This document presents a research protocol for a study aimed at reducing HIV/AIDS risks among intravenous drug users (IDUs) in Bangladesh through community-based outreach programs. The study aims to design effective prevention programs and reduce risky behaviors among high-risk groups like IDUs. It provides background on HIV/AIDS and drug use in Bangladesh, describing current interventions for IDUs that incorporate harm reduction strategies like drop-in centers and needle exchange programs. The proposed study will use qualitative and quantitative methods to assess current knowledge and behaviors of IDUs and evaluate community-based outreach programs to identify best practices for prevention.
Achievements and Implications of HIV Prevention Programme among Female Sex wo...QUESTJOURNAL
Background: Plateau State, Nigeria with HIV prevalence rate of 7.7% as at 2010 had among the highest HIV and syphilis levels in Nigeria, earning itself a reputation of being one of the 12 + 1 states contributing the highest HIV prevalence in Nigeria and described as “hot zone” of HIV infections. Factors responsible for this were not unrelated to the high-risk activities of Female Sex Workers (FSWs). This paper therefore presents achievements and implications HIV prevention among FSWs in Plateau State, Nigeria Methods: This project was an intervention effort focused on delivering evidence-based HIV prevention activities