Фактори, пов’язані з досвідом передозувань наркотиками опіоїдного ряду у споживачів ін’єкційних наркотиків

АКТУАЛЬНІСТЬ. Смертям, пов’язаним з передозуванням опіоїдними наркотиками, можна запобігти. При цьому в країнах Європейського Союзу серед людей віком 20-40 років щороку реєструють 8 000 таких смертей. В Україні щороку реєструють 10 000 смертей, пов’язаних зі вживанням наркотиків, проте на даний момент не можливо встановити рівень смертності від передозувань наркотиками опіоїдного ряду. Поведінкові дослідження 2007–2009 років показують, що 11-14% опитаних споживачів ін’єкційних наркотиків мали випадки передозувань та вижили. Метою дослідження було встановити, з якими характеристиками споживачів наркотиків пов’язаний ризик передозувань. МЕТОДИ. У дослідженні було використано дані опитування, яке провів Міжнародний Альянс з ВІЛ/СНІД в Україні протягом січня-листопада 2007 року серед споживачів наркотиків, які вживали наркотики протягом останніх 3 місяців, що передували опитуванню. Вибірка була сформована за принципом місця та зручності та охопила 8 575 респондентів. РЕЗУЛЬТАТИ. Вживання коли-небудь в житті героїну (скориговане відношення шансів 1,54, довірчий інтервал 1,07-2,22), «бовтушки» (СВШ 1,70 ДІ 1,22 -2,36), щоденне споживання наркотиків ін’єкційним шляхом (СВШ 1,92 ДІ 1,10-3,34), надання респондентом свого використаного шприцу іншій людині протягом останніх 3 місяців (СВШ 1,68 ДІ 1,15-2,45) були позитивно пов’язані з досвідом передозувань після врахування третіх факторів. Звернення до швидкої медичної допомоги протягом останніх 3 місяців (СВШ 0,46 ДІ 0,21-0,99) та придбання респондентом готової наркотичної речовини (СВШ 0,56 ДІ 0,41-0,76) були негативно пов’язані з досвідом передозувань. ОБГОВОРЕННЯ. Отримані результати щодо вживання «бовтушки» можуть свідчити про те, що даний вид наркотичної речовини найчастіше поєднують з різними опіоїдними наркотиками. Героїн не є широко розповсюдженим в Україні, тому споживачі можуть помилково розрахувати потрібну їм дозу чи концентрацію, що може призвести до передозування. Висока частота ін’єкцій свідчить про збільшення толерантності до наркотичної речовини і намагання збільшити дозу, при цьому перерви в прийомах можуть значно скорочуватись. В такі періоди СІНи в прагненні полегшити свій стан можуть ввести в організм критичну кількість наркотику. Ризикована поведінка щодо надання свого використаного шприцу іншій людині може бути характеристикою респондентів, яким загалом властива ризикована сексуальна та ін’єкційна поведінка, а отже такі респонденти наражені на ризик передозування наркотиками. Респонденти, які купують готовий розчин наркотичної речовини, не можуть впливати на концентрацію даного розчину, і в порівнянні з тими, хто готує наркотики самостійно, споживають менш концентрований наркотик. Усі ці фактори варто враховувати в програмах профілактики передозувань

Occupational barriers to HIV care in female sex workers living with HIV: structural or community solutions?

The UNAIDS 90-90-90 targets, defined as 90% of people living with HIV aware of their status, among which 90% are on antiretroviral treatment (ART) and among which 90% have HIV viral suppression, have galvanised efforts worldwide to reduce HIV transmission with the goal of ending the HIV epidemic by 2030. Sex workers, who are particularly vulnerable to HIV, and their sexual partners account for more than half (54%) of new HIV infections globally.1 Available data suggest that the relative risk of HIV acquisition among sex workers globally was 21 times higher than it was among all adults aged 15–49 years in 2018.1 Still, ART utilisation is poor among female sex workers (FSWs) globally—with an estimated 38% and 57% pooled prevalence for current ART use and viral suppression, respectively.2 With the goal of ending the AIDS epidemic by 2030, the critical question is how to increase the 90-90-90 targets, including awareness of HIV status, initiation and adherence to ART among sex workers

Курение подростков в Российской Федерации в сравнении с другими странами бывшего Советского Союза и Центрально-Восточной Европы. Результаты Глобального опроса молодежи о табаке

