Drug use among female sex workers in Hanoi, Vietnam

Aims To describe the drug use practices among female sex workers (FSWs) in Hanoi and to identify factors associated with their drug injecting. Design, setting and participants A two-stage cluster survey of 400 FSWs was conducted from June to September, 2002. Participating FSWs were both establishment- (160) and street-based (240), who were practising in seven urban and one suburban districts of Hanoi. Measurements Subjects were interviewed face to face using a structured questionnaire. Findings Among the middle-class FSWs, 27% used drugs, of whom 79% injected. Among low-class FSWs, 46% used drugs and 85% injected. Among drug-using FSWs, 86% had started using drugs within the past 6 years. Among drug-injecting FSWs, 81% had started injecting within the past 4 years. Cleaning of injecting equipment was not common among those who shared. Having drug-injecting 'love mates', drug-using clients, longer residence in Hanoi, more clients and not currently cohabiting were found to be independently associated with drug injecting among FSWs. Conclusions The high prevalence of injecting drug use among FSWs makes them susceptible to HIV infection, and is a threat to their clients. There is a strong relationship between drug-using FSWs and male drug-using clients and non-client partners. Intervention to prevent drug use initiation among non-drug-using FSWs and harm reduction among drug-using FSWs are urgently needed

A despistagem do VIH/sida: saúde pública e motivações dos utentes do teste rápido no Nordeste de Portugal

The article examines the adherence of citizens to the quick test for HIV in the Counseling and Early Detection of HIV/AIDS Center (CAD), in the city of Bragança (Northeast Portugal). Specifically, it seeks to examine the role of a fast diagnosis in the fight against AIDS within the Portuguese public health system, to understand the circumstances underlying the demand for the service and to interpret the perceptions and practices of CAD users. In terms of methodology, it was a case study based on ethnographic inquiry, linking direct observation, informal conversations and interviews, which was associated with extensive documental and statistic research. The results obtained allow us to state that the quick test gave a very positive contribution to the fight against HIV/AIDS infection, facilitating citizen access to knowledge of their serological status almost instantly and improving their follow-up by health technicians. The so-called “dissipation of uncertainty”, following sexual risk behavior, is the main reason that leads users to perform a quick test.O artigo analisa a adesão dos cidadãos ao teste rápido de despistagem do VIH no Centro de Aconselhamento e Deteção Precoce do VIH/sida (CAD) da cidade de Bragança (Nordeste de Portugal). Em concreto, procura-se examinar o papel do diagnóstico rápido na luta contra a infeção pelo VIH/sida no quadro do sistema público de saúde português, compreender as circunstâncias subjacentes à procura do serviço e interpretar as percepções e práticas dos utentes do CAD objecto desta pesquisa. Em termos metodológicos, tratou-se de um estudo de caso assente em inquirição etnográfica, articulando observação direta, diálogos informais e entrevistas, a que se associou uma extensa pesquisa documental e estatística. Os resultados apurados permitem afirmar que o teste rápido proporcionou um contributo muito positivo para a luta contra a infeção pelo VIH/sida, facilitando o acesso dos cidadãos ao conhecimento praticamente imediato do seu estado serológico e melhorando o seguimento destes por parte dos técnicos de saúde. A chamada “dissipação da incerteza”, na sequência de uma situação de risco, é o principal motivo que leva os utentes a realizar o teste rápido

Co-operation in Drug Treatment Services: Views of Offenders on Court Orders in Scotland

Accessing client perspectives about cooperation in substance misuse treatment offers important information to enhance services and improve drop-out rates. This article reports upon qualitative data from a localized study of service needs of offenders in Scotland who were undertaking community-based court orders. The views of 27 men and 2 women on their current and recent treatment offers rich insights into factors influencing their cooperation in treatment. In contradiction to the voluntaristic ideology of treatment services, their voices identify the criminal justice system as offering strong support in the completion of treatment programmes

Treatment and Intervention for Opiate Dependence in the United Kingdom:Lessons from Triumph and Failure

