The joint work of NGOs and UNAIDS in realizing a project for the prevention of HIV/AIDS among people using narcotics by injection in a region with relatively low rates of HIV infection spread

In recent years the Ukraine has become the epicenter of AIDS in Eastern Europe, though there are still regions with a relatively low number of HIV-infected persons, such as Vinnitsa Province. After the comprehensive study of the factors contributing to the spread of HIV infection in groups of risk the realistic evaluation of the epidemiological danger could be made and the preventive work could be carried out with the help of collaboration between a non-governmental organization (NGO) and the UN Theme Group on the Problems of HIV/AIDS. The successful work of the Public Congress "Stalist" one of such NGO, in Vinnitsa in 1998-1999, carried out with the financial and methodological support of UNAIDS in the Ukraine, created conditions for the introduction of such components of the strategy of harm reduction as information and educational work, as well as the exchange of syringes and needles, which showed a high degree of efficiency in controlling the spread of HIV/AIDS.     

The prevention of HIV infection and other blood-contact diseases among intravenous narcotic users in Nizhniy Novgorod within the framework of the Harm Reduction program

The results of the development and realization principles of the project on the decrease of harm, envisaging work in three directions (the determination of the technology of using drugs, the exchange of syringes/needles and other accessories, as well as laboratory examination for the presence of antibodies to HIV, hepatitis B and hepatitis C viruses and consultations of narcologists). 1075 injecting drug users took part in this project. Out of 611 participants filling-in the questionnaires, 338 persons underwent tests for HIV and 3 of them were found to be HIV-infected; out of 305 persons screened for the presence of markers of hepatitis B virus, positive results were obtained in 98 (32% of cases); in 218 (65%) out of 335 persons antibodies to hepatitis C virus were found (49 persons, i.e. 14%, had hepatitis C registered in the medical history and in the rest antibodies were detected for the first time). The preventive program of the decrease of harm was assessed as effective.     

The HIV/AIDS epidemic and the trends in the behavior of people using injection narcotics (IDU)

The degree of risk of the spread of HIV infection among drug addicts in Zhitomir has been prognosticated. As revealed in this study, narcotic drugs are mostly introduced by individual dispensable syringes or by individual reusable syringes. But such factors as the repeated use of needles (47%), obtaining drug solution from different persons (49%), the injection of drugs under unsanitary conditions (62%), with-drawing drug solution into the syringe by some other person (32%), unavailability of the means of disinfection (64%), absence of knowledge and practice in disinfection (91%), the presence HIV-infected persons among IDU (41%), a low level of sanitary and hygienic culture (41%), lack of sexual restraint (93%), concubinage with IDU (44%), unemployment (66%), etc. have been found to increase the possibility of getting HIV infection twofold. The results of this sociological study have demonstrated new trends in the study of the behavior of IDU, necessary for the creation of the module for preventive work both in Zhitomir and the Zhitomir region.     

The epidemiological characteristics of HIV infection in Turkmenistan

In the presence of the low spread of HIV infection a sharp increase in sexually transmitted diseases is noted. Nevertheless, taking into account a rise in STD, the reality of the potential risk of the spread of HIV is emphasized. Thus, in 1996 morbidity is syphilis was found to grow 7.2 times in comparison with 1992, amounting to 37.5 cases per 100,000 of the population; morbidity in gonorrhea amounted to 32.4 cases per 100,000 of the population with the proportion coming to medical institutions not exceeding 30%. A high proportion of hepatitis B virus carriers was also established (from 15% to 30% of healthy persons), while morbidity in virus hepatitides rose twofold for the period of 1994-1995. During recent years the service for the prophylaxis of AIDS was noted to considerably decrease measures on mass screening. At the same time the article attracts attention to the necessity of increasing the work on the dissemination of information and education on HIV/AIDS drug among addicts, prostitutes and homosexuals. The Draft National Program of the Prophylaxis of HIV infection and STD for 1998-2002 has been worked out. Great importance of methodological and financial assistance rendered since 1994 by international organizations, including WHO, UNFPA, etc., have been emphasized.     