We aimed to compare characteristics of tobacco consumption among adolescents in Russian Federation with countries of Central and Eastern Europe based on the data of Global Youth Tobacco Survey, carried out among adolescents aged 13—15 years in European middle and low income countries in 1999-2005. Russian Federation was characterized with higher rates of smoking prevalence among adolescents, earlier smoking initiation, higher chances to be daily smokers and dependent smokers. In Russian society, awareness of smoking-related harm was lower than in other European countries. Smoking was more likely to be considered a characteristic of popularity and success. Russian adolescents were more often exposed to second-hand smoke in their homes and in public places, but not in educational institutions. Keywords: tobacco smoking, adolescents, Global Youth Tobacco Survey.Оценены особенности потребления табачных изделий среди подростков в Российской Федерации в сравнении с соседними странами Европы по данным Глобального опроса о табаке среди подростков 13-15 лет, который проводился в Европейских странах со средним или низким уровнем доходов в 1999-2005 годах. Российская Федерация отличается более высокими показателями распространенности курения среди подростков, его более ранним началом и большей склонностью к переходу к ежедневному и зависимому курению. В российском обществе представления о вреде курения для здоровья являлись менее распространенными, чем в других странах Европы. Курение чаще рассматривалось как признак популярности и успешности. Российские подростки в большей мере подвергались воздействию вторичного дыма в жилищах и в общественных местах, но не в учебных заведениях.Ключевые слова: курение табачных изделий, подростки, Глобальный опрос молодежи о потреблении табака

'I don't want anyone to know': Experiences of obtaining access to HIV testing by Eastern European, non-European Union sex workers in Amsterdam, the Netherlands.

Historically, the Netherlands has hosted a large number of migrant sex workers. Since sex work is considered a legal profession it might serve as an example of better access to health services, including HIV testing, at least for those working within the legal framework. However, migrant sex workers, especially non-European Union (EU) nationals, might not be eligible to register for official employment and thus face obstacles in obtaining access to health services, becoming essentially invisible. This study examined context-specific vulnerabilities of migrant female sex workers (FSWs) from Belarus, Moldova, Russia and Ukraine, whether and how they have access to HIV testing compared to other EE, non-EU migrant FSWs in Amsterdam in the Netherlands. We conducted a multi-stakeholder perspective study from November 2015 to September 2017 in Amsterdam. The study comprised 1) semi-structured interviews with key stakeholders (N = 19); 2) in-depth interviews with Eastern European, non-EU migrant FSWs (N = 5) and field observations of the escort agency working with them; and 3) in-depth interviews with key stakeholders (N = 12). We found six key barriers to HIV testing: 1) migration and sex-work policies; 2) stigma, including self-stigmatization; 3) lack of trust in healthcare providers or social workers; 4) low levels of Dutch or English languages; 5) negative experience in accessing healthcare services in the home country; and 6) low perceived risk and HIV-related knowledge. Having a family and children, social support and working at the licensed sex-work venues might facilitate HIV testing. However, Internet-based sex workers remain invisible in the sex-work industry. Our findings indicate the importance of addressing women's diverse experiences, shaped by intrapersonal, interpersonal, community, network and policy-level factors, with stigma being at the core. We call for the scaling up of outreach interventions focusing on FSWs and, in particular, migrant FSWs working onlin

'Virus Carriers' and HIV testing: navigating Ukraine's HIV policies and programming for female sex workers

