Structural Barriers to HIV Prevention and Treatment with IDUs in Ukraine

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DESCRIPTION (provided by applicant): This is a 2 year proposed study designed to systematically assess, using qualitative and quantitative methods, structural barriers that impede IDUs in Ukraine from receiving HIV prevention services, drug treatment and HIV antiretroviral therapy. Ukraine is presently at the epicenter of HIV in all of Europe, with an estimated prevalence of nearly 500,000 or 1.5% of the adult population. Our work there has led us to believe that law enforcement, health and governmental entities in Ukraine contribute to the risk environment IDUs face on a daily basis. The proposed project will be implemented in Odessa, a city where we have worked since 2001. Specific aims are: 1. Gain an understanding of the varied perspectives in which IDUs are regarded and how they are acted toward and served in Odessa using focus groups with police officers and in-depth semi- structured interviews with officials from law enforcement, health (including the AIDS Center) and government; 2. Assess IDUs experiences with the legal system (including street officers and the courts) and members of the medical establishment, as well as their perception of the government's position regarding IDUs and HIV, through focus groups and in-depth semi-structured interviews with HIV-infected and non-infected IDUs; 3. Using quantitative methods, interview 200 IDUs, 50% of whom will have prior knowledge that they are HIV positive, about their experiences with the legal, drug treatment and health care systems; 4. Convene a series of meetings and a summit with officials and drug users to disseminate findings, make recommendations and develop a partnership between law enforcement, health and government officials and drug users using the information gained from the qualitative and quantitative assessment. These aims will allow us to: assess attitudes, knowledge and beliefs of officials and frontline staff concerning IDUs, HIV prevention and antiretroviral treatment; factors that affect how drug laws are enforced and treatment is provided to those infected; and how ecological factors could be changed with respect to drug injectors. It is our intention to use the findings from this exploratory study to develop a structural intervention that will be tested in Odessa and the other cites where we have worked. PUBLIC HEALTH RELEVANCE: Ukraine is presently at the epicenter of HIV in all of Europe, with an estimated prevalence of nearly 500,000 or 1.5% of the adult population. Our work in the country over the past six years has indicated that structural barriers from the legal, health and governmental systems often impede IDUs from receiving HIV prevention services, drug treatment and HIV antiretroviral therapy. Using qualitative and quantitative methods, we will systemically assess these barriers, recommend measures to improve them, and develop a structural intervention to be tested in a larger trial.