'It's risky to walk in the city with syringes': understanding access to HIV/AIDS services for injecting drug users in the former Soviet Union countries of Ukraine and Kyrgyzstan
Identifieur interne : 002388 ( Pmc/Checkpoint ); précédent : 002387; suivant : 002389'It's risky to walk in the city with syringes': understanding access to HIV/AIDS services for injecting drug users in the former Soviet Union countries of Ukraine and Kyrgyzstan
Auteurs : Neil Spicer [Royaume-Uni] ; Daryna Bogdan [Ukraine] ; Ruairi Brugha [Irlande (pays)] ; Andrew Harmer [Royaume-Uni] ; Gulgun Murzalieva ; Tetiana Semigina [Ukraine]Source :
- Globalization and Health [ 1744-8603 ] ; 2011.
Abstract
Despite massive scale up of funds from global health initiatives including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other donors, the ambitious target agreed by G8 leaders in 2005 in Gleneagles to achieve universal access to HIV/AIDS treatment by 2010 has not been reached. Significant barriers to access remain in former Soviet Union (FSU) countries, a region now recognised as a priority area by policymakers. There have been few empirical studies of access to HIV/AIDS services in FSU countries, resulting in limited understanding and implementation of accessible HIV/AIDS interventions. This paper explores the multiple access barriers to HIV/AIDS services experienced by a key risk group-injecting drug users (IDUs).
Semi-structured interviews were conducted in two FSU countries-Ukraine and Kyrgyzstan-with clients receiving Global Fund-supported services (Ukraine n = 118, Kyrgyzstan n = 84), service providers (Ukraine n = 138, Kyrgyzstan n = 58) and a purposive sample of national and subnational stakeholders (Ukraine n = 135, Kyrgyzstan n = 86). Systematic thematic analysis of these qualitative data was conducted by country teams, and a comparative synthesis of findings undertaken by the authors.
Stigmatisation of HIV/AIDS and drug use was an important barrier to IDUs accessing HIV/AIDS services in both countries. Other connected barriers included:
criminalisation of drug use; discriminatory practices among government service providers; limited knowledge of HIV/AIDS, services and entitlements; shortages of commodities and human resources; and organisational, economic and geographical barriers.
Approaches to thinking about universal access frequently assume increased availability of services means increased accessibility of services. Our study demonstrates that while there is greater availability of HIV/AIDS services in Ukraine and Kyrgyzstan, this does not equate with greater accessibility because of multiple, complex, and interrelated barriers to HIV/AIDS service utilisation at the service delivery level. Factors external to, as well as within, the health sector are key to understanding the access deficit in the FSU where low or concentrated HIV/AIDS epidemics are prevalent. Funders of HIV/AIDS programmes need to consider how best to tackle key structural and systemic drivers of access including prohibitionist legislation on drugs use, limited transparency and low staff salaries within the health sector.
