Transcript Slide 1

Legal climate for HIV prevention
work with injection drug users in
Temirtau, Kazakhstan
Republic of Kazakhstan, Karaganda, NGO “Credo”
Gulnara Darbekova (1), Nadezhda Kozachenko (1), Irina
Mingazova (1), Alexander Solodov (1), Natalia Kartashova
(1), Zita Lazzarini (2,3), Patricia Case (4), Scott Burris (5,3)
Kazakhstan
Background. Temirtau, Kazakhstan, is a city of 170, 000 in northern
Kazakhstan. There were 1,322 prevalent cases of HIV reported (9/06) with
75% attributable to injection drug use (IDU). Previous research has shown
that laws and law enforcement practices are important factors influencing:
the spread of HIV-infection among IDUs; related risk behaviors; and
availability and efficiency of prevention measures. Kazakhstan, like all the
countries of CIS, has reformed its drug law and policy, trying to influence
the HIV/AIDS epidemic. But law enforcement practices have had results
different from those planned by the law-makers. Due to the fast spread of
HIV and drug-addiction, the situation is becoming critical. Local information
on laws, policies and law enforcement practices are necessary to influence
the situation locally and to develop the strategy of local preventive
measures against HIV/AIDS.
Methods. Using a research method called Rapid Policy Assessment (RPA), a team of local researchers from NGO
“Credo” collected written laws and policies, conducted 3 focus groups, interviews with key informants including
health care providers, lawyers, law enforcement representatives, NGO staff (N=26) and injection drug users
(N=14) to learn how the law, policies and their implementation influence health risks among IDUs. The Temirtau
RPA was conducted in 2006.
RESULTS
1. Police, especially low ranking officers, often
hold negative attitudes towards drug users,
characterizing them as criminals likely to
commit crimes in addition to drug use.
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• IDUs are the constant focus of police attention
(harassment, detention, threats and arrest).
• Police will stop intoxicated persons, or coerce
commercial sex workers to provide information to the
police.
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14
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10
Interview subjects reported …
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5
0
Negative attitude of police tow ards IDU
IDUs are the constant focus of police attention
Police is using force against IDUs
Figure 1: Attitudes of Law Enforcement Agencies to IDUs
2. Drug treatment is available, but it falls short
of “best practices”.
Interview subjects reported …
• Substitution therapy is not available; No 12-Step
programs
• Drug treatment only available in Narcological
Centers; only detox and talk therapy
Interview subjects reported …
• “Registered” drug users are subject to
discrimination in employment and other stigma.
3. Narcological Centers provide mandatory
drug treatment and require “Registration”
as a drug user.
• Drug users are reluctant to participate due to long
term consequences of registration
4. Obstacles to HIV testing include “informal”
charges for care.
Interview subjects reported …
• Although HIV tests are supposed to be free (by
regulation), clinics charge for drawing blood.
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10
10
0
Figure 2: Availability of HIV testing and
counseling & drug treatment services
Availability of HIV-testing and consultations
Availability of in-patient and out-patient drug addiction
therapy
CONCLUSIONS
Although drug law reform and official government policies aim to reduce drug use and the spread
of HIV, in practice, law enforcement, the official mechanisms for drug treatment, and even some
public health interventions are creating barriers to the government’s goals. Interventions that
could reduce these barriers include: education of police regarding drug use, drug users and their
rights; expansion of drug treatment to include opiate substitution therapy, 12-step programs, and a
wider range of treatment sites; elimination of “registration” of drug users and enforcement of laws
against discrimination; and government intervention to ensure real “access” to public health
programs such as HIV counseling and testing.
This research was supported by NIDA/NIH Grant # 5 R01 DA17002-02 PI: LAZZARINI, ZITA . The findings and conclusions expressed are those of the
authors and not necessarily of NIH, NIDA, or the US Government.
The development of RPAR was supported by the International Harm Reduction Development Program of the Open Society Institute in 2001-2002.
(1) Public Association CREDO, Karaganda, Kazakhstan (2) University of Connecticut Health Center, USA, (3) Center for Law and the Public’s Health at
Georgetown and Johns Hopkins Universities, USA, (4) Fenway Community Health Center, USA , (5) Temple University Beasley School of Law, USA
Public
Association
CREDO