The history of opiate treatment in the United Kingdom (UK) since the early 1980s is a rich source of learning about the benefits and pitfalls of drug treatment policy. We present five possible lessons to be learnt about how factors outside the clinic, including government, charities and researchers can influence treatment and outcomes. First, do not let a crisis go to waste. The philosophical shift from abstinence to harm reduction in the 1980s, in response to an HIV outbreak in injecting users, facilitated expansion in addiction services and made a harm reduction approach more acceptable. Second, studies of drug-related deaths can lead to advances in care. By elucidating the pattern of mortality, and designing interventions to address the causes, researchers have improved patient safety in certain contexts, though significant investment in Scotland has not arrested rising mortality. Third, collection of longitudinal data and its use to inform clinical guidelines, as pursued from the mid-1990s, can form an enduring evidence base and shape policy, sometimes in unintended ways. Fourth, beware of the presentation of harm reduction and recovery as in conflict. At the least, this reduces patient choice, and at worst, it has caused some services to be redesigned in a manner that jeopardises patient safety. Fifth, the relationship between the third and state sectors must be carefully nurtured. In the UK, early collaboration has been replaced by competition, driven by changes in funding, to the detriment of service provision

Women and community sentences

Despite the increasing numbers of women given community sentences in the UK and in other jurisdictions in recent years, there has been relatively little research into women’s experiences of these disposals. This is particularly surprising given what is known about the distinctive characteristics of women in conflict with the law and the gendered nature of pathways to crime. This article draws upon the experiences of women made subject to a range of community sentences to identify recurring themes including the complexity of women’s problems, the significance of stigma, trauma and abuse, the importance to women of their supervisory relationships, the relevance of self-efficacy and the nature of barriers to compliance. The article considers the consequences of the discourses of ‘penality’ when underpinned by ideological assumptions and expectations based on gender relations. The implications for the supervision of women in the community are considered, while acknowledging that community sanctions are unlikely in themselves to be capable of addressing broader issues that bring women into and retain them in the criminal justice system

Evidence and morality in harm-reduction debates: can we use value-neutral arguments to achieve value-driven goals?

It is common to argue that politicians make selective use of evidence to tacitly reinforce their moral positions, but all stakeholders combine facts and values to produce and use research for policy. The drug policy debate has largely been framed in terms of an opposition between evidence and politics. Focusing on harm reduction provides useful ground to discuss a further opposition proposed by evidence advocates, that between evidence and morality. Can evidence sway individuals from their existing moral positions, so as to “neutralise” morality? And if not, then should evidence advocates change the way in which they frame their arguments? To address these questions, analysis of N=27 interviews with stakeholders involved in drug policy and harm reduction research, advocacy, lobbying, implementation and decision-making in England, UK and New South Wales, Australia, was conducted. Participants’ accounts suggest that although evidence can help focus discussions away from values and principles, exposure to evidence does not necessarily change deeply held views. Whether stakeholders decide to go with the evidence or not seems contingent on whether they embrace a view of evidence as secular faith; a view that is shaped by experience, politics, training, and role. And yet, morality, values, and emotions underpin all stakeholders’ views, motivating their commitment to drug policy and harm reduction. Evidence advocates might thus benefit from morally and emotionally engaging audiences. This paper aims to develop better tools for analysing the role of morality in decision-making, starting with moral foundations theory. Using tools from disciplines such as moral psychology is relevant to the study of the politics of evidence-based policymaking

Depenalization, diversion and decriminalization: A realist review and programme theory of alternatives to criminalization for simple drug possession

Alternatives to criminalization for the simple possession of illicit drugs are increasingly of interest to policy makers. But there is no existing theoretically based, empirically tested framework that can inform development and evaluation. This article presents a realist programme theory of such alternatives. It bases this on a realist review, which followed the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES). It describes the systematic process of searching the literature in English on nine relevant countries (Australia, Czech Republic, Denmark, Germany, Jamaica, Netherland, Portugal, the UK, the USA) for information on alternative measures in three categories: depenalization; diversion; and decriminalization. It shows how these measures – in theory and in practice – combine with pre-existing social conditions and institutional contexts to trigger mechanisms across three causal pathways (normative; criminal justice; and health and social services). It shows how some posited causal processes are more empirically supported than others. Alternative measures can reduce harms imposed by criminal justice processes without increasing drug use or related health and crime harms, but this depends on specific combinations of contexts, mechanisms and outcomes

Potential for non-combustible nicotine products to reduce socioeconomic inequalities in smoking: a systematic review and synthesis of best available evidence

While some experts have emphasised the potential for e-cigarettes to facilitate cessation among smokers with low socioeconomic status (SES), there is limited evidence of their likely equity impact. We assessed the potential for electronic cigarettes and other non-combustible nicotine-containing products (NCNPs) to reduce inequalities in smoking by systematically reviewing evidence on their use by SES in countries at stage IV of the cigarette epidemic