OBJECTIVE: To estimate access, activity and coverage of needle and syringe programmes (NSP) in Central and Eastern Europe and Central Asia. METHODS: Two data sets ('regional' and 'high-coverage sites') were used to estimate NSP provision (availability/number of sites), NSP utilization (syringes distributed/year), needle and syringe distribution (needles/syringes distributed/IDU/year), IDU reached (number/percentage of IDU contacted/year), regular reach (five or more contacts/month) and syringe coverage (percentage of injections/IDU/year administrable with new injecting equipment). RESULTS: Regional data set: results from 213 sites in 25 countries suggested that Czech Republic, Poland, Russia and Ukraine had > 10 NSP during 2001/2. Czech Republic, Kazakhstan, Latvia, Russia, Slovakia and Ukraine had >or= 10,000 IDU in contact with NSP. Ten countries reached >or= 10% of the estimated IDU population. The 25 countries distributed approximately 17 million syringes/needles. Eight countries distributed > 0.5 million syringes/year. Syringe coverage (assuming 400 injections/IDU/year) was 15% in Macedonia. Overall syringe coverage was 1.2% and when assuming 700 injections/IDU/year it decreased to 0.7%. Syringe coverage for the IDU population in contact with NSP was 60% in Croatia, Macedonia, Moldova and Tajikistan. Overall syringe coverage for the population in contact with NSP was 9.8%. High-coverage data set: Soligorsk, Pskov and Sumy's NSP reached 92.3%, 92.2% and 73.3% of their estimated IDU population, respectively (regular reach: 0.2%, 1.8% and 22.7%). The distribution levels were 47.2, 51.7 and 94.2 syringes/IDU/year, respectively. CONCLUSION: The evidence suggests suboptimal levels of NSP implementation, programme activity and coverage. This paper provides a baseline for development of indicators that could be used to monitor NSP. Strategies to increase coverage that may go beyond NSP are urgently required, as is research into understanding how NSP can contribute to better syringe coverage among IDU.
We report findings from a multi-method study investigating drug injectors' access to needles and syringes in three large Russian cities (Moscow, Volgograd, Barnaul).
We undertook 209 qualitative interviews among drug injectors, and supplemented these with baseline data from a community-recruited survey of 1473 drug injectors.
Almost all (93%; 1277) injectors used pharmacies as their main source of clean injecting equipment, and only 7% (105) reported ever having had contact with city syringe exchange projects. Good access to syringes has coincided with the expansion of private pharmacies. Key factors contributing to pharmacy access included: geographic proximity; low cost; and the restrictive policies of exchange instituted at local syringe exchanges. A fear of police interference surrounded the use of pharmacies and syringe exchanges, and fed a reluctance to carry used needles and syringes, which in turn acted as a disincentive to syringe exchange attendance. The perceived benefits of syringe exchanges over pharmacies included the additional health services on offer and the social support provided, but these benefits were over-shadowed by disadvantages. Multivariable analyses of survey data in two cities show no differences on account of risk behaviour among injectors sourcing equipment from pharmacies compared to syringe exchanges.
HIV prevention coverage indicators need to include measures of pharmacy-based syringe distribution and not only measures of syringe exchange coverage. There is an urgent need to pilot pharmacy-based distribution and exchange projects in Russia as well as other forms of secondary syringe distribution. Alongside expanding the reach of dedicated syringe exchange projects, pharmacy-based syringe distribution, and exchange, may help improve coverage of cost effective HIV prevention measures targeting drug injectors.
The comparative study of the level knowledge on HIV infection and AIDS among school children was carried out. The prophylactic work among school children yielded positive results, which was statistically confirmed by the analysis of answers to questionnaires, distributed before and after lectures.
The main principles of the concept of the "decrease of harm", realized in many countries of the world, are presented and the expediency of using this concept in Russia is substantiated. The beginning of the realization of the Project "Decrease of Harm: the Russian Federation", aimed at training specialists capable of carrying out prophylactic work among users of intravenous drugs (UID), is demonstrated. The principles of the selection of the groups of trainees are shown: the groups are made up of physicians working at AIDS centres, specialists in narcology and representatives of non-governmental organizations. The course of training provides the basic information on the strategy of the prophylaxis of HIV infection among UID, including evaluation and study, outreach, change of syringes and needles, replacement therapy, the program of the treatment of drug addiction. At the present moment 46 specialists from 18 regions of Russia are taking the course of training.
To prevent or mitigate an AIDS epidemic among injecting drug users (IDUs), effective activities need to be implemented on a large enough scale to reach and assist sufficient numbers of drug users and thereby change their risk behaviors related to drug use and sex. Recent work by UNAIDS on "high coverage sites", adopting the above strategies, has shown that one of the key elements in achieving high coverage is ongoing and sophisticated advocacy. High coverage harm reduction sites were studied through literature search and site visits, including key informant interviews, review of service statistics, and data analysis, in order to document the steps that led to scaling up, the way coverage was defined in these sites, and the lessons learned from their efforts. Syringe-exchange programs can achieve high coverage of IDUs. Monitoring to determine regular reach (those who are in regular contact with harm reduction services) should be added to uniform data collection carried out by harm reduction programs. Advocacy is crucial to achieving high coverage.
This qualitative, community-based research study explored the influence of gender on community perceptions of HIV/AIDS service needs among African immigrant men and women in Calgary, Canada. A total of 41 key informant participants (24 male, 17 female) from 14 sub-Saharan countries completed individual, semi-structured interviews. Thematic interview analysis results produced four themes directly related to HIV and gender, including different sexual standards for men and women, condom use, infidelity, and the need for dialogue between partners on sex and HIV. Each of these themes was related to a contextual theme of "family breakdown", which resulted from cultural adjustment challenges faced by African immigrants. For men, finding suitable employment was a key issue; for women, isolation was identified as an adjustment factor. The findings suggest that a more holistic conception of HIV prevention may be necessary for programmes to be successful and that HIV/AIDS services should be better integrated with newcomer services.