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HIV treatment, drug use and community action in Ekaterinburg, Russia
Transcript of HIV treatment, drug use and community action in Ekaterinburg, Russia
median age 29 (25-48)
50% have children
44% currently employed
median years since HIV diagnosis - 5,5 69% (n=25/36) last IS </= 350 CD4,
22% (n=7/36) </= 100 CD4. Findings Vanya diagnosed in 2001
active drug use
volunteering at harm reduction program
in 2005 - felt acute need for treatment They wouldn’t give it to me. Initially, it was due to the fact I was using drugs, I didn’t hide that from the [doctors]. I also didn’t have registration papers, they had expired. They constantly found reasons not to prescribe me the treatment, although at that point I was already on my knees, my immune status was 60, and I was prepared to go to any lengths for my condition to end. I was really dying. I had loads of side effects. Most people had written me off for dead. They thought that that was it for me. And of course I was really suffering. I went to [the AIDS Center at] and had an argument with them. I asked them what they needed, whether they wanted me to crawl to them? I had given up help from the HR program condition improves starts to work in HR program
and help others however he faces Resistance From his peers From the AIDS Center serbia Yekaterinburg availability of treatment significantly increases in the last 5 years - wait until disease manifests itself physically Only when the shit hits the fan. I’ll start considering going there only when it gets really hot. I don’t think about it now. If I feel bad I’ll go get the pills, but not until then – why bother, I feel fine now. (AS13) ... but then get in for treatment when its very late - convinced that ARV uptake is not compatible with drug or alcohol and thus excused their resistance to initiation - refuse to get information about HIV - feel insecure and lack assurance of sustainability of the State provision of treatment ARV uptake is percieved as final submission to disease / official health moral boundary by multiplying regulations and bureaucratic procedures
required to initiate treatment the system builds barriers to accessing it IDU is not a formal contradition to ARV, but... “If you want to get ARVs – quit drugs and then come back” They told my husband to go and treat drug addiction, so off he went [from the AIDS center]. He never returned – what’s the point, he thought. They already told him everything. Next time he was brought there when he was very bad – a lying-down case by then. What did he die from? HIV. Low cell count or something, don’t know. (AS09: 42-51) System too hard to navigate - a complex scheme of pre-requirements of getting on treatment: multiple doctors, multiple visits to psychologist etc Drug treatment inefficient Golden standard treatment (opioid substitution) banned Existing system - no effectiveness and even that available only for money I went to that narcologist at the AIDS Center. She asked me tons of questions, like, how long I’ve been using, how long I’ve been a regular, what’s my dose, etc. And then she says... ‘I can’t help you’. I said I thought we have those special clinics and stuff, and if I wanted to quit they could help me. She said – no, can’t help you. Quit yourself, arrange it yourself, no problem. (AS09: 178-205) Absence of effective drug treatment seen by Vanya and others as the main barrier to receiving ARVs institualized stigma could organized community bridge IDUs
and health system and facilitate change? Community is not organized
No faith in self-help
IDUs busy doing drugs
Groups very underdeveloped
Several small initiatives by Vanya's NGO
but all initiatives repressed and have little effect Yet, change is achieved on individual level Vanya and his friends provide important
resource for individuals:
- through his work in harm reduction project
- constantly pushing people to health system
- and helping them navigate through
- and importantly, providing a resource of hope... Vanya often talks about being tired and exhausted, unrewarded and overwhelmed with the magnitude of the problem and number of people who require help. This feeling is reinforced with the place where Vanya finds himself and his organization – between the patients and health system, both resistant to build bridges Need for systemic change – such as decriminalization of drug use, making treatment (including OST) available may lead to decrease in internalized and institutionalized stigma, improved access to HIV treatment, and reinforce community organizing.
Health systems need to review existing barriers to HIV treatment and establish transparent systems of quality monitoring.
Vanya rules. Conclusion HIV treatment, drug use and community action in Ekaterinburg, Russia
Results of a qualitative study
Anya Sarang, Tim Rhodes, Nicolas Sheon One of a few countries where HIV epidemics continues to rise: 1.5 mln or more
- Especially among IDUs (80% of all PLWHs)
-37%IDUs HIV+, in some regions 75%
- 60.000 receive ARV- est 120.000 need it number of barriers to timely treatment initiation
emerging both from patients:
- due to varying interpretations of the dynamics of health and treatment
- moral resistance to submit to the medical authority
- perceived insecurity of treatment provision
and the public health system:
- imposes complex set or pre-requirements of getting ARVs which repel patients from timely initiation.
- drug users face many structural barriers
- absence of drug treatment, including ban on OST
Community work is underdeveloped
Howevre help is accomplished through efforts of committed individuals harm reduction
TB clinic summary/discussion