Background: There are an estimated 80,100 female sex workers (FSWs) in Ukraine, of whom 7% are living with HIV. Early HIV diagnosis continues to be a public health priority in Ukraine as only approximately 54% of people living with HIV are diagnosed nationwide. This study aims to analyse the content, context and discourse of HIV testing policies among female sex workers in Ukraine and how these policies are understood and implemented in practice. Methods: To analyse past and current national policies, we searched the database of the Ukrainian Parliament and the Ministry of Health for relevant policy documents (e.g. legislation and orders). To analyse the day-to-day practice of those involved in the implementation of these HIV programmes, we conducted face-to-face semi-structured interviews with key stakeholders. All data were coded using deductive thematic analysis initially guided by the Policy Triangle, a framework which addresses policy content, the process of policy-making, the health policy context, actors involved in policy formulation and implementation. Results: HIV testing policies are formed and implemented in the post-Soviet context through a vertical system of AIDS clinics, resulting in the separation of key affected populations from the rest of the health system. Successive testing policies have been strongly influenced by international donors and non-governmental organisations. Furthermore, a lack of government funding for HIV prevention created a gap that international donors and local non-governmental organisations covered to ensure the implementation of testing policies. Their role, however, had limited influence on the Ukrainian government to increase funding for prevention, including testing of FSWs. Since the early 1990s, when stigmatising and discriminatory forced/mandatory HIV testing was applied, these approaches were slowly replaced with voluntary testing, self-testing and assisted HIV testing, yet stigma was found to be a barrier among FSWs to access testing. Conclusion: Poor governance and the fragmentation of the health system, ongoing health sector reforms, shrinking international funding, and persisting stigma towards people living with HIV and sex workers might impede the continuity and sustainability of HIV testing programmes. Local civil society may now have the opportunity to contribute to the development and further implementation of HIV testing policies in Ukraine

Scale Up Multilingualism in Health Emergency Learning : Developing an Automated Transcription and Translation Tool

World Health Organization's (WHO) emergency learning platform OpenWHO provided by Hasso Plattner Institut (HPI) delivered online learning in real-time and in multiple languages during the COVID-19 pandemic. The challenge was to move from manual transcription and translation to automated to increase the speed and quantity of materials and languages available. TransPipe tool was introduced to facilitate this task. We describe the TransPipe development, analyze its functioning and report key results achieved. TransPipe successfully connects existing services and provides a suitable workflow to create and maintain video subtitles in different languages. By the end of 2022, the tool transcribed nearly 4,700 minutes of video content and translated 1,050,700 characters of video subtitles. Automated transcription and translation have enormous potential as a public health learning tool, allowing the near-simultaneous availability of video subtitles on OpenWHO in many languages, thus improving the usability of the learning materials in multiple languages for wider audiences.publishedVersionPeer reviewe

Observations from three years of online pandemic learning response on OpenWHO

publishedVersionPeer reviewe

Using Digital Tools to Train Health Emergencies Personnel in Fragile Contexts

The Leadership in Emergencies learning programme, launched in 2019, was designed to strengthen the competencies of World Health Organization (WHO) and Member State staff in teamwork, decision-making and communication, key skills required to lead effectively in emergencies. While the programme was initially used to train 43 staff in a workshop setting, the COVID-19 pandemic required a new remote approach. An online learning environment was developed using a variety of digital tools including WHO's open learning platform, OpenWHO.org. The strategic use of these technologies enabled WHO to dramatically expand access to the programme for personnel responding to health emergencies in fragile contexts and increase participation among key groups that were previously underserved.publishedVersionPeer reviewe

Digitalizing WHO’s Health Emergency Leadership Training During the Pandemic

publishedVersionPeer reviewe

Harnessing technology to respond to the global demand for learning during the COVID-19 pandemic

The COVID-19 pandemic generated an unprecedented global demand for learning about the disease and how to manage it. This paper draws on theWorld Health Organization (WHO)'s experience of COVID-19 knowledge-transfer to a worldwide audience of millions of learners registered on OpenWHO, WHO's massive open online course platform. It aims to illustrate the technological solutions that WHO, in collaboration with the Hasso Plattner Institute (HPI), OpenWHO's platform provider, employed in response to the unique challenges this surge in demand for learning engendered. Data on OpenWHO use, including geographic patterns and certificate attainment, were extracted from OpenWHO's internal and external reporting systems. Descriptive analysis was employed to identify trends and compare OpenWHO use with COVID-19 caseload in each WHO region. Data on the OpenWHO system load were obtained from the OpenWHO load balancer (HAProxy). The OpenWHO team responded to the need for trustworthy, evidence-based knowledge on COVID-19 via three main avenues: increased scale, targeting the needs of affected and underserved communities, and prioritising multilingualism. Each approach brought novel problems, which WHO and HPI leveraged their collaboration to meet by employing technology. This included increasing server bandwidth, expanding support teams, adding new language capabilities, and deploying functions to streamline workflows and boost learner experience. In doing so, the ability to effectively and efficiently harness technology became a critical step towards empowering learning's life-saving potential during the COVID-19 pandemic.publishedVersionPeer reviewe