Development of HIV infection epidemic among intravenous drug users in the Sverdlovsky region

The Sverdlovsky region takes the fourth place among the 89 subjects of the Russian Federation by the number of registered cases of HIV infection. Drug addiction has reached an excessive scale in this region: according to the data of express evaluation carried out by the Regional Narcological Hospital and the Regional AIDS Center, not less than 7-8% of persons aged 15-30 years constantly use injection drugs. The large-scale epidemic of injection drug addiction has led to the rapid spread of HIV among addicts. The first penetration of HIV into this population took place in 1996 and, starting from the year 2000, rapid, development of the epidemic began, taking the character of an avalanche. The peak of new cases of HIV infection fell on 2001 (9,230 cases were registered). The concentrated stage of the epidemic development is observed in the region at present, the prevalence of HIV infection among drug addicts being 13.8%. Children born from HIV-infected drug addicted mothers now represent a new risk group due to great difficulties in the prophylaxis of the vertical virus transmission.     

HIV and measures to control infection in general practice.

OBJECTIVE--To assess the impact of HIV on procedures to control infection in general practices. DESIGN--A postal questionnaire survey. SETTING--General practices throughout Britain. SUBJECTS--5359 General practitioners, 3429 (63.9%) of whom returned the questionnaire. MAIN OUTCOME MEASURE--Response to questionnaire on knowledge about HIV and policies for controlling infection. RESULTS--Most doctors (2018) had started to wear gloves when taking blood. Almost half (1510) had not resheathed needles previously but a further 776 had adopted this policy because of HIV. Over half of the doctors did not know or were unsure about the risk of infection from needlestick injuries, and 1759 had no practice policy for controlling infection. CONCLUSIONS--Many doctors are uncertain about measures to control infection in general practice. More information and advice are needed to help doctors develop policies to protect patients and staff.     

HIV infection in Saint Petersburg: the changing face of the epidemic

The specific features of the epidemiological situation in St. Petersburg at the first stage (1987-1995) and the second stage (1986-1999) of the development of HIV infection are described. During this period morbidity in HIV infection, starting from the insignificant rate of growth, sharply increased. For the first time injecting drug users were noted to come out to the foreground in the structure of the contingent of persons affected by HIV infection (57.5% and 72.6% in 1998 and 1999 respectively). Such change on the epidemic situation requires corrections in the strategy and tactics of preventive measures and medical assistance. To control HIV infection among drug users, only the combination of medical assistance given by narcologists with the realization of all elements of the program "Harm Reduction" can be effective.     

Attitudes towards HIV/AIDS among four year medical students at the University of Zagreb Medical School--better in 2002 than in 1993 but still unfavorable

Fourth-year medical students at Zagreb University School of Medicine were surveyed about their knowledge and attitudes regarding HIV/AIDS in 2002/03 and this was compared to a student generation studying during 1993/94. Results indicated that the 2002/03 students scored significantly higher then did 1993/94 students on knowledge, and attitudes towards HIV/AIDS. However, 84% of 2002/03 students believed that health care workers (HCW) have the right to know the HIV status of their patients, 50% would disclose the HIV status to another HCW against patient's wishes and only 35% believed that HIV testing should be voluntary. The following factors were independently associated with a more favorable attitude towards HIV/AIDS: less homophobia (beta = -0.37, p < 0.001), experience with HIV/AIDS patients (beta = 1.02, p < 0.001), better knowledge about transmission (beta = 0.18, p = 0.016), and 2002/03 academic year (beta = -1.45, p = 0.011). Despite improvements, some negative attitudes towards HIV/AIDS remained prevalent in 2002/03.     

The prevalence of the intravenous use of psychoactive preparations in Nizhegorod Province and the possible ways to prevent HIV infection among the users

The number of users of intravenous drugs (UID), altogether from 35,000 to 25,000 persons, was determined by the method of coefficients. The analysis of 130 anonymous questionnaires, including 75 street questionnaires (61%) and 51 questionnaires (39%) distributed among UID in narcological and infectious hospitals showed that out of 130 respondents 60% underwent hospital treatment. The study revealed that most of the questioned users used crudely made opiates, 48 (37%) out of 130 persons made injections with used syringes and needles (in younger age groups the proportion of such UID amounted to 63%). 70% of the respondents used individual injection instruments (in a group of persons older than 25 years they amounted to 90%). The conclusion was made on the necessity of introducing a school program on the healthy mode of life and information programs on the prevention of the spread of infection among UID with due regard to different age groups, as well as training outreach workers for disseminating information on the prophylaxis of HIV infection among UID.     

