The realization of the concept of Harm Reduction in Russia

By the present moment cases of HIV infection among injecting narcotic users (INU) have been registered in more than 100 countries. To prevent HIV infection, the program "Harm Reduction" has been developed in Britain; the program states that the prevention of HIV infection must be considered more important than the prevention of the use of narcotic drugs, as this infection is a growing danger for both drug users and public health in general. Breaking drug dependence must not be the only aim of services working with drug addicts, because this will exclude persons decisively disposed to the mode of life including the prolonged use of drugs from the sphere of their activity. Active INU having no contacts with organizations which must give them treatment and assistance find themselves in dangerous situations more often than INU maintaining contacts with such organizations. Penetration into such hidden group and its education must be the primary task. Propaganda plays a decisive role in this process, as the only way to penetrate into such group is to develop work in its territory, so that drug addicts, supplied with the necessary means could change their behavior in the desired direction. In the Russian Federation work on the project "Harm Reduction" has been carried out in 50 regions. This work has contributed to conducting teaching seminars, working out teaching programs, as well as to augmenting the interest among specialists of different professions to the problem of decreasing the spread of HIV infection. The importance of information distributed by the narcological service and the probability that very responsible persons take correct decisions on the basis of their understanding the situation have increased. The rating of public organization has risen.     

The prevention of HIV/AIDS among injection drug abusers and women in the sex business in the city of Kharkiv

A steady increase of the number of persons with drug addiction has been noted both on Kharkov and Kharkov Province. Since 1996 a considerable number of HIV-infected persons has been detected among injecting drug users (80-82% of them infected parenterally). Rapid evaluation, carried out in 1997 within the project "Harm Reduction", served as the basis for the creation of the Charity Fund "Scarlet Ribbon" collaborating with the UNAIDS Representation in the Ukraine and other international organizations. The information and educational activity of the Fund among injecting drug users is presented. The necessity of organizing additional stationary and mobile exchange stations of the syringe is pointed out.     

Regional government policy in the area of preventing the spread of HIV infection and drug abuse among youth

In 1993 the Youth Social Service, aimed at the creation of favorable conditions for the development of young people, the realization of their rights, the preservation of their individuality, their self determination and self expression, the support of their innovative activities, was created in Kiev. The work on the prevention of the spread if HIV infection and injection drug use should be considered only in the aspect of the involvement of young people in the work on the prevention of negative phenomena. The prerequisite for these programs was the tendency to an increase in the number of manifestations of negative phenomena among young people in Kiev. One of the most complicated programs was the program "Harm Reduction" among injecting drug users. The main prospect in the realization of this program was the involvement of a large number of volunteers and training by the method "Per Education".     

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.     

Listen to one another and act in concert (the Renewal Project)

The organization of work on the project "Harm Reduction for Intravenous Drug Users in Kazan" is substantiated. Difficulties in the realization of such projects due to the lack of coordination between different services, also taking part in controlling the spread of drug addiction and ensuring the treatment of addicts, are emphasized. The coordination of actions of various state structures will make it possible to enhance the effectiveness of programs of harm reduction. The expediency of the development of the general state program of primary prophylaxis, realized by trained specialists with the use of effective technology, is discussed.     

An analysis of the situation with injection narcotic usage in the city of Voronezh during the development of the HIV infection epidemic in Russia

The medico-demographic situation in Voronezh, characterized by a decrease in the birth rate, a rise in the mortality rate, the prevalence of pensioners (38%) in the structure of the population, is presented. The negative influence of the deterioration of socio-economic conditions on the social health of the population, especially on the situation with drug addiction, is pointed out. The extent of the misuse of narcotic and toxic substances among adolescents essentially increased. The rapid assessment of the situation with the intravenous use of drugs in Voronezh was carried out, following the WHO methodology. The conclusion was made concerning the necessity of complex sociological monitoring with a view to obtaining more reliable data on the number of drug addicts. The calculation of the supposed number of users in Voronezh among persons aged 15-30 years, made by three modules of assessment, revealed this number reached 61,374 persons, i.e. every fifth or sixth young person used some narcotic substances. The necessity of taking drastic measures on the primary prophylaxis of HIV infection among injecting drug users by creating conditions for the realization of the programs "Harm Reduction" and "Equal Helps Equal" which proved to be effective in other regions of the Russian Federation.     