Url:
DOI: 10.1186/1744-8603-7-22
PubMed: 21752236
PubMed Central: 3143914
Affiliations:
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id="I2">School of Social Work, Kyiv-Mohyla Academy, 2 Skovorody Vul, Kyiv, 04070, Ukraine</nlm:aff><country xml:lang="fr">Ukraine</country><wicri:regionArea>School of Social Work, Kyiv-Mohyla Academy, 2 Skovorody Vul, Kyiv, 04070</wicri:regionArea><wicri:noRegion>04070</wicri:noRegion></affiliation></author><author><name sortKey="Brugha, Ruairi" sort="Brugha, Ruairi" uniqKey="Brugha R" first="Ruairi" last="Brugha">Ruairi Brugha</name><affiliation wicri:level="1"><nlm:aff id="I3">Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland</nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea>Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2</wicri:regionArea><wicri:noRegion>Dublin 2</wicri:noRegion></affiliation></author><author><name sortKey="Harmer, Andrew" sort="Harmer, Andrew" uniqKey="Harmer A" first="Andrew" last="Harmer">Andrew 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wicri:stream="Pmc" wicri:step="Checkpoint">002388</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main"><italic>'It's risky to walk in the city with syringes'</italic>: understanding access to HIV/AIDS services for injecting drug users in the former Soviet Union countries of Ukraine and Kyrgyzstan</title><author><name sortKey="Spicer, Neil" sort="Spicer, Neil" uniqKey="Spicer N" first="Neil" last="Spicer">Neil Spicer</name><affiliation wicri:level="1"><nlm:aff id="I1">Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT</wicri:regionArea><wicri:noRegion>WC1E 7HT</wicri:noRegion></affiliation></author><author><name sortKey="Bogdan, Daryna" sort="Bogdan, Daryna" uniqKey="Bogdan D" first="Daryna" last="Bogdan">Daryna Bogdan</name><affiliation wicri:level="1"><nlm:aff id="I2">School of Social Work, Kyiv-Mohyla Academy, 2 Skovorody Vul, Kyiv, 04070, Ukraine</nlm:aff><country xml:lang="fr">Ukraine</country><wicri:regionArea>School of Social Work, Kyiv-Mohyla Academy, 2 Skovorody Vul, Kyiv, 04070</wicri:regionArea><wicri:noRegion>04070</wicri:noRegion></affiliation></author><author><name sortKey="Brugha, Ruairi" sort="Brugha, Ruairi" uniqKey="Brugha R" first="Ruairi" last="Brugha">Ruairi Brugha</name><affiliation wicri:level="1"><nlm:aff id="I3">Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland</nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea>Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2</wicri:regionArea><wicri:noRegion>Dublin 2</wicri:noRegion></affiliation></author><author><name sortKey="Harmer, Andrew" sort="Harmer, Andrew" uniqKey="Harmer A" first="Andrew" last="Harmer">Andrew Harmer</name><affiliation wicri:level="1"><nlm:aff id="I1">Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT</wicri:regionArea><wicri:noRegion>WC1E 7HT</wicri:noRegion></affiliation></author><author><name sortKey="Murzalieva, Gulgun" sort="Murzalieva, Gulgun" uniqKey="Murzalieva G" first="Gulgun" last="Murzalieva">Gulgun Murzalieva</name><affiliation><nlm:aff id="I4">Health Policy Analysis Center, Togolok Moldo 1, Bishkek, 720040, Kyrgyz Republic</nlm:aff><wicri:noCountry code="subfield">Kyrgyz Republic</wicri:noCountry></affiliation></author><author><name sortKey="Semigina, Tetiana" sort="Semigina, Tetiana" uniqKey="Semigina T" first="Tetiana" last="Semigina">Tetiana Semigina</name><affiliation wicri:level="1"><nlm:aff id="I2">School of Social Work, Kyiv-Mohyla Academy, 2 Skovorody Vul, Kyiv, 04070, Ukraine</nlm:aff><country xml:lang="fr">Ukraine</country><wicri:regionArea>School of Social Work, Kyiv-Mohyla Academy, 2 Skovorody Vul, Kyiv, 04070</wicri:regionArea><wicri:noRegion>04070</wicri:noRegion></affiliation></author></analytic><series><title level="j">Globalization and Health</title><idno type="eISSN">1744-8603</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Despite massive scale up of funds from global health initiatives including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other donors, the ambitious target agreed by G8 leaders in 2005 in Gleneagles to achieve universal access to HIV/AIDS treatment by 2010 has not been reached. Significant barriers to access remain in former Soviet Union (FSU) countries, a region now recognised as a priority area by policymakers. There have been few empirical studies of access to HIV/AIDS services in FSU countries, resulting in limited understanding and implementation of accessible HIV/AIDS interventions. This paper explores the multiple access barriers to HIV/AIDS services experienced by a key risk group-injecting drug users (IDUs).