HIV infection associated with drug injecting in the Newly Independent States, eastern Europe: the social and economic context of epidemics
HIV infection associated with drug injecting in the Newly Independent States, eastern Europe: the social and economic context of epidemics
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DOI：
10.1046/j.1360-0443.1999.94913235.x
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发表时间：
1999-09-01
期刊：
影响因子：
6
通讯作者：
Andrushchak, L
中科院分区：
文献类型：
--
作者：
Rhodes, T;Ball, A;Andrushchak, L
目标。我们回顾了东欧新独立国家（NIS）中与注射吸毒（IDU）相关的艾滋病毒最新趋势，包括中亚的白俄罗斯、摩尔多瓦、俄罗斯、乌克兰和哈萨克斯坦。我们的目的是提请人们注意艾滋病毒在注射吸毒者中迅速传播的社会和经济“风险环境”。方法。调查结果借鉴了由国际发展机构资助的集中登记的艾滋病毒监测数据、已发表的研究报告和评估报告。发现。自 1995 年以来，有证据表明艾滋病毒在白俄罗斯、哈萨克斯坦、摩尔多瓦、俄罗斯和乌克兰迅速传播，估计新发艾滋病毒感染者中有 50% 至 90% 是注射吸毒者。与此同时，梅毒发病率迅速上升，健康和福利状况下降，包括白喉、结核病和霍乱的爆发。调查结果强调了社会和经济环境在创造有利于艾滋病毒和流行病传播的“风险环境”方面的潜在影响。关键因素包括：注射吸毒者的快速扩散；人口迁移和混合；经济转型和衰退；失业和贫困加剧；非正规经济的增长；药品生产、销售和消费方式；公共卫生收入和基础设施下降；以及政治、思想和文化转型。结论。了解介导艾滋病毒传播的社会和经济背景是确定流行病爆发的环境“先决条件”的先决条件，因此也是预测和预防艾滋病毒传播的先决条件。 “风险环境”可能会影响个人和社区层面艾滋病毒预防的效果，并凸显针对社会和环境变化的干预措施的紧迫性。
Aims. We review recent trends in HIV associated with injecting drug use (IDU) in the Newly Independent States (NIS) in eastern Europe, including Belarus, Moldova, Russia, Ukraine, and Kazakhstan in central Asia. We aim to draw attention to the social and economic "risk environments" in which rapid HIV spread among IDUs has occurred. Methods. Findings draw on centrally registered HIV surveillance data, published research studies and assessment reports funded by international development agencies. Findings. Since 1995, there is evidence of rapid HIV spread in Belarus, Kazakhstan, Moldova, Russia and Ukraine, with estimates suggesting between 50% and 90% of new HIV infections among IDUs. At the same time, there have been rapid increases in the incidence of syphilis and declines in health and welfare status, including outbreaks of diphtheria, tuberculosis and cholera. Findings emphasize the potential influence of the social and economic context in creating the "risk environments" conducive to HIV and epidemic spread. Key factors include: rapid diffusions in IDU; population migration and mixing; economic transition and decline; increasing unemployment and impoverishment; the growth of informal economies; modes of drug production, distribution and consumption; declines in public health revenue and infrastructure; and political, ideological and cultural transition. Conclusions. An understanding of the social and economic contexts mediating HIV spread is a prerequiste to identifying the environmental "pre-conditions" of epidemic outbreaks, and thus also, for predicting and preventing HIV transmission. The "risk environment" may influence the efficacy of individual and community-level HIV prevention and highlights the concomitant urgency for interventions targeting social and environmental change.