A review of medical and substance use co-morbidities in Central Asian prisons: implications for HIV prevention and treatment.
A review of medical and substance use co-morbidities in Central Asian prisons: implications for HIV prevention and treatment.
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DOI：
10.1016/j.drugalcdep.2013.07.010
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发表时间：
2013-11
影响因子：
4.2
通讯作者：
Altice FL
中科院分区：
文献类型：
--
作者：
Vagenas P;Azbel L;Polonsky M;Kerimi N;Mamyrov M;Dvoryak S;Altice FL
中亚的艾滋病毒发病率正在迅速上升。注射毒品(PWID)的人对这一流行病的贡献最大，所有艾滋病毒病例的四分之一以上在刑事司法系统(CJS)。这项审查汇集和汇总了中亚和阿塞拜疆共和国CJS与毒品有关的健康问题和各自的医疗服务的最新数据。审查了在线数据库和已发表的文献(同行评议和灰色文献)。此外，这6个国家的监狱官员应邀参加了一项调查，来自哈萨克斯坦、吉尔吉斯斯坦和塔吉克斯坦的监狱管理人员完成了调查。关于中亚监狱条件和医疗保健的数据不一致，缺乏公正的细节。报告主要基于“官方”疾病登记，而这些登记明显低估了流行率。然而，即使是这些有限的数据也表明，艾滋病毒流行率和与毒品有关的健康问题高度集中，在一些国家迅速上升。该区域只实施了国际组织建议的艾滋病毒预防干预措施中的一部分，其中两项关键干预措施--针头和注射器交换方案(NSP)和阿片类药物替代疗法(OST)--仅在吉尔吉斯斯坦监狱提供，塔吉克斯坦实施了NSP试点，并考虑引入监狱中的OST。尽管在常规健康报告方面存在缺陷，监狱中对艾滋病毒哨点的监测也不充分，但关于监狱中高危人群中艾滋病毒浓度的现有数据表明，有必要扩大艾滋病毒预防和治疗服务的范围和规模。
HIV incidence in Central Asia is rising rapidly. People who inject drugs (PWIDs) contribute greatest to the epidemic, with more than a quarter of all HIV cases being in the criminal justice system (CJS). This review assembled and aggregated recent data on drug-related health problems and respective healthcare services in the CJS of Central Asia and the Republic of Azerbaijan. Online databases and published literature (peer-reviewed and grey) were reviewed. Additionally, prison officials in the 6 countries were invited to participate in a survey and prison administrators from Kazakhstan, Kyrgyzstan and Tajikistan completed it. The data on conditions and healthcare in Central Asian prisons are inconsistent and lack unbiased details. Reporting is primarily based on “official” disease registries, which markedly underestimate prevalence. Even these limited data, however, indicate that HIV prevalence and drug-related health problems are high, concentrated and, in some countries, rising rapidly. Only some of the range of HIV prevention interventions recommended by international organizations have been implemented in the region with two of the crucial interventions, needle and syringe exchange programs (NSP) and opioid substitution therapy (OST), only available in Kyrgyzstan prisons, with Tajikistan implementing a pilot NSP and contemplating introduction of prison-based OST. Despite deficiencies in routine health reporting and insufficient HIV sentinel surveillance undertaken in prisons, the data available on the concentration of HIV within at-risk populations in prisons indicate a necessity to broaden the range and increase the scale the scale of HIV prevention and treatment services.