We rely on the common sense of young people

The principles of the primary prophylaxis, analogous to the program "Harm Reduction", are presented. The basis for placing this work on broad footing was the rapid assessment of the situation with the use of narcotic drugs in the city (the number of users exceeded 10,000 per 238,000 inhabitants) with a tendency towards a sharp decrease of the age of the users (9-13 years). The experience of work on the training of medical personnel, directly contacting with blood and thus considered to be a risk group, taking into account risky professional behavior (potentially dangerous), was accumulated. The training activities among students of medical schools proved to be effective. They became the best volunteers and leaders among young people. Adolescents aged 14-18 years were enlisted as volunteers: they worked in different places usually attended by young people and invited drug addicts to the anonymous examination room. The role of local mass media in educating the public on of the problems of the prevention of HIV infection is discussed. As a result, the activation of the youth movement in support of the program "Anti-AIDS" and an increase in the number of people in target groups coming to the anonymous examination room are noted.     

The course of the realization of the Harm Reduction program in the city of Nikolayev

The growth of drug addiction has been noted in Nikolaev. This growth has not been stopped by methods based on the use of force. The results of work in accordance with the program "Harm Reduction" are presented. The program functions on the basis of the Charity Fund "Blahodiinist" and is intended for the prevention of the spread of HIV infection in groups of risk among injecting drug users and in other groups. The realization of the program includes provision of information material, reduction of harm in connection with the use of drugs by injection and the risk of getting HIV and sexually transmitted diseases. The analysis of the results has shown the effectiveness of the program (the frequency of using condoms has increased, the number of sex partners and the number of casual liaisons have dropped, the custom of using sterile syringes has been formed). Considering that during epidemics the coverage of not less than 70% of the representative of risk groups is necessary, the program should be realized on a greater scale to increase its effectiveness.     

A strategy for the control of HIV infection and viral hepatitides against the background of the narcotic abuse epidemic

The presence of the epidemic of drug addiction in the Russian Federation is stated: for the recent 10 years the number of drug addicts increased 3.5-fold. The questioning of several thousand drug addicts has revealed that 60% of them have hepatitis B, 80% have hepatitis C, 10% have syphilis. The strategy of controlling HIV infection among drug addicts is proposed. It includes, in the first place, the prevention of the secondary infection from HIV-infected addicts; in the second place, the detection of HIV-infected persons in groups of drug addicts, difficult to establish contacts with; in the third place, the primary prophylaxis within the program "Harm reduction" in the most susceptible groups of drug addicts. The thesis that the prevention of HIV infection must become the prevention of drug addiction by rendering multi-stage assistance to HIV-infected persons, including mainly drug addicts, is substantiated.     

The UNAIDS strategy in the prevention of HIV/AIDS in the countries of Eastern Europe

Grounds for the necessity of the formation of effective approaches to the prevention of HIV epidemic with a view to counteract the rapid spread of infection in East European countries are presented. Attention is specially drawn to fact that the epidemic will not be limited by drug users, but will quickly cross the boundaries of this group. The development of preventive measures must be based on the use of the world experience. New effective approaches to work with vulnerable groups (the strategy of harm reduction, work in communities, consultations, etc.) must be widely used. The program of actions of the UNAIDS European Section, stipulating the strengthening and extension of the potential of the countries in the region for the effective counteraction to the epidemic, is formulated. As priority areas, activities covering vulnerable groups and with young people have been determined. The strategy of UNAIDS is realized through 20 UN theme groups on HIV/AIDS in the countries of Eastern Europe. Special attention is drawn to the creation of methodological networks. The creation of a unified strategic plan for counteraction the epidemic of HIV/AIDS is regarded by UNAIDS as its perspective for the future.     

