Cent Eur J Public Health 2010, 18(2):110-115 | DOI: 10.21101/cejph.a3583

HIV/AIDS in the Countries of the Former Soviet Union: Societal and Attitudinal Challenges

Bernd Rechel
European Observatory on Health Systems and Policies and London School of Hygiene & Tropical Medicine, Keppel Street, UK

For several years, some of the countries of the former Soviet Union have experienced the fastest growing HIV epidemic in the world, with the vast majority of reported infections contracted through injecting drug use. However, most governments of the region have been slow to recognize the severity of the problem. The scope and coverage of governmental HIV/AIDS programmes have remained very limited. Harm reduction programmes are mainly financed by external donors, while substitution treatment remains illegal in Russia and unavailable in some other countries of the region. Being based on a review of published and grey literature, this paper explores attitudinal and societal barriers to scaling up HIV programmes in the countries of the former Soviet Union. A major challenge in many countries is negative public attitudes towards people living with HIV, as well as towards those most at risk of contracting the disease: injecting drug users, sex workers, and men who have sex with men. This extends to the actions of state authorities which often pursue a punitive approach to drug users, with high rates of incarceration for minor drug offences. While many of the findings reported here relate to the Russian Federation, there is reason to believe that similar challenges exist in many other countries of the former Soviet Union. More needs to be done to document challenges to HIV prevention and treatment programmes across the region, so that policy interventions can be more effective.

Klíčová slova: Central and Eastern Europe, former Soviet Union, HIV/AIDS, prejudice, discrimination

Vloženo: 31. srpen 2009; Revidováno: 18. únor 2010; Přijato: 18. únor 2010; Zveřejněno: 1. červen 2010  Zobrazit citaci

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Rechel B. HIV/AIDS in the Countries of the Former Soviet Union: Societal and Attitudinal Challenges. Cent Eur J Public Health. 2010;18(2):110-115. doi: 10.21101/cejph.a3583. PubMed PMID: 20939262.
Stáhnout citaci