</p></sec><sec><title>Methods</title><p>Semi-structured interviews were conducted in two FSU countries-Ukraine and Kyrgyzstan-with clients receiving Global Fund-supported services (Ukraine n = 118, Kyrgyzstan n = 84), service providers (Ukraine n = 138, Kyrgyzstan n = 58) and a purposive sample of national and subnational stakeholders (Ukraine n = 135, Kyrgyzstan n = 86). Systematic thematic analysis of these qualitative data was conducted by country teams, and a comparative synthesis of findings undertaken by the authors.</p></sec><sec><title>Results</title><p>Stigmatisation of HIV/AIDS and drug use was an important barrier to IDUs accessing HIV/AIDS services in both countries. Other connected barriers included:</p><p>criminalisation of drug use; discriminatory practices among government service providers; limited knowledge of HIV/AIDS, services and entitlements; shortages of commodities and human resources; and organisational, economic and geographical barriers.</p></sec><sec><title>Conclusions</title><p>Approaches to thinking about universal access frequently assume increased availability of services means increased accessibility of services. Our study demonstrates that while there is greater availability of HIV/AIDS services in Ukraine and Kyrgyzstan, this does not equate with greater accessibility because of multiple, complex, and interrelated barriers to HIV/AIDS service utilisation at the service delivery level. Factors external to, as well as within, the health sector are key to understanding the access deficit in the FSU where low or concentrated HIV/AIDS epidemics are prevalent. Funders of HIV/AIDS programmes need to consider how best to tackle key structural and systemic drivers of access including prohibitionist legislation on drugs use, limited transparency and low staff salaries within the health sector.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Mournier, S" uniqKey="Mournier S">S Mournier</name></author><author><name sortKey="Mckee, M" uniqKey="Mckee M">M McKee</name></author><author><name sortKey="Atun, R" uniqKey="Atun R">R Atun</name></author><author><name sortKey="Coker, R" uniqKey="Coker R">R Coker</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Godinho, J" uniqKey="Godinho J">J Godinho</name></author><author><name sortKey="Renton, A" uniqKey="Renton A">A Renton</name></author><author><name sortKey="Vinogradov, V" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Global Health</journal-id><journal-title-group><journal-title>Globalization and Health</journal-title></journal-title-group><issn pub-type="epub">1744-8603</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21752236</article-id><article-id pub-id-type="pmc">3143914</article-id><article-id pub-id-type="publisher-id">1744-8603-7-22</article-id><article-id pub-id-type="doi">10.1186/1744-8603-7-22</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title><italic>'It's risky to walk in the city with syringes'</italic>: understanding access to HIV/AIDS services for injecting drug users in the former Soviet Union countries of Ukraine and Kyrgyzstan</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" id="A1"><name><surname>Spicer</surname><given-names>Neil</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>neil.spicer@lshtm.ac.uk</email></contrib><contrib contrib-type="author" id="A2"><name><surname>Bogdan</surname><given-names>Daryna</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>daryna.bogdan@gmail.com</email></contrib><contrib contrib-type="author" id="A3"><name><surname>Brugha</surname><given-names>Ruairi</given-names></name><xref ref-type="aff" rid="I3">3</xref><email>rbrugha@rcsi.ie</email></contrib><contrib contrib-type="author" id="A4"><name><surname>Harmer</surname><given-names>Andrew</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>andrew.harmer@lshtm.ac.uk</email></contrib><contrib contrib-type="author" id="A5"><name><surname>Murzalieva</surname><given-names>Gulgun</given-names></name><xref ref-type="aff" rid="I4">4</xref><email>gulgun@manas.elcat.kg</email></contrib><contrib contrib-type="author" id="A6"><name><surname>Semigina</surname><given-names>Tetiana</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>tv_sem@ukma.kiev.ua</email></contrib></contrib-group><aff id="I1"><label>1</label>Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK</aff><aff id="I2"><label>2</label>School of Social Work, Kyiv-Mohyla Academy, 2 Skovorody Vul, Kyiv, 04070, Ukraine</aff><aff id="I3"><label>3</label>Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland</aff><aff