'Social evils' and harm reduction: the evolving policy environment for human immunodeficiency virus prevention among injection drug users in China and Vietnam
'Social evils' and harm reduction: the evolving policy environment for human immunodeficiency virus prevention among injection drug users in China and Vietnam
复制标题
DOI：
10.1111/j.1360-0443.2007.02053.x
复制
发表时间：
2008-01-01
期刊：
影响因子：
6
通讯作者：
Jarlais, Don C. Des
中科院分区：
文献类型：
--
作者：
Hammett, Theodore M.;Wu, Zunyou;Jarlais, Don C. Des
目的 本文回顾了中国和越南政府在预防人类免疫缺陷病毒 (HIV) 的减害干预措施方面政策的演变，例如提供针头/注射器和阿片类药物替代治疗。方法 这项工作基于作者对这些政策发展的经验和观察，以及相关的政府政策文件和立法。结果 两国都正在经历由注射吸毒引起的艾滋病毒流行，并且对注射吸毒者（IDU）普遍保持严厉的政策。然而，近年来，他们也正式支持减少危害。我们试图了解这种明显令人惊讶的政策演变是如何以及为何发生的。中国和越南与日益增长的减少危害支持相关的因素相似但不相同。其中包括此类政策的有效“拥护者”的出现、务实和接受证据的精神、公共卫生、警察和其他部门之间日益加强的合作、严重急性呼吸系统综合症（SARS）流行等突发事件的影响以及捐助者和国际组织要求采取艾滋病毒预防最佳做法的压力。结论 持续存在的挑战和吸取的经验教训包括药物管制和减少危害之间持续存在的紧张关系，在建立完全协调的政策环境之前，这可能会对规划产生负面影响。过度依赖执法和强制戒毒并不能解决吸毒者的药物滥用或艾滋病毒问题。还需要对减少危害计划进行持续评估，并提高多部门培训、合作和支持的水平。
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.