HIV infection in the penitentiaries of Ukraine

In connection with a sharp increase of the number of HIV-infected persons in the Ukraine the natural growth of the number of such persons in penitentiary institutions was registered, starting from 1995 (455 persons in 1995, 2,937 persons in 1996, 2,779 persons in 1997 and 173 persons during 5 months of 1998). 83% of HIV infection persons were drug addicts introducing drugs intravenously. In 1997 the strategy of decreasing the risk of infection in penitentiary institutions was worked out in collaboration with UNAIDS experts: repressive and isolation measures were replaced with measures aimed at the "decrease of harm". Special attention is given to circumstances aggravating the epidemic situation in HIV infection, and particularly at the sharp growth of morbidity in tuberculosis and syphilis (10.6 and 10.3 times respectively in 1997 in comparison with 1993). In addition, in 1997 the number of person having drug addiction was noted to increase 2.3 times in comparison with 1993. The necessity of taking constant information and educational measures aimed at decreasing the risk of the spread of HIV infection is emphasized.     

A comparative study of the level of knowledge of schoolchildren about HIV infection and AIDS

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.     

General practitioners and management of infection with HIV

General practitioners will have an increasingly important role in the management of patients with the acquired immune deficiency syndrome (AIDS) and infections with human immunodeficiency virus (HIV) as the numbers of cases increase. Altogether 280 general practitioners working in Oxfordshire were sent a postal questionnaire inquiring about their education, knowledge, current practice, and attitudes in relation to managing infections with HIV. Of the 235 (84%) general practitioners who replied, nine out of 10 were giving advice about infection with HIV to their patients. One in two were testing patients for such infection, and one in four were caring for infected patients. Nevertheless, uncertainty remained about the risks of transmission of infection with HIV and general practitioners'' knowledge of educational activities for their patients could be improved.The introduction of a facilitator to work with general practitioners in managing patients with AIDS or infection with HIV is planned, especially to help general practitioners develop the skills needed for prevention.     

The determinants of the spread of HIV among injection drug addicts in Ukraine

The main tendencies in the development of drug addiction in the Ukraine, the dynamics of the spread of HIV among drug addicts introducing drugs intravenously, epidemiological data on HIV, AIDS and drug addiction, as well as prognoses on the development of HIV infection are presented. Since 1995 the number of HIV-infected persons grew 34-fold, the number of cases of HIV infection resulting from the intravenous use drugs rose to 70% simultaneously with the rise (about 34-fold) of the number of persons infected with HIV through sexual contacts (about 13 fold). In 1996-1997 such tendency increased. On the whole, the proportion of drug addicts introducing drugs by intravenous injection was 83% in the Ukraine. By April 1, 1998, official registration covered 18,800 HIV-infected persons, including 270 foreign nationals, as well as 499 AIDS patients, including 487 Ukrainian citizens, among them 28 children. Out of 18,800 HIV-infected persons, 78.3% were drug addicts, most of them young people aged 15-30 years; about 18% were young people under 20 years of age, 80% being males. According to the model the rapid spread of HIV from the group of drug addicts to the heterosexual population, the total number of HIV-infected persons reaching 1,500,000 is expected in the country by 2014.     

The prevention of HIV infection and STDs among injection drug addicts in Ukraine

In 1996-1998 joint pilot Projects of the National Committee and the UNAIDS Program were carried out in 10 Ukrainian cities. The behavior determinants contributing to the spread of HIV infection, common for all regions under study, were determined. They were linked with the injections of narcotic drugs, sexual behavior and the level of knowledge on the infection. The effectiveness of the projects was due to the 80% coverage of those drug addicts who could not be reached by common narcotic drug services; to the use of individual syringes (increased from 43% to 95%); to a decrease in the sale of ready-made drugs in used syringes to 14%; to an increase in the index of the return of used syringes; to an increase in the proportion of persons constantly using condoms (58%); etc. Still the situation was found to give no grounds for optimism, and the conclusion was made that the strategy of "decreasing the harm" must become the policy and strategy of the public health system.     

Strategic problems in counteracting the spread of HIV infection in the Altai Territory

The Altai Territory belongs at present to regions with the insignificant level of the spread of HIV infection. By December 1, 1999, the Altai Territory had 31 registered cases of HIV infection, which constituted 1.33 per 10,000 of the population (the corresponding figure for the whole of Russia being 14.92). But the situation with HIV/AIDS showed the general tendency to the development of the epidemic of HIV infection due to steady growth and the wide involvement of injecting drug users in the epidemic process. Before 1999 all cases of HIV infection registered in the Altai Territory were imported. Out of 31 HIV infected persons detected in the territory, 18 were injecting drug users. In 1999 local foci of HIV infection were formed among drug users in two big cities of the Altai Territory, which was indicative of the gradual transition of HIV infection from the phase of the registration of individual cases to the phase of the formation of local foci among some groups of the population.     