A decrease in harm: a new concept for Russian public health

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.     

Studying the effect of a charged surface on the interaction of bleomycin with DNA using an atomic force microscope

The cleavage of DNA caused by the antitumoral drug bleomycin has been investigated using atomic force microscopy (AFM). This work deals with the effect that adsorbing DNA onto a positively- or negatively-charged surface has on the double-strand cleavage of DNA by Fe(III)/bleomycin. Quantitative analysis of the number of breaks per DNA molecule, in bulk and at the surface of the mica substrate, has been performed by analyzing AFM images. It turns out that the cleavage of DNA is strongly inhibited by a positively-charged surface. Our experiments can be interpreted using a simple electrostatic model. This paper is a first step in the study of DNA accessibility to ligand such as bleomycin, using AFM in liquids.Olivier Piétrement and David Pastré have contributed equally to the work.     

Monuments, power and personhood in the British Neolithic

Recent research on British Neolithic monuments describes how the ordering of space within these sites contributed to the production and maintenance of dominant discourses. This article argues that aspects of this work are implicitly built on conceptions of personhood specific to post-Enlightenment thought, resulting in a somewhat static and one-dimensional conception of power relations during the period. One way out of this problem is provided by anthropological and feminist literature in which an alternative characterization of the self as inherently fluid and relational has been outlined. This facilitates a shifting and contextual conception of power relations which can be reconciled more easily with the evidence from Neolithic monuments for the continuous creation and reinterpretation of spatial meanings.     

Preventing Ultimate Harm as the Justification for Biomoral Modification

Most advocates of biogenetic modification hope to amplify existing human traits in humans in order to increase the value of such traits as intelligence and resistance to disease. These advocates defend such enhancements as beneficial for the affected parties. By contrast, some commentators recommend certain biogenetic modifications to serve social goals. As Ingmar Persson and Julian Savulescu see things, human moral psychology is deficient relative to the most important risks facing humanity as a whole, including the prospect of Ultimate Harm, the point at which worthwhile life is forever impossible on the planet. These risks can be mitigated, they say, by enhancing moral psychology in novel ways. Persson and Savulescu argue that some parents should modify the underlying biogenetics of their children's moral psychology, if such measures were safe and effective, but they admit these interventions may not decouple humanity from Ultimate Harm. Neither are these modifications the only options, they concede, for addressing risks to humanity. Even with these concessions, saving humanity from itself is a fairly poor reason to modify the moral psychology of children. In most ways, adults would be better candidates, morally speaking, for modifications of psychology. Even then, there is no direct link between morally enhanced human beings and the hoped‐for effect of better protection from Ultimate Harm. Asserting a general duty of all to contribute to the avoidance of Ultimate Harm is a better moral strategy than intervening in the moral psychology of some, even though meeting that duty may involve substantial interference with the free exercise of one's interests.     

The role of nongovernmental organizations in the response to the AIDS epidemic

The main trends in the activities of the Public Movement "Faith, Hope, Love", organized by an initiative group of specialists in public health, law, public order maintenance, as well as volunteers, in June 1996 are presented. The main aspects of the activities of this non-governmental organization are the prevention of AIDS and sexually transmitted diseases (STD) among vulnerable groups of the population (female sex workers, injecting drug users, street children, representatives of sexual minorities); educational activities on the problems of the prevention of drug addiction and AIDS/STD among adolescents and young people; rendering psychological assistance to the vulnerable groups of the population; practical assistance to street children. Approaches and methods used in the work on AIDS/STD prevention among vulnerable groups of the population are as follows: active involvement of the representatives of vulnerable groups in preventive work, the creation of the possibility of contacts with specialists for representatives of vulnerable groups by opening confidence rooms, mutual assistance centers, provision with individual preventive remedies, active involvement of representatives of government structures in the realization of the projects carried out by the Movement, etc.     