Reference

  1. Joint United Nations Programme on HIV/AIDS UNAIDS. 2009 AIDS epidemic update. Geneva: UNAIDS; 2009.
  2. Field MG. HIV andAIDS in the Former Soviet Bloc. N Engl J Med. 2004 Jul 8;351(2):117-20. Přejít k původnímu zdroji... Přejít na PubMed...
  3. Brown H. Russia's blossoming civil society holds the key to HIV. Lancet. 2006 Aug 5;368(9534):437-40. Přejít k původnímu zdroji... Přejít na PubMed...
  4. Open Society Institute. Harm reduction developments: countries with injection-driven HIV epidemics [Internet]. New York: Open Society Institute; 2008 [cited 2008 Apr 10]. Available from: http://www.soros.org/initiatives/health/focus/ihrd/articles_publications/publications/developments_20080304/developments_20080304.pdf.
  5. Joint United Nations Programme on HIV/AIDS UNAIDS. 2008 Report on the global AIDS epidemic. Geneva: UNAIDS; 2008.
  6. Wallander CA. Russian politics and HIV/AIDS: the institutional and leadership sources of an inadequate policy. In: Twigg JL, editor. HIV/ AIDS in Russia and Eurasia. New York: Palgrave Macmillan; 2006. p. 33-55. Přejít k původnímu zdroji...
  7. Bernitz BL, Rechel B. HIV data in Central and Eastern Europe: fact or fiction? In: Martic S, Lazarus JV, Donoghoe MC, editors. HIV/AIDS in Europe moving from death sentence to chronic disease management. Copenhagen: WHO Regional Office for Europe; 2006. p. 232-42.
  8. Mason J. Linking qualitative and quantitative data analysis. In: Bryman A, Burgess RG, editors. Analyzing qualitative data. London: Routledge; 1994. p. 89-110. Přejít k původnímu zdroji...
  9. Mays N, Pope C, Popay J. Systematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field. J Health Serv Res Policy. 2005 Jul;10 Suppl 1:6-20. Přejít k původnímu zdroji... Přejít na PubMed...
  10. Bobrova N, SarangA, Stuikyte R, Lezhentsev K. Obstacles in provision of anti-retroviral treatment to drug users in Central and Eastern Europe and CentralAsia: a regional overview. Int J Drug Policy. 2007Aug;18(4):31318. Přejít k původnímu zdroji... Přejít na PubMed...
  11. Wolfe D. Paradoxes in antiretroviral treatment for injecting drug users: access, adherence and structural barriers in Asia and the former Soviet Union. Int J Drug Policy. 2007 Aug;18(4):246-54. Přejít k původnímu zdroji... Přejít na PubMed...
  12. Tkatchenko-Schmidt E, Renton A, Gevorgyan R, Davydenko L, Atun R. Prevention of HIV/AIDS among injecting drug users in Russia: opportunities and barriers to scaling-up of harm reduction programmes. Health Policy. 2008 Feb;85(2):162-71. Přejít k původnímu zdroji... Přejít na PubMed...
  13. Sarang A, Stuikyte R, Bykov R. Implementation of harm reduction in Central and Eastern Europe and Central Asia. Int J Drug Policy. 2007 Mar;18(2):129-35. Přejít k původnímu zdroji... Přejít na PubMed...
  14. Rhodes T, Platt L, Sarang A, Vlasov A, Mikhailova L, Monaghan G. Street policing, injecting drug use and harm reduction in a Russian city: a qualitative study of police perspectives. J Urban Health. 2006 Sep;83(5):911-25. Přejít k původnímu zdroji... Přejít na PubMed...
  15. Heimer R, Booth RE, Irwin K, Merson M. HIVand drug use in Eurasia. In: Twigg JL, editor. HIV/AIDS in Russia and Eurasia. New York: Palgrave Macmillan; 2006. p. 141-63. Přejít k původnímu zdroji...
  16. Elovich R, Drucker E. On drug treatment and social control: Russian narcology's great leap backwards. Harm Reduct J. 2008 Jun 24;5:23. Přejít k původnímu zdroji... Přejít na PubMed...
  17. Latypov A. Understanding post 9/11 drug control policy and politics in Central Asia. Int J Drug Policy. 2009 Sep;20(5):387-91. Přejít k původnímu zdroji... Přejít na PubMed...
  18. Bobrova N, Rhodes T, Power R,Alcorn R, Neifeld E, Krasiukov N, et al. Barriers to accessing drug treatment in Russia: a qualitative study among injecting drug users in two cities. Drug Alcohol Depend. 2006 Apr;82 Suppl 1:S57-63. Přejít k původnímu zdroji...
  19. Stachowiak J, Peryshkina A. NGOs and HIV in Russia: lessons from a unique case study. In: Twigg JL, editor. HIV/AIDS in Russia and Eurasia. New York: Palgrave Macmillan; 2006. p. 57-76. Přejít k původnímu zdroji...
  20. Myers SL. 45 women die in fire at drug treatment hospital in Moscow. International Herald Tribune. 2006.
  21. Csete J. Rights and lessons scorned: human rights and HIV/AIDS in Russia and Eurasia. In: Twigg JL, editor. HIV/AIDS in Russia and Eurasia. New York: Palgrave Macmillan; 2006. p. 165-79. Přejít k původnímu zdroji...
