Poel

Introducing hepatitis C virus healthcare pathways in addiction care in the Netherlands with a Breakthrough project: a mixed method study

People who inject drugs (PWID) are disproportionally affected by the hepatitis C virus (HCV) infection. In the Netherlands, active HCV transmission in PWID has practically been halted but uptake of HCV testing and linkage to care remains insufficient in this risk group. A national HCV in Addiction Care (HAC) quality improvement project based on the Breakthrough methodology (i.e. Breakthrough project) aimed to secure proper linkage to care in PWID by introducing local HCV healthcare screening and treatment pathways in addiction care units.

The HAC Breakthrough project has brought about good quality HCV healthcare pathways in the majority of participating addiction care centers and has successfully linked PWID with ongoing HCV viremia to care. Uptake of HCV screening and treatment after referral were identified as the main gaps to be closed in the HCV cascade of care to achieve final HCV elimination in Dutch PWID (i.e. micro-elimination).

Project Nova: A Combination HIV Prevention and Microfinance Intervention for Women Who Engage in Sex Work and Use Drugs in Kazakhstan (pdf)

Gaukhar Mergenova (Global Health Research Center of Central Asia, Kazakhstan)

Nabila El‑Bassel (Columbia University School of Social Work, USA)

Project Nova: A Combination HIV Prevention and Microfinance Intervention for Women Who Engage in Sex Work and Use Drugs in Kazakhstan

Innovative combination HIV-prevention and microfinance interventions are needed to address the high incidence of HIV and other STIs among women who use drugs. Project Nova is a cluster-randomized, controlled trial for drug-using female sex workers in two cities in Kazakhstan. The intervention was adapted from prior interventions for women at high risk for HIV and tailored to meet the needs of female sex workers who use injection or noninjection drugs. We describe the development and implementation of the Nova intervention and detail its components: HIV-risk reduction, financial-literacy training, vocational training, and a matched-savings program. We discuss session-attendance rates, barriers to engagement, challenges that arose during the sessions, and the solutions implemented. Our findings show that it is feasible to implement a combination HIV-prevention and microfinance intervention with highly vulnerable women such as these, and to address implementation challenges successfully.

Hepatitis C - good practice Examples (pdf)

Correlation - European Harm Reduction Network

Hepatitis C - good practice Examples

In 2018, C-EHRN collected the experiences of 90 organisations from all over Europe related to their viral Hepatitis C activities.

The examples presented here were chosen by a review committee based on a questionnaire and an interview conducted by C-EHRN with selected respondents. This selection does not aim to put forward a ‘gold standard’ for harm reduction service providers in Europe, nor is it an inclusive sample of existing models.

It does provide, however, an insight into how organisations offering harm reduction services respond to the threat of viral hepatitis C in different settings, with different resources and in different legal and political contexts.

Attitudes towards people living with HIV and people who inject drugs: A mixed method study of stigmas within harm reduction programs in Kazakhstan (pdf)

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.

РОЛЬ НЕПРАВИТЕЛЬСТВЕННЫХ ОРГАНИЗАЦИЙ В ПРОТИВОДЕЙСТВИИ ВИЧ/СПИДУ В РОССИИ (pdf)

Ulla Pape (Freie Universität Berlin)

РОЛЬ НЕПРАВИТЕЛЬСТВЕННЫХ ОРГАНИЗАЦИЙ В ПРОТИВОДЕЙСТВИИ ВИЧ/СПИДУ В РОССИИ

Неправительственные, или некоммерческие, организации (НПО или НКО) играют ключевую роль в борьбе с эпидемией ВИЧ/СПИДа в Рос$ сийской Федерации. Данная статья рассматривает политические пер$ спективы, возможности и организационные формы российских НПО, работающих в области противодействия ВИЧ/СПИДу в контексте раз$ вития гражданского общества в постсоветской России 1. Как показало исследование трех российских регионов, при взаимодействии с государ$ ственными институтами НПО используют различные стратегии. C од$ ной стороны, они зависят от политического контекста и отношения властей к различным программам, направленным на предотвращение распространения ВИЧ/СПИДа. С другой стороны, они могут способ$ ствовать изменениям государственной политики в сфере ВИЧ/СПИДа, а также содействовать налаживанию связи с социальными группами, особо подверженными риску инфицирования ВИЧ. Подводя итоги, ав$ тор статьи утверждает то, что, несмотря на активную работу НПО по противодействию эпидемии, подобные организации имеют ограничен$ ные возможности влияния на принятие политических решений и, соот$ ветственно, – на социальную политику в сфере ВИЧ/СПИДа.

