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.     

The 1st results in the realization of the Harm Reduction program for intravenous narcotic users in the city of Penza

To achieve the aims of the project, the following stages were consecutively defined: (1) the exchange of syringes, organized by outreach workers, with the simultaneous popularization of the project, (2) the orientation of intravenous drug users to attending syringe exchange stations and (3) the extension of the area covered by the activities of outreach workers. Our experience showed that outreach workers, especially those working in the street, were the main force to count on for achieving success in the work of the projects. The budget of the project should provide for the publication of information material. Special assignments for outreach workers to study some concrete problem (drug service, the use of blood, etc.) can be useful. It is expedient to raise the status of syringe exchange stations by turning them into multi-purpose consultation centers.     

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.     

Treating Addictions: Harm Reduction in Clinical Care and Prevention

This paper examines the role of clinical practitioners and clinical researchers internationally in establishing the utility of harm-reduction approaches to substance use. It thus illustrates the potential for clinicians to play a pivotal role in health promoting structural interventions based on harm-reduction goals and public health models. Popular media images of drug use as uniformly damaging, and abstinence as the only acceptable goal of treatment, threaten to distort clinical care away from a basis in evidence, which shows that some ways of using drugs are far more harmful than others and that punitive approaches and insistence on total abstinence as the only goal of treatment often increases the harms of drug use rather than reducing drug use. Therefore the leadership and scientific authority of clinicians who understand the health impact of harm-reduction strategies is needed. Through a review of harm-reduction interventions in Canada, the United Kingdom, the United States, Australia, Switzerland, and the Netherlands, we identify three ways that clinicians have helped to achieve a paradigm shift from punitive approaches to harm-reduction principles in clinical care and in drug policy: (1) through clinical research to provide data establishing the effectiveness and feasibility of harm-reduction approaches, (2) by developing innovative clinical programmes that employ harm reduction, and thereby (3) changing the standard of care to include routine use of these evidence-based (but often misunderstood) approaches in their practices. We argue that through promotion of harm-reduction goals and methods, clinicians have unique opportunities to improve the health outcomes of vulnerable populations.     

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 introduction of the concept of Harm Reduction in the city of Cherkassy

The introduction of the concept of Harm Reduction into the practical work of the narcological survive confidence relations with injecting drug users were established, which resulted in the possibility to carry out information and educational, as well as preventive work. In addition, there occurred changes in public opinion with respect to the problems of drug addiction (a drug addict was now regarded as a sick person) and AIDS (HIV infection was considered to be a problem, topical for wide strata of the population). The creation of a dedicated team comprising medical personnel, psychologists, representatives of the clergy, volunteers from drug addicts contributed to successes in this work. The work on the correction of negative manifestations, carried out by the organs of law protection, also contributed to the creation of balance between the strategy of Harm Reduction and the strategy of the reduction of need in narcotic drugs.     

Experience with a hospital-based weight reduction program

A pilot project “Nutritional Service for Weight Reduction”, utilizing allied health personnel, was organized by the Departments of Medicine and Dietetics at the Calgary General Hospital. Body measurements and biochemical tests were required at the beginning and end of the 12-week program. Meetings were held at which the subjects submitted their weekly food record, received counselling by nutritionists, and attended lectures on physiology, metabolism of food, nutrition and the importance of exercise. Thirty-one subjects completed the program. All lost weight, the total for the group being 197 kg. At the first follow-up meeting, 17 subjects showed further weight loss, three maintained their weight and 11 regained some weight.     

Experience with a blood component program in surgical hemotherapy

Within the component concept applied during the past 6 years at the University Hospital in Berne (Switzerland), 85% of all red cell units are transfused as concentrates with a hematocrit of 70%, and the remaining 15% as fresh whole blood. The rationale in surgical patients is to exploit the different "critical levels" of the blood volume, hematocrit, total serum protein, plasmatic coagulation factors, and platelets. A colloid plasma substitute compensating for the plasma deficit of the red cell concentrates is an integral part of the system. A carefully checked, retrospective study in 372 patients revealed no disadvantages for the postoperative course. During the first 4 1/2 years after its introduction it did not increase the demand for human plasma protein solutions. With the red cells as a pacemaker for the number of blood donations, this system can simultaneously cover a reasonable national demand for albumin and factor VIII.     

Experience of an interactive program in undergraduate investigative practicals

A microcomputer program is described which has been used by first-year undergraduates throughout an investigation in microbiology, totalling five hours of practical work. The computer is used by students to check their suggestions of possible lines of investigation, the results of practical procedures, and the decisions made on the basis of this experimental evidence. The program offers advice when entries which are inadvisable or incorrect are entered thus providing guidance without usurping student control of the investigation. Evidence for the effectiveness of this program is presented and the potential for this type of consultative program in other areas is indicated. Based on this experience, advice is offered on the general design of this type of program.     

Experience with the expanded WHO program on immunization against tetanus

According to (WHO) statistics, over 1 million infants in the developing countries die each year from tetanus. The estimated annual occurrence of tetanus in the 3rd World exceeds 2.5 million cases, including approximately 1.3 million newborn infants. In 1974, WHO began an expanded program for the systematic immunization of infants against tetanus and certain other diseases. The program uses 2 approaches for preventing tetanus: 1) immunization of infants under 1 year of age with the AKDS vaccine; and 2) immunization of pregnant women or, if possible, all women, with tetanus anatoxin. The 2nd approach is more effective, especially when 2 doses of tetanus anatoxin are administered within a minimum interval of 4 weeks. The anatoxin has no harmful effects on the fetus and can be used during any stage of pregnancy. The program strives to reduce infant mortality caused by tetanus to less than 1 case in 1000 by 1990, and to 0 by 2000. To attain these goals, systematic immunization should be combined with drastic improvements in delivery techniques and hygiene in developing countries. Specialized surveys indicate that initial steps toward implementation of the program resulted in a significant reduction of infant mortality caused by tetanus. Experience with the expanded WHO program shows that elimination of tetanus in infants is a realistic and attainable goal.     

Clinico-epidemiologic aspects of campylobacteriosis in Moscow and Moscow Province

The clinical course and epidemiological features of campylobacteriosis in Moscow and Moscow Province in 1986-1987 are described. The specific proportion of this infection in the structure of acute enteric infections is, on the average, 4.8%. The level of Campylobacter contamination of animals and birds and their role in the spread of campylobacteriosis have been established. The possible ways and factors of the transfer of this infection are discussed.     

Aeromicrobiological studies in the Moscow cathedrals

A microbiological examination of the air has been carried out inside the Moscow Kremlin Cathedrals. Comparison studies on concentrations of airborne microorganisms were performed in different indoor environments -- with and without air-conditioning system, with many and without visitors. The highest values were found indoors with great public attendance and where no air-conditioning system was available. The Gram-positive bacteria were predominant in the air whereas the Gram-negative ones mainly were found on the surface of walls and of stone objects. The majority of airborne microorganisms were capable of producing acid.     

Thymus participation in realizing the immunomodulating action of hydrocortisone

It has been shown in experiments on CBA mice that in certain conditions injection of hydrocortisone (10 mg/kg) results in suppression of the delayed type hypersensitivity reaction and prolongation of the skin allograft survival. Preliminary thymectomy abolishes the immunomodulating effect of the drug, being, in the authors' opinion, the evidence for thymus involvement in mediation of the immuno-suppressive effect of hydrocortisone.