Structural Barriers to HIV Prevention and Treatment with IDUs in Ukraine

描述(申请人提供)：这是一项为期两年的拟议研究，旨在利用定性和定量的方法，系统地评估阻碍乌克兰注射吸毒者接受艾滋病毒预防服务、药物治疗和艾滋病毒抗逆转录病毒治疗的结构性障碍。乌克兰目前是整个欧洲艾滋病毒的中心，据估计，其感染率接近50万，占成年人口的1.5%。我们在那里的工作使我们相信，乌克兰的执法、卫生和政府实体导致了注射吸毒者每天面临的风险环境。拟议的项目将在敖德萨实施，我们自2001年以来一直在该市工作。具体目标是：1.通过与警察的焦点小组和对执法、卫生(包括艾滋病中心)和政府官员的深入半结构化访谈，了解在敖德萨对待注射吸毒者的不同观点以及他们是如何被对待和服务的；2.通过焦点小组和对感染艾滋病毒的和未感染的注射吸毒者进行深入的半结构化访谈，评估注射吸毒者在法律制度(包括街头警察和法院)和医疗机构成员方面的经验，以及他们对政府对注射吸毒者和艾滋病毒的立场的看法；3.使用定量方法，约谈200名注射吸毒者，其中50%将事先知道他们是艾滋病毒阳性者，了解他们在法律、戒毒治疗和保健系统方面的经验；4.与官员和吸毒者举行一系列会议和首脑会议，利用从定性和定量评估中获得的信息，传播调查结果，提出建议，并在执法、卫生和政府官员与吸毒者之间建立伙伴关系。这些目标将使我们能够：评估官员和前线工作人员对注射吸毒者、艾滋病毒预防和抗逆转录病毒治疗的态度、知识和信念；影响禁毒法律执行和向感染者提供治疗的因素；以及如何改变注射吸毒者的生态因素。我们打算利用这项探索性研究的结果来开发结构性干预措施，并将在敖德萨和我们工作过的其他城市进行测试。 公共卫生相关性：乌克兰目前处于整个欧洲艾滋病毒的中心，估计其流行率接近50万，占成年人口的1.5%。我们过去六年在该国的工作表明，来自法律、卫生和政府系统的结构性障碍往往阻碍注射吸毒者接受艾滋病毒预防服务、药物治疗和艾滋病毒抗逆转录病毒治疗。我们将运用定性和定量的方法，对这些障碍进行系统评估，提出改善措施，并制定结构性干预措施，以便在更大规模的试验中进行测试。

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.