Framing the Epidemic: NGOs and the Fight Against HIV/AIDS in Russia (pdf)

Ulla Pape (Freie Universität Berlin)

Framing the Epidemic: NGOs and the Fight Against HIV/AIDS in Russia

With more than one million people living with HIV, Russia is facing the biggest HIV epidemic in Europe and is one of the few countries in the world where infection rates are increasing. The response to the epidemic is shaped by the way Russian state actors and non-governmental organizations (ngos) view the issue of HIV and how they define policy priorities.

In order to understand the factors that underlie HIV policies in Russia, this contribution analyses the framing of HIV. It thereby makes use of framing theory. Based on document analysis and interviews with NGO experts, the article differentiates between four main framings in Russia: the framing of HIV as a medical issue, as a security threat, as a moral problem or as a human rights concern.

In Russia, the moral framing of HIV has become dominant over the past decade. The epidemic is increasingly viewed as the result of harmful influences from the West which need to be overcome. As a result, Russia has departed from evidencebased approaches to HIV. Instead, it solely focuses on strengthening so-called “traditional values”, e.g. by engaging in healthy lifestyle promotion. The moral framing of HIV has also impacted the mobilization potential of Russian NGOs, as it favour those organizations that relate to the dominant framing of HIV and support government priorities.

EASL Recommendations on Treatment of Hepatitis C (pdf)

(European Association for the Study of the Liver)

EASL Recommendations on Treatment of Hepatitis C

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, with approximately 71 million chronically infected individuals worldwide. Clinical care for patients with HCV-related liver disease has advanced considerably thanks to an enhanced understanding of the pathophysiology of the disease, and because of developments in diagnostic procedures and improvements in therapy and prevention. These European Association for the Study of the Liver Recommendations on Treatment of Hepatitis C describe the optimal management of
patients with acute and chronic HCV infections in 2018 and onwards.

Establishing trust in HIV/HCV research among people who inject drugs (PWID): Insights from empirical research (pdf)

Shira Goldenberg

Melissa Welch-Lazoritz

Celia B. Fisher

Establishing trust in HIV/HCV research among people who inject drugs (PWID): Insights from empirical research

Background: The establishment of trust between researchers and participants is critical to advance HIV and HCV prevention particularly among people who inject drugs (PWID) and other marginalized populations, yet empirical research on how to establish and maintain trust in the course of community health research is lacking. This paper documents ideas about trust between research participants and researchers amongst a sub-sample of PWID who were enrolled in a large, multi-year community health study of social networks and HIV/HCV risk that was recently conducted in rural Puerto Rico.

Methods: Qualitative research was nested within a multi-year Social Network and HIV/HCV Risk study involving N = 360 PWID > 18 years of age living in four small, rural Puerto Rican communities. Semi-structured interviews were conducted between March 2017 and April 2017 with a subset of 40 active PWID who had been enrolled in the parent study. Interview questions invited participants to draw upon their recent experience as research participants to better understand how PWID perceive and understand participant-researcher trust within the context of HIV/HCV-related epidemiological research.

Results: Fear of police, stigma and concerns regarding confidentiality and anonymity were identified as structural factors that could compromise participation in HIV/HCV-related research for PWID. While monetary compensation was an important motivation, participants also valued the opportunity to learn about their HIV/HCV status. During their participation in the study, gaining knowledge of safe injection practices was perceived as a valuable benefit. Participant narratives suggested that PWID may adopt an incremental and ongoing approach in their assessment of the trustworthiness of researchers, continuously assessing the extent to which they trust the research staff throughout the course of the research. Trust was initially generated through peer Respondent Driven Sampling recruitment. Research staff who maintained a presence in the community for the entire duration of the prospective study reinforced trust between participants and the research team.

Conclusion: Although PWID face numerous structural barriers to research-related trust in HIV/HCV research, we found that using a peer-based recruitment method like RDS, and employing a research staff who are knowledgeable about the targeted population, culturally sensitive to their needs, and who maintain a long-term presence in the community may help mitigate many of these barriers. The reputation of the research is built incrementally as participants join the study. This contributes to a “street reputation” that grows as current or former participants vouch for the study. Establishing trust was identified as only the first step towards building a collaborative relationship with participants, and our findings suggest that steps to address criminalization and stigmatization also are necessary to support research trust.

