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Objective To estimate access, activity and coverage of needle and syringe programmes (NSP) in Central and Eastern Europe and Central Asia. Methods Two data sets (‘regional’ and ‘high-coverage sites’) were used to estimate NSP provision (availability/number of sites), NSP utilization (syringes distributed/year), needle and syringe distribution (needles/syringes distributed/IDU/year), IDU reached (number/percentage of IDU contacted/year), regular reach (five or more contacts/month) and syringe coverage (percentage of injections/IDU/year administrable with new injecting equipment). Results Regional data set: results from 213 sites in 25 countries suggested that Czech Republic, Poland, Russia and Ukraine had > 10 NSP during 2001/2. Czech Republic, Kazakhstan, Latvia, Russia, Slovakia and Ukraine had ≥ 10 000 IDU in contact with NSP. Ten countries reached ≥ 10% of the estimated IDU population. The 25 countries distributed ∼ 17 million syringes/needles. Eight countries distributed > 0.5 million syringes/year. Syringe coverage (assuming 400 injections/IDU/year) was < 5% in 19 countries, 5–15% in five and > 15% in Macedonia. Overall syringe coverage was 1.2% and when assuming 700 injections/IDU/year it decreased to 0.7%. Syringe coverage for the IDU population in contact with NSP was ≤ 15% in 10 countries, 15–60% in 11 and > 60% in Croatia, Macedonia, Moldova and Tajikistan. Overall syringe coverage for the population in contact with NSP was 9.8%. High-coverage data set: Soligorsk, Pskov and Sumy's NSP reached 92.3%, 92.2% and 73.3% of their estimated IDU population, respectively (regular reach: 0.2%, 1.8% and 22.7%). The distribution levels were 47.2, 51.7 and 94.2 syringes/IDU/year, respectively. Conclusion The evidence suggests suboptimal levels of NSP implementation, programme activity and coverage. This paper provides a baseline for development of indicators that could be used to monitor NSP. Strategies to increase coverage that may go beyond NSP are urgently required, as is research into understanding how NSP can contribute to better syringe coverage among IDU. [ABSTRACT FROM AUTHOR]

While harm reduction advocates, policy makers and practitioners have a right to be proud of the impact of interventions such as needle and syringe programmes on HIV risk, we can be less sanguine about the ongoing high levels of HCV transmission among injecting drug users (IDUs) and the expanding burden of hepatitis C virus (HCV)-related liver disease. In this Harm Reduction Digest Drs Byrne and Hallinan from the Redfern Clinic and Dr Dore from the National Centre in HIV Epidemiology and Clinical Research offer a model of integrated HCV prevention and treatment services within the setting of opioid pharmacotherapy. In their experience, this common-sense approach provides an opportunity to reduce the burden of HCV and improve overall patient management. They believe that the key elements of a HCV-specific harm reduction model include: regular HCV testing; clinical assessment and determination of need for HCV treatment referral; use of broader HCV treatment inclusion criteria; and flexibility in opioid pharmacotherapy dosing. In an environment when our macro harm reduction interventions seem to have, at best, modest impact on HCV transmission, good clinical practice may be our most effective strategy against the HCV epidemic. This paper provides some practical suggestions as to how this can be done. Simon Lenton Editor, Harm Reduction Digest [ABSTRACT FROM AUTHOR]

Eleven haemophilia treatment centres in the United States collaborated in the Hemophilia Behavioural Intervention Evaluation Projects (HBIEP) to develop theory-based interventions to reduce the risk of HIV transmission from seropositive adolescents and young adults with haemophilia. While the Transtheoretical Model of Behaviour Change and the Theory of Reasoned Action provided the theoretical underpinnings, the exact form in which these theories would be applied depended on developmental research. This paper presents the various phases of the process to develop the theory based interventions: literature review, qualitative interviews, quantitative surveys, a provider survey, a materials review, and the actual planning. All or portions of this process could be applied to the development of interventions for many behaviour-change projects. A description of the HBIEP interventions is also provided. [ABSTRACT FROM AUTHOR]

Epidemiological data on HIV seroprevalence has been essential in assessing the (future) extent of the AIDS epidemic. By coupling these data with quantifiable variables related to injection drug use (frequency of injecting, number of needle sharing partners) specific 'risk behaviors' could be determined, accounting for the rapid spread of the virus in the injecting drug user (IDU) population. Yet, such data give little information on the social mechanisms and setting generating such risk behaviors. In order to understand the transmission of HIV among the IDU population one needs to study the micro settings and social context of drug use. This paper describes and explores certain patterns of drug use, sharing, and natural support systems found amongst IDUs in two very different cities, Rotterdam (The Netherlands) and the Bronx, New York City (USA). By specifying details of the micro-settings of everyday drug use in both locales, it is possible to identify certain common elements and consequences of personal and social behavior driven by drug use per se (e.g. drug preference), and to differentiate these from behaviors and consequences determined by drug policy and the social context in which drug use actually occurs. These policies and the social context they create can in turn be shown to relate to risks for HIV transmission, e.g. the increased likelihood of sharing injection equipment. A more careful ethnographic approach, taking advantage of natural experimental opportunities, comparisons and controls, may be utilized to examine drug-related behaviors in their social context and to better assess their relevance to public health--especially to AIDS. [ABSTRACT FROM AUTHOR]