id="I4"><label>4</label>Health Policy Analysis Center, Togolok Moldo 1, Bishkek, 720040, Kyrgyz Republic</aff><pub-date pub-type="collection"><year>2011</year></pub-date><pub-date pub-type="epub"><day>13</day><month>7</month><year>2011</year></pub-date><volume>7</volume><fpage>22</fpage><lpage>22</lpage><history><date date-type="received"><day>30</day><month>3</month><year>2011</year></date><date date-type="accepted"><day>13</day><month>7</month><year>2011</year></date></history><permissions><copyright-statement>Copyright ©2011 Spicer et al; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2011</copyright-year><copyright-holder>Spicer et al; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri xlink:href="http://www.globalizationandhealth.com/content/7/1/22"></self-uri><abstract><sec><title>Background</title><p>Despite massive scale up of funds from global health initiatives including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other donors, the ambitious target agreed by G8 leaders in 2005 in Gleneagles to achieve universal access to HIV/AIDS treatment by 2010 has not been reached. Significant barriers to access remain in former Soviet Union (FSU) countries, a region now recognised as a priority area by policymakers. There have been few empirical studies of access to HIV/AIDS services in FSU countries, resulting in limited understanding and implementation of accessible HIV/AIDS interventions. This paper explores the multiple access barriers to HIV/AIDS services experienced by a key risk group-injecting drug users (IDUs).</p></sec><sec><title>Methods</title><p>Semi-structured interviews were conducted in two FSU countries-Ukraine and Kyrgyzstan-with clients receiving Global Fund-supported services (Ukraine n = 118, Kyrgyzstan n = 84), service providers (Ukraine n = 138, Kyrgyzstan n = 58) and a purposive sample of national and subnational stakeholders (Ukraine n = 135, Kyrgyzstan n = 86). Systematic thematic analysis of these qualitative data was conducted by country teams, and a comparative synthesis of findings undertaken by the authors.</p></sec><sec><title>Results</title><p>Stigmatisation of HIV/AIDS and drug use was an important barrier to IDUs accessing HIV/AIDS services in both countries. Other connected barriers included:</p><p>criminalisation of drug use; discriminatory practices among government service providers; limited knowledge of HIV/AIDS, services and entitlements; shortages of commodities and human resources; and organisational, economic and geographical barriers.</p></sec><sec><title>Conclusions</title><p>Approaches to thinking about universal access frequently assume increased availability of services means increased accessibility of services. Our study demonstrates that while there is greater availability of HIV/AIDS services in Ukraine and Kyrgyzstan, this does not equate with greater accessibility because of multiple, complex, and interrelated barriers to HIV/AIDS service utilisation at the service delivery level. Factors external to, as well as within, the health sector are key to understanding the access deficit in the FSU where low or concentrated HIV/AIDS epidemics are prevalent. Funders of HIV/AIDS programmes need to consider how best to tackle key structural and systemic drivers of access including prohibitionist legislation on drugs use, limited transparency and low staff salaries within the health sector.</p></sec></abstract></article-meta></front></pmc><affiliations><list><country><li>Irlande (pays)</li><li>Royaume-Uni</li><li>Ukraine</li></country></list><tree><noCountry><name sortKey="Murzalieva, Gulgun" sort="Murzalieva, Gulgun" uniqKey="Murzalieva G" first="Gulgun" last="Murzalieva">Gulgun Murzalieva</name></noCountry><country name="Royaume-Uni"><noRegion><name sortKey="Spicer, Neil" sort="Spicer, Neil" uniqKey="Spicer N" first="Neil" last="Spicer">Neil Spicer</name></noRegion><name sortKey="Harmer, Andrew" sort="Harmer, Andrew" uniqKey="Harmer A" first="Andrew" last="Harmer">Andrew Harmer</name></country><country name="Ukraine"><noRegion><name sortKey="Bogdan, Daryna" sort="Bogdan, Daryna" uniqKey="Bogdan D" first="Daryna" last="Bogdan">Daryna Bogdan</name></noRegion><name sortKey="Semigina, Tetiana" sort="Semigina, Tetiana" uniqKey="Semigina T" first="Tetiana" last="Semigina">Tetiana Semigina</name></country><country name="Irlande (pays)"><noRegion><name sortKey="Brugha, Ruairi" sort="Brugha, Ruairi" uniqKey="Brugha R" first="Ruairi" last="Brugha">Ruairi Brugha</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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