Differences by sex in associations between injection drug risks and drug crime conviction among people who inject drugs in Almaty, Kazakhstan (pdf)

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.

Project Nova: A Combination HIV Prevention and Microfinance Intervention for Women Who Engage in Sex Work and Use Drugs in Kazakhstan (pdf)

HIV prevention Intervention science Microfinance Sex work Drug use

Project Nova: A Combination HIV Prevention and Microfinance Intervention for Women Who Engage in Sex Work and Use Drugs in Kazakhstan

Innovative combination HIV-prevention and microfinance interventions are needed to address the high incidence of HIV and other STIs among women who use drugs. Project Nova is a cluster-randomized, controlled trial for drug-using female sex workers in two cities in Kazakhstan. The intervention was adapted from prior interventions for women at high risk for HIV and tailored to meet the needs of female sex workers who use injection or noninjection drugs. We describe the development and implementation of the Nova intervention and detail its components: HIV-risk reduction, financial-literacy training, vocational training, and a matched-savings program. We discuss session-attendance rates, barriers to engagement, challenges that arose during the sessions, and the solutions implemented. Our findings show that it is feasible to implement a combination HIV-prevention and microfinance intervention with highly vulnerable women such as these, and to address implementation challenges successfully.

Reducing opioid overdose in Kazakhstan: A randomized controlled trial of a couple-based integrated HIV/HCV and overdose prevention intervention “Renaissance” (pdf)

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.

Национальный доклад о достигнутом прогрессе в осуществлении глобальных мер в ответ на СПИД Отчетный период: 2017 год (pdf)

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.

Hepatitis C infection, related services, and barriers to HCV treatment among drug users in methadone maintenance treatment (MMT) clinics in Shanghai, China (pdf)

Harm Reduction Journal

Hepatitis C infection, related services, and barriers to HCV treatment among drug users in methadone maintenance treatment (MMT) clinics in Shanghai, China

The purpose of this study was to document the prevalence of hepatitis C among MMT patients, hepatitis C virus (HCV) knowledge of patients and MMT staff members, and the barriers preventing them from receiving or delivering HCV-related services in MMT clinics of China.

Getting to Zero: Global Social Work responds to HIV (pdf)

Mark Henrickson (IASSW)

David Chipanta (UNAIDS)

Getting to Zero: Global Social Work responds to HIV

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection (pdf)

(European Association for the Study of the Liver)

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

Hepatitis B virus (HBV) infection remains a global public health problem with changing epidemiology due to several factors including vaccination policies and migration. This Clinical Practice Guideline presents updated recommendations for the optimal management of HBV infection.

Информация, образование и коммуникация для борьбы с ВИЧ и СПИД и наркозависимостью (pdf)

Информация, образование и коммуникация для борьбы с ВИЧ и СПИД и наркозависимостью

Профилактика ВИЧ и снижение вреда в тюрьмах : Права человека и подходы общественного здравоохранения (pdf)

Профилактика ВИЧ и снижение вреда в тюрьмах : Права человека и подходы общественного здравоохранения

•Эпидемиология: тюрьмы, ЛУИН (люди, употребляющие инъекционные наркотики), ВИЧ

•Профилактика ВИЧ и снижение вреда среди ЛУИН в гражданском секторе и в тюрьмах

•Международный закон о правах человека и стандарты медицинских услуг в тюрьмах

•Извлечённые уроки и дальнейшие шаги

HIV testing and access to HIV medical care among people who inject drugs and their intimate partners in Kazakhstan (pdf)

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.

Preliminary Population Size Estimation of Men Who Have Sex With Men in Kazakhstan: Implications for HIV Testing and Surveillance (pdf)

men who have sex with men International research (research outside the US) HIV/AIDS health screening

Preliminary Population Size Estimation of Men Who Have Sex With Men in Kazakhstan: Implications for HIV Testing and Surveillance

Purpose: The purpose of this study is to estimate the population size of men who have sex with men (MSM) in Kazakhstan and their HIV testing history.

Methods: We conducted structured interviews with MSM in four geographically disparate cities—N = 400 (n = 100/city)—to implement four population estimation methods and ascertain HIV testing history.

Results: Approximately 3.2% of men—corresponding to*154,000 individuals—in Kazakhstan aged 18–59 are MSM. The 49.9% of the sample who reported taking an HIV test far exceeds the <1% reported as MSM in surveillance data.