British government stragey for the prevention of HIV transmission in injecting drug users includes experimental syringe-exchange schemes for the provision of sterile injecting equipment to drug injectors who are unable or unwilling to stop injecting. This paper reports on the HIV risk behaviour of clients interviewed during the first year of the schemes. Most clients had accurate knowledge of the risk of infection from sharing syringes but few considered themselves to be at risk of HIV infection, 36% reported sharing needles and syringes at and shortly after intake. Most clients were sexually active and many had partners who did not inject drugs. The two main reasons for attendance were scarcity of injecting equipment and worry about AIDS. A majority of clients reported that they had already made changes in their injecting practices because of AIDS, and some reported changes in sexual behaviour. The study highlights the scale and nature of the task of helping drug injectors to change their behaviour. [ABSTRACT FROM AUTHOR]

Introduction: This paper examines the extent to which an intervention succeeded in locating people who had recently become infected with HIV in the context of the large‐scale Ukrainian epidemic. Locating and intervening with people who recently became infected with HIV (people with recent infection, or PwRI) can reduce forward HIV transmission and help PwRI remain healthy. Methods: The Transmission Reduction Intervention Project (TRIP) recruited recently‐infected and longer‐term infected seeds in Odessa, Ukraine, in 2013 to 2016, and asked them to help recruit their extended risk network members. The proportions of network members who were PwRI were compared between TRIP arms (i.e. networks of recently‐infected seeds vs. networks of longer‐term infected seeds) and to the proportion of participants who were PwRI in an RDS‐based Integrated Biobehavioral Surveillance of people who inject drugs in 2013. Results: The networks of PwRI seeds and those of longer‐term infected seeds had similar (2%) proportions who were themselves PwRI. This was higher than the 0.25% proportion in IBBS (OR = 7.80; p = 0.016). The odds ratio among the subset of participants who injected drugs was 11.17 (p = 0.003). Cost comparison analyses using simplified ingredients‐based methods found that TRIP spent no more than US $4513 per PwRI located whereas IBBS spent $11,924. Conclusions: Further research is needed to confirm these results and improve TRIP further, but our findings suggest that interventions that trace the networks of people who test HIV‐positive are a cost‐effective way to locate PwRI and reduce HIV transmission and should therefore be implemented. [ABSTRACT FROM AUTHOR]

Discusses the abstract of the research paper 'Transfusional Transmission of Human Immunodeficiency Virus (HIV) Despite Negativity of Nuclear Amplification Test,' by P. Renaudier, J.C. Tardy, et al, to be presented at the American Association of Blood Banks' 55th Annual Meeting on October 26-29, 2002.

The article offers information on topics related to women's health. It discusses the report by the U.S. Agency for International Development AIDS Support and Technical Assistance Resources (AID-STAR-One) Project on community's perception of services preventing mother-to-child transmission (PMTCT) of HIV. It mentions the policy brief exploring the need for family planning in Arab countries. It explores the paper by the Center for Global Development on adolescent fertility.

Discusses the abstract of the research paper 'The Fight Against the HIV Infection Transmission by Blood Transfusion in a Poor and Isolated Environment, Case of Kingasani Hospital Complex, Kinshasa, Democratic Republic of the Congo,' by C.A. Kazadi, et al, to be presented at the American Association of Blood Banks' 55th Annual Meeting on October 26-29, 2002.

Discusses the abstract of the research paper 'HIV Transmission during Antibody and Antigen Window Period,' by O.C. Ferreira Jr., et al, to be presented at the American Association of Blood Banks' 55th Annual Meeting on October 26-29, 2002.

Discusses the abstract of the research paper 'Residual Risk for Transfusion-Transmitted HIV and Cost-Benefit for HIV Nucleic Acid Amplification Technology in Brazil,' by L. Amorim, C. Silvia, et al, to be presented at the American Association of Blood Banks' 55th Annual Meeting on October 26-29, 2002.

The maternal-fetal HIV transmission trials, conducted in developing countries in the 1990s, undoubtedly generated one of the most intense, high profile controversies in international research ethics. They sparked off a prolonged acrimonious and public debate and deeply divided the scientific community. They also provided an impetus for the revision of the Declaration of Helsinki – the most widely known guideline for international research. In this paper, I provide a brief summary of the context, outline the arguments for and against the controversial use of placebo controls, and focus on particular areas that I believe merit further discussion or clarification. On balance, I argue that the researchers failed in their duties to protect the best interests of their research subjects, and to promote distributive justice. I discuss the difficulties of obtaining valid consent in this research context, and argue that it is unethical to inform women of their HIV status without at least offering them prophylactic treatment for their unborn children. A global view of justice, which endorses international equity, cannot be squared with international research guidelines that allow ‘local conditions’ to define the scope of duty to the control group. Finally, I suggest that the heated debate reflects a tension, if not an outright war, between two conflicting meta-ethical systems, or incommensurable paradigms, that underpin scientific research involving human subjects. [ABSTRACT FROM AUTHOR]