‘Social evils’ and harm reduction: the evolving policy environment for human immunodeficiency virus prevention among injection drug users in China and Vietnam
Identifieur interne : 000147 ( Psycho/Analysis ); précédent : 000146; suivant : 000148‘Social evils’ and harm reduction: the evolving policy environment for human immunodeficiency virus prevention among injection drug users in China and Vietnam
Auteurs : Theodore M. Hammett ; Zunyou Wu ; Tran Tien Duc ; David Stephens ; Sheena Sullivan ; Wei Liu ; Yi Chen ; Doan Ngu [Viêt Nam] ; Don C. Des Jarlais [États-Unis]Source :
- Addiction [ 0965-2140 ] ; 2008-01.
Descripteurs français
- KwdFr :
- Chine (épidémiologie), Femelle, Humains, Infections à VIH (), Infections à VIH (épidémiologie), Mâle, Partage de seringue (effets indésirables), Politique de santé, Programme d'échange de seringues (organisation et administration), Programmes gouvernementaux, Promotion de la santé (), Toxicomanie intraveineuse (), Vietnam (épidémiologie).
- MESH :
- effets indésirables : Partage de seringue.
- organisation et administration : Programme d'échange de seringues.
- épidémiologie : Chine, Infections à VIH, Vietnam.
- Femelle, Humains, Infections à VIH, Mâle, Politique de santé, Programmes gouvernementaux, Promotion de la santé, Toxicomanie intraveineuse.
- Pascal (Inist)
- Wicri :
- geographic : République populaire de Chine.
- topic : Homme, Psychiatrie, Psychologie, Santé publique, Toxicomanie.
English descriptors
- KwdEn :
- AIDS, Addiction, China, China (epidemiology), Danger, Drug addiction, Environment, Female, Government Programs, HIV Infections (epidemiology), HIV Infections (prevention & control), Health Policy, Health Promotion (methods), Health policy, Human, Human immunodeficiency virus, Humans, Illicit drug, Intravenous administration, Male, Needle Sharing (adverse effects), Needle-Exchange Programs (organization & administration), Prevention, Psychiatry, Psychology, Public health, Reduction, Social aspect, Substance Abuse, Intravenous (prevention & control), Vietnam, Vietnam (epidemiology).
- MESH :
- geographic , epidemiology : China, Vietnam.
- adverse effects : Needle Sharing.
- epidemiology : HIV Infections.
- methods : Health Promotion.
- organization & administration : Needle-Exchange Programs.
- prevention & control : HIV Infections, Substance Abuse, Intravenous.
- Female, Government Programs, Health Policy, Humans, Male.
Abstract
Aims This paper reviews the evolution of government policies in China and Vietnam regarding harm reduction interventions for human immunodeficiency virus (HIV) prevention, such as needle/syringe provision and opioid substitution treatment. Methods The work is based upon the authors' experiences in and observations of these policy developments, as well as relevant government policy documents and legislation. Results Both countries are experiencing HIV epidemics driven by injection drug use and have maintained generally severe policies towards injection drug users (IDUs). In recent years, however, they have also officially endorsed harm reduction. We sought to understand how and why this apparently surprising policy evolution took place. Factors associated with growing support for harm reduction were similar but not identical in China and Vietnam. These included the emergence of effective ‘champions’ for such policies, an ethos of pragmatism and receptivity to evidence, growing collaboration across public health, police and other sectors, the influence of contingent events such as the severe acute respiratory syndrome (SARS) epidemic and pressure from donors and international organizations to adopt best practice in HIV prevention. Conclusions Ongoing challenges and lessons learned include the persistence of tensions between drug control and harm reduction that may have negative effects on programs until a fully harmonized policy environment is established. Excessive reliance on law enforcement and forced detoxification will not solve the problems of substance abuse or of HIV among drug users. Ongoing evaluation of harm reduction programs, as well as increased levels of multi‐sectoral training, collaboration and support are also needed.
Url:
DOI: 10.1111/j.1360-0443.2007.02053.x
Affiliations:
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ISTEX:1BE9947E5FF430575D3F83A424EB043E63630CA4Le document en format XML
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Vietnam regarding harm reduction interventions for human immunodeficiency virus (HIV) prevention, such as needle/syringe provision and opioid substitution treatment. Methods The work is based upon the authors' experiences in and observations of these policy developments, as well as relevant government policy documents and legislation. Results Both countries are experiencing HIV epidemics driven by injection drug use and have maintained generally severe policies towards injection drug users (IDUs). In recent years, however, they have also officially endorsed harm reduction. We sought to understand how and why this apparently surprising policy evolution took place. Factors associated with growing support for harm reduction were similar but not identical in China and Vietnam. These included the emergence of effective ‘champions’ for such policies, an ethos of pragmatism and receptivity to evidence, growing collaboration across public health, police and other sectors, the influence of contingent events such as the severe acute respiratory syndrome (SARS) epidemic and pressure from donors and international organizations to adopt best practice in HIV prevention. Conclusions Ongoing challenges and lessons learned include the persistence of tensions between drug control and harm reduction that may have negative effects on programs until a fully harmonized policy environment is established. Excessive reliance on law enforcement and forced detoxification will not solve the problems of substance abuse or of HIV among drug users. Ongoing evaluation of harm reduction programs, as well as increased levels of multi‐sectoral training, collaboration and support are also needed.</div></front></TEI><affiliations><list><country><li>Viêt Nam</li><li>États-Unis</li></country><region><li>État de New York</li></region></list><tree><noCountry><name sortKey="Chen, Yi" sort="Chen, Yi" uniqKey="Chen Y" first="Yi" last="Chen">Yi Chen</name><name sortKey="Duc, Tran Tien" sort="Duc, Tran Tien" uniqKey="Duc T" first="Tran Tien" last="Duc">Tran Tien Duc</name><name sortKey="Hammett, Theodore M" sort="Hammett, Theodore M" uniqKey="Hammett T" first="Theodore M." last="Hammett">Theodore M. Hammett</name><name sortKey="Liu, Wei" sort="Liu, Wei" uniqKey="Liu W" first="Wei" last="Liu">Wei Liu</name><name sortKey="Stephens, David" sort="Stephens, David" uniqKey="Stephens D" first="David" last="Stephens">David Stephens</name><name sortKey="Sullivan, Sheena" sort="Sullivan, Sheena" uniqKey="Sullivan S" first="Sheena" last="Sullivan">Sheena Sullivan</name><name sortKey="Wu, Zunyou" sort="Wu, Zunyou" uniqKey="Wu Z" first="Zunyou" last="Wu">Zunyou Wu</name></noCountry><country name="Viêt Nam"><noRegion><name sortKey="Ngu, Doan" sort="Ngu, Doan" uniqKey="Ngu D" first="Doan" last="Ngu">Doan Ngu</name></noRegion></country><country name="États-Unis"><region name="État de New York"><name sortKey="Des Jarlais, Don C" sort="Des Jarlais, Don C" uniqKey="Des Jarlais D" first="Don C." last="Des Jarlais">Don C. Des Jarlais</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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