The results of sentinel epidemiological surveillance on the level of HIV prevalence among injection narcotic abusers in the city of Poltava

The sentinel epidemiological surveillance on the level of spread of HIV infection among injecting drug users in Poltava, taking part in the program of harm reduction, was carried out. The results of the surveillance revealed that the level of HIV infection among drug users was 37.8%, the level of HIV infection among females being higher than that among males. These data indicate that the level of HIV infection rises with the increase of age and the time of drug consumption. Still in the age group of 30 years and older and among drug addicts using drugs for 7 years and longer the lowest level of HIV infection was noted.     

Sexual risk behaviors for HIV/AIDS in Chuuk State, Micronesia: the case for HIV prevention in vulnerable remote populations

Background

After the first two cases of locally-acquired HIV infection were recognized in Chuuk State, Federated States of Micronesia (FSM), a public health response was initiated. The purpose of the response was to assess the need for HIV education and prevention services, to develop recommendations for controlling further spread of HIV in Chuuk, and to initiate some of the prevention measures.

Methodology/Principal Findings

A public health team conducted a survey and rapid HIV testing among a sample of residents on the outer islands in Chuuk. Local public health officials conducted contact tracing and testing of sex partners of the two locally-acquired cases of HIV infection. A total of 333 persons completed the survey. The majority knew that HIV is transmitted through unprotected sexual contact (81%), injection drug use (61%), or blood transfusion (64%). Sexual activity in the past 12 months was reported among 159 participants, including 90 females and 69 males. Compared to women, men were more likely to have had multiple sex partners, to have been drunk during sex, but less likely to have used a condom in the past 12 months. The two men with locally acquired HIV infection had unprotected anal sex with a third Chuukese man who likely contracted HIV while outside of Chuuk. All 370 persons who received voluntary, confidential HIV counseling and testing had HIV negative test results.

Conclusions/Significance

Despite the low HIV seroprevalence, risky sexual behaviors in this small isolated population raise concerns about the potential for rapid spread of HIV. The lack of knowledge about risks, along with stigmatizing attitudes towards persons infected with HIV and high risk sexual behaviors indicate the need for resources to be directed toward HIV prevention in Chuuk and on other Pacific Islands.     

The results of conducting a rapid assessment of the situation in relation to intravenous narcotic abuse in the city of Rostov-on-Don

The main aspects of the spread and intravenous use of drugs in the city, contributing to the transmission of HIV infection among users of intravenous drugs (UID) have been studied. Anonymous questionnaires were distributed among 61 UID; of these, 50 were males (82%) and 11 were females (18%), mainly at the age of 19-35 years. In addition, sociological study was carried out among 582 persons; 61% of them were under 18 years of age, 18% were aged 19-25 years, 13% were aged 26-35 years. The drug users regarded their individual risk of getting HIV infection as insignificant in 23% of cases, slight in 21% of cases, high in 15% of cases, and 15% believed they were at no risk. As shown by the results of the sociological study, 91% of the respondents believed that the problem of drug addiction was topical in the city. The analysis of data obtained from physicians treating drug addicts and from the Head Office of Public Health made it possible to calculate that the number of UID in the city was about 9,000-10,000 persons. Taking into account the results of the rapid evaluation of the situation, the development of the draft program of "diminishing the harm" of the intravenous use of drugs is now in progress.     

The organization of the work to determine antibodies to the human immunodeficiency virus in the Republic of Byelarus

The study revealed that the method of mass screening for the detection of antibodies to HIV antigen, carried out in the Republic till 1993, proved to be economically and diagnostically unjustified. Starting from 1993, the work on the step-by-step reduction of groups to be tested for the presence of antibodies to HIV began. At the same time from 1997 the proportion of tested donors of blood, organs and tissues, as well as persons belonging to high risk groups, increased in comparison with 1993 (from 23.3% to 40% and from 5.3% to 21% respectively). Voluntary and anonymous testing for the presence of HIV infection was organized and legally introduced. In comparison with 1991, in 1997 the number of persons who voluntarily underwent testing increased 3.7 times. The period of transition from mass screening to selective one was noted to have no effect on the detection of HIV-infected persons. Since 1995 the method of "patrol" epidemiological surveillance was also used. 2,118 persons underwent testing, the results of screening were negative. During the period of 3 years the testing of 12,547 young people called up for military service revealed 28 seropositive persons in the region where an outbreak of HIV infection had been registered among addicts using drugs intravenously.