Access to human services for medication clients as a powerful device for HIV control in Uzbekistan Azizbek A. Boltaev, M.


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Access to medicinal services for medication clients as a viable device for HIV control in Uzbekistan Azizbek A. Boltaev, M.D. Licit and Illegal Medications Class Bolstered by OSI IPF-Budapest, Honor B9163 and IHRA Infusing Drug Use and HIV in Uzbekistan
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Access to social insurance for medication clients as a successful device for HIV control in Uzbekistan Azizbek A. Boltaev, M.D. Licit and Illicit Drugs Seminar Supported by OSI IPF-Budapest, Award B9163 & IHRA

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Injecting Drug Use and HIV in Uzbekistan According to UNODC there are 61,000-91,000 medication clients in Uzbekistan 90% of evaluated 22,000 of medication clients in Tashkent use heroin as a medication of decision 58% (~12,700) of them devour heroin regular 78% are rehearsing infusion course of medication utilization

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Injecting Drug Use and HIV in Uzbekistan 82% of medication clients may have shared infusing gear And just 6% of IDUs “have never risked” 29.6% of all enlisted HIV people are IDUs 89.3% of HIV cases enrolled amid initial 6 month of 2004 are blood blaze contaminations

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Barriers in access to social insurance doubt of medication clients to Trust focuses and narcology administration in regards to their cooperation with local army (police) insufficient or once in a while no procurement with clean infusing hardware nonappearance of effort work among IDUs; nonattendance of arrangement of prizes or motivating forces for Trust focuses representatives: all the time specialists in charge of Trust focuses are not paid at all for this employment and they attempt to exchange this occupation to another specialist.

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Barriers in access to social insurance once in a while workers of Trust focuses don\'t comprehend their central goal, and some of them surmise that their essential obligation is to enlist whatever number IDUs as could be allowed and control their conduct: One of key sources has remembered a situation when one of new specialists of city-based Trust focuses as proof of his phenomenal action brought several letters marked by IDUs promising not to impart their infusing hardware to peers!

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Barriers in access to human services NGOs, effectively getting to IDUs and offering SEP, were demonstrated as not practical foundations and absolutely reliant on budgetary backing of universal contributors. The more drawn out medication use history the lesser consideration they could call their own wellbeing among medication clients and social insurance looking for Detox in authority state possessed facilities was shown as exceptionally out of reach because of deficiency of beds in healing centers and extremely undesirable because of apprehension of being enrolled and subsequently to get into the “black list” of police.

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Barriers in access to medicinal services High edge administrations limits use of the administrations by medication clients Often the individuals who came to narcology dispensary to go into treatment project are being rejected because of that more than ¾ of beds in centers are being possessed by the individuals who are on obligatory treatment which may proceed with 3-6 months. Police coordinate their endeavors on seizure of medication clients as wrongdoings as opposed to street pharmacists Key sources think about bunches of cases medication clients were detained by solicitations of relatives after a few unsuccessful endeavors to get off the needle with backing of specialists or experiencing issues to get to a decent habit treatment. Sources trust that there are heaps of IDUs are put into prisons under specified circumstances.

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Barriers in access to medicinal services No hostile to retroviral treatment is accessible in Uzbekistan No opioid support treatment is accessible yet Introduction of methadone in Uzbekistan relies on upon individual conclusion and accepts of authorities from state medication control offices. General Practitioners absence of information and aptitudes to successfully work with patients who utilization drugs. Subsequently, all the time specialists don\'t make inquiries identified with conceivable medication use history of the patient Services for medication clients gave by NGOs are packed for the most part in Tashkent, the capital of Uzbekistan while exceptionally humble number or none of IDUs from urban communities and provincial regions outside of the capital have admittance to such sort of administrations.

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Barriers in access to social insurance Different wellbeing administrations, for example, narcology, AIDS, SEPs, concentrated consideration, Infection facilities, psychiatric clinics are not incorporated in HIV aversion endeavors and in enhancing access to human services for IDUs and frequently don’t think about the administrations offered by accomplices “Total forbearance from medication utilization or nothing” methodology is commanded in medication treatment administration Services offered to medication clients are composed without admiration of their phase of progress (Prochaska & De Clemente) and focused on just goodness the individuals who are in Determination\Preparation and Action stages. As a rule there are no backslide anticipation project is offered in Uzbekistan

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Barriers in access to medicinal services Recent confinements on NGOs action with gifts from global contributors generously predetermined number of medication administrations and scope of helpless gatherings of individuals

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What is Uzbekistan’s reaction to HIV plague? Current medication enslavement & HIV/AIDS treatment programs Uzbekistan has set up a countrywide system of trust focuses (n=230) managed by AIDS Center to convey hurt diminishment administrations as syringe trade and condom dispersion for IDUs and SWs (spread around 1% of evaluated # of IDUs Swiss Government accounts two syringe/needle trade programs in Samarqand and Tashkent worked by nearby NGOs Governmental Narcology Dispensaries have around 1600 beds to give treatment of substance utilization issue which generally comprises of detox with fractional restoration program which is ~60 times lower contrasting with the # of assessed medication clients required treatment

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Current medication compulsion & HIV/AIDS treatment programs AFEW had started a few jail ventures in Tashekent, Chirchik and Samarkand USAID and OSI are running Program on medication request lessening in Uzbekistan and Tajikistan World Vision and JICA are working a joint HIV counteractive action venture with 10 trust focuses in Tashkent-city covering give or take 1800 IDU with syringe trade administration

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Current medication habit & HIV/AIDS treatment programs Global Fund against AIDS, TB, and Malaria bolstered Uzbekistan’s award proposition on “Scaling-Up the Response to HIV/AIDS and Tuberculosis in Uzbekistan: A Focus on Vulnerable Populations” with a more than 25 million spending plan for the time of 2004-2007 Two AA and A self care groups work in Tashkent and one in Angren. One SMART-Recovery self improvement gathering works in Bukhara

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Are this projects successful? We don’t know! Be that as it may, WHY ? Exceptionally restricted looks into are directed to examine the viability of medication treatment and HIV anticipation programs in Uzbekistan Substance misuse related administrations regularly cover little gathering * of target populace to have an effect on epidemiologic circumstance Very frequently these administrations are not feasible to gauge long haul impacts of mediation Even when assessment of adequacy is arranged, it is being executed by the same administration suppliers who are not intrigued by “bad results or poor effectiveness”

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Are this projects compelling? We don’t know! Why? Evaluators normally don’t have essential aptitudes and/or learning to benefit an exploration Unreliable Soviet model of information gathering & measurements in Uzbekistan generously restricts capacities of specialists Substance misuse related administrations are not all around incorporated with one another Importance of assessment of viability of mediations in change of administrations is disparaged by administration suppliers and benefactors

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Conclusions & Recommendations During most recent 4 years number of enrolled HIV cases in Uzbekistan has expanded more than 1300 % Injecting medication utilization assumes a main part in HIV transmission in Uzbekistan Without powerful reactions Uzbekistan soon may turn into a pioneer by HIV notice rate among all Central Asian nations Treatment and HIV counteractive action (as SEPs) projects concealment to 600% less of all objective populace Existing system of trust focuses in Uzbekistan DOES permit to give syringe trade project to dominant part of IDUs and to turn into a viable device in control of HIV scourge in the district

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Acknowledgments International Harm Reduction Association Open Society Institute’s International Policy Fellowship and International Harm Reduction Development Programs International Socie

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