Identification of EPAC (Exchange Protein Activated by cAMP) bioinformatically as a potential signalling biomarker in Cardiovascular Disease (CVD) and its molecular docking by a lead molecule

The present work delineates the combinatorial approach of firstly, creation of a centralized data-set comprising signalling proteins identified on the basis of altered expression, such as over-expression or repression of a set of signalling protein(s) leading to the cause of the disease, which is based on published reports screened through Pubmed and secondly, in the in silico creation of novel lead (drug) molecules and docking of identified signalling biomarkers using such drugs to investigate possibility of their future application in the model systems eventually. EPAC (Exchange Protein Activated by cAMP) emerges as a signalling biomarker in cases studied presently. Brefeldin, the known inhibitor of EPAC, though the mechanism yet unexplored, has been the molecule used as the pharmacophore for creation of lead drug molecule. Various modifications have been incorporated into the pharmacophore to increase the hydrophobic interactions for increasing the binding efficiency of the generated lead molecule. Side-chain modifications of the pharmacophore and refinement of data through firedock upon docking of EPAC with the modified pharmacophore yielded best results on the bases of atomic contact energy, van der Waal and partial electrostatic interactions as well as additional estimations of the binding free energy. Modifications of CH3 at C15 with COOH and H at C2 with OH in brefeldin showed the best docking results on the basis of protein-drug interaction parameters. The present work provides a clue in rational design of EPAC inhibitors which could be developed as drug lead in combating CVD.     

Efficient synthesis of an aldehyde functionalized hyaluronic acid and its application in the preparation of hyaluronan-lipid conjugates

An efficient method to synthesize hyaluronan oligosaccharide lipid conjugates is described. This strategy is based on the introduction of a double bond in the glucuronic acid of the hyaluronic acid (HA), by the biodegradation of HA with hyaluronate lyase, followed by the generation of a free aldehyde group at the nonreducing end of hyaluronic acid via ozonolysis and the subsequent reduction of the generated ozonide. The resulting aldehyde-functionalized HA is then coupled to dipalmitoyl phosphatidylethanolamine (DPPE) using reductive amination chemistry. This methodology can be extended to link molecules such as biotin, polymers, or proteins to HA for numerous applications in drug delivery and in the creation of biocompatible materials for tissue repair and engineering.     

Discovery of novel fragments inhibiting O-acetylserine sulphhydrylase by combining scaffold hopping and ligand–based drug design

Several bacteria rely on the reductive sulphur assimilation pathway, absent in mammals, to synthesise cysteine. Reduction of virulence and decrease in antibiotic resistance have already been associated with mutations on the genes that codify cysteine biosynthetic enzymes. Therefore, inhibition of cysteine biosynthesis has emerged as a promising strategy to find new potential agents for the treatment of bacterial infection. Following our previous efforts to explore OASS inhibition and to expand and diversify our library, a scaffold hopping approach was carried out, with the aim of identifying a novel fragment for further development. This novel chemical tool, endowed with favourable pharmacological characteristics, was successfully developed, and a preliminary Structure–Activity Relationship investigation was carried out.     

The costs of breed reconstruction from cryopreserved material in mammalian livestock species

The aim of this work was to compare costs, in the horse, cattle, sheep, swine, and rabbit species, for the creation of gene banks for reconstruction of an extinct breed, using different strategies: embryos-only, embryos in combination with semen, and semen-only. Three cost measures were used: time required for population reconstruction, cost for creation of the gene bank, number of years-keeping-female to reach reconstruction. Semen costs were estimated across four scenarios: the presence or absence of a commercial market for semen, purchase of semen donors, and semen extracted from the epididymus. The number of cells were doubled to take into account the creation of two storage sites. The strategy embryos-only required the shortest time to reach reconstruction. With the strategy embryos + semen, time increased with decreasing proportions of embryos. With semen-only, reconstruction time varied from 2 to 21 years. A high variation of costs was observed across species and strategies, from 360 Euros in the rabbit to 1 092 300 in the horse. In all species, the embryos-only strategy was about 10% more expensive than using 90% embryos + semen. Decreasing the percentage of embryos further diminished costs. The number of years-keeping-female ranged across strategies, from 2 in the rabbit, to a maximum of 12 878 in the horse.