  22. HIV/AIDS in Eastern Europe and the Commonwealth of Independent States. Reversing the epidemic: facts and policy options. Bratislava: United Nations Development Programme; 2004.
  23. Human Rights Watch. Rhetoric and risk: human rights abuses impeding Ukraine's fight against HIV/AIDS. New York: Human Rights Watch; 2006.
  24. Barcal K, Schumacher JE, Dumchev K, Moroz LV. A situational picture of HIV/AIDS and injecting drug use in Vinnitsya, Ukraine. Harm Reduct J. 2005 Sep 15;2(1):16. Přejít k původnímu zdroji... Přejít na PubMed...
  25. NationalScientificandAppliedCenterforPreventativeMedicine.Moldova: demographic and health survey 2005 [Internet]. Calverton: National Scientific and Applied Center for Preventive; 2006 [cited 2008 Dec 26]. Available from: http://pdf.usaid.gov/pdf_docs/PNADH788.pdf.
  26. International Labour Organization. Factsheet on HIV/AIDS discrimination at the workplace in Moldova [Internet]. Chisinau: International Labour Office; 2006 [cited 2008 Dec 26].Available from: http://www.aids.md/files/library/2006/1174/ilo-factsheet-hiv-discrimination-moldova2006.pdf.
  27. Balabanova Y, Coker R, Atun RA, Drobniewski F. Stigma and HIV infection in Russia. AIDS Care. 2006 Oct;18(7):846-52. Přejít k původnímu zdroji... Přejít na PubMed...
  28. Betteridge G. CEE/CA: Report calls for decriminalization of sex work. HIV AIDS Policy Law Rev. 2006 Apr;11(1):29-30.
  29. CragoAL, RakhmetovaA, Karadafov M, Islamova S, Maslova I. Central & Eastern Europe and CentralAsia: police raids and violence put sex workers at risk of HIV. HIV AIDS Policy Law Rev. 2008 Dec;13(2-3):71-2.
  30. Kelly JA,AmirkhanianYA. The newest epidemic: a review of HIV/AIDS in Central and Eastern Europe. Int J STD AIDS. 2003 Jun;14(6):36171. Přejít k původnímu zdroji...
  31. Republic of Moldova. Report on annual HIV/AIDS expenditures in the Republic of Moldova [Internet]. Chisinau: Ministry of Health of the Republic of Moldova; 2007 [cited 2008 Dec 26].Available from: http://www.aids.md/files/library/2007/1642/nasa-moldova-report-2007-en.pdf.
  32. Feshbach M. The early days of the HIV/AIDS epidemic in the former Soviet Union. Washington, DC: Woodrow Wilson International Center for Scholars; 2005. Přejít k původnímu zdroji...
  33. Shiffman J, Smith S. Generation of political priority for global health initiatives: a framework and case study of maternal mortality. Lancet. 2007 Oct 13;370(9595):1370-79. Přejít k původnímu zdroji... Přejít na PubMed...
  34. Hønneland G, Rowe L. Health as international politics: combating communicable diseases in the Baltic sea region. Aldershot: Ashgate; 2004.
  35. Vlassov VV, Danishevskiy KD. Biomedical journals and databases in Russia and Russian language in the former Soviet Union and beyond. Emerg Themes Epidemiol. 2008 Sep 30;5:15. Přejít k původnímu zdroji... Přejít na PubMed...
  36. Donoghoe MC, Lazarus JV, Matic S. HIV/AIDS in the transitional countries of Eastern Europe and Central Asia. Clin Med. 2005 SepOct;5(5):487-90. Přejít k původnímu zdroji...
  37. McKee M. Cochrane on Communism: the influence of ideology on the search for evidence. Int J Epidemiol. 2007 Apr;36(2):269-73. Přejít k původnímu zdroji... Přejít na PubMed...
  38. Moran D, Jordaan JA. HIV/AIDS in Russia: determinants of regional prevalence. Int J Health Geogr. 2007 Jun 6;6:22. Přejít k původnímu zdroji... Přejít na PubMed...
  39. Atun RA, McKee M, Drobniewski F, Coker R. Analysis of how the health systems context shapes responses to the control of human immunodeficiency virus: case-studies from the Russian Federation. Bull World Health Organ. 2005 Oct;83(10):730-38. Přejít na PubMed...
  40. Malinowska-Sempruch K, Bonnell R, Hoover J. Civil society - a leader in HIV prevention and tobacco control. Drug and Alcohol Rev. 2006 Nov;25(6):625-32. Přejít k původnímu zdroji... Přejít na PubMed...
  41. Rowe L, Rechel B. Fighting tuberculosis and HIV/AIDS in Northeast Europe: sustainable collaboration or political rhetoric? Eur J Public Health. 2006 Dec;16(6):609-14. Přejít k původnímu zdroji... Přejít na PubMed...
  42. Republic of Moldova. The Global Fund Proposal Summary - Round 8, 2008 [Internet]. Chisinau: Centre for Public Health and Sanitary Management; 2008 [cited 2008 Dec 26]. Available from: [http://www.aids.md/coordination/consultation/global-fund-viii/.
  43. Kübler D. Ideas as catalytic elements for policy change: advocacy coalitions and drug policy in Switzerland. In: Braun D, BuschA, editors. Public policy and political ideas. Cheltenham: Edward Elgar; 1999. p. 116-34.