Conclusion: HIV testing surveillance in Kazakhstan has underestimated the number of MSM. This underscores the need to redress social and structural barriers to HIV testing and disclosure of sexual behavior experienced by MSM in Kazakhstan. Recommendations include promoting cultural sensitivity among testing staff through quality assurance and regular training, and increasing protection and public awareness through antidiscrimination policy development.

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.

HCV among Male Injection Drug Users and their Female Partners in Almaty, Kazakhstan: Implications for HCV Treatment and Prevention (pdf)

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.

(pdf)

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.

Access to HIV counseling and testing among people who inject drugs in Central Asia: Strategies for improving access and linkages to treatment and care (pdf)

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.

Tuberculosis, drug use and HIV infection in Central Asia: An urgent need for attention (pdf)

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.

Redressing the epidemics of opioid overdose and HIV among people who inject drugs in Central Asia: The need for a syndemic approach (pdf)

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.

HIV Among Injection Drug Users and Their Intimate Partners in Almaty, Kazakhstan (pdf)

Nabila El-Bassel

Assel Terlikbayeva

Injecting drug use HIV Central Asia

HIV Among Injection Drug Users and Their Intimate Partners in Almaty, Kazakhstan

This paper examines prevalence rates of HIV, HCV, and syphilis among a sample of injecting drug users (IDUs) and their heterosexual intimate partners (N = 728) from Almaty, Kazakhstan. The study uses baseline data from Project Renaissance, a couple-based HIV prevention intervention delivered to a couple where one or both partners are IDUs. HIV prevalence rates among female and male IDUs were 28 %. Among the full sample, 75 % had HCV, and 13 % tested positive for the syphilis antibody test. Only 10 % of the sample ever visited a needle exchange program. One-fourth (25.3 %) had never been tested for HIV. One-quarter of those who tested positive were unaware of their status. Being HIV positive was associated with a history of incarceration, being an IDU, and having access to needle exchange programs. The findings call for increasing efforts to improve access to HIV testing, prevention, treatment, and care for IDUs in Almaty, Kazakhstan.

Tuberculosis in Kazakhstan: analysis of risk determinants in national surveillance data (pdf)

Assel Terlikbayeva

Sabrina Hermosilla

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.

HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy (pdf)

HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy

HIV among people who inject drugs (PWID) is a major public health concern in Eastern and Central Europe and Central Asia. HIV transmission in this group is growing and over 27 000 HIV cases were diagnosed among PWID in 2010 alone. The objective of this systematic review was to examine risk factors associated with HIV prevalence among PWID in Central and Eastern Europe and Central Asia and to describe the response to HIV in this population and the policy environments in which they live.

Assessment of the Medication Assisted Therapy (MAT) Program in Kyrgyz Republic (pdf)

Azizbek Boltaev (ICAP, Columbia University)

Anna Deryabina (ICAP, Columbia University)

Oleg Aizberg (Belarus Academy for Post-graduate Medical Education)

David Otiashvili (Addiction Research Center/Alternative Georgia)

Andrea Howard (ICAP, Columbia University)

Kyrgyz Republic - assessment of the Medication Assisted Therapy (MAT) Program

The purpose of this assessment was to collect and analyze data indicating the extent to which the MAT program in the Kyrgyz Republic complies with the minimal recommendations developed by World Health Organization for psychosocially assisted pharmacological treatment of opioid dependence and the Principles of drug dependence treatment. The overall goal of this assessment was to provide data to inform improvements in opioid drug dependence treatment, particularly MAT, services in the Kyrgyz Republic.

Couple-Based HIV Prevention for Injecting Drug Users in Kazakhstan: A Pilot Intervention Study (pdf)

Journal of Prevention & Intervention in the Community

Central Asia couple-based intervention HCV HIV HIV prevention injecting drug users STIs

Couple-Based HIV Prevention for Injecting Drug Users in Kazakhstan: A Pilot Intervention Study

This pilot randomized controlled trial in Kazakhstan aimed to adapt and test the feasibility of a couple-based HIV=STI risk-reduction intervention (CHSR) for couples who are injecting drug users (IDUs). The study examined the preliminary effects of the intervention versus an attentional control wellness promotion (WP) condition on HIV risk behavioral outcomes among 40 couples who are IDUs (n=80 participants). Compared with WP participants, CHSR participants were significantly more likely to increase condom use and decrease unsafe injection acts at the 3-month follow-up. This pilot trial demonstrates the feasibility and preliminary effects of the CHSR in reducing drug-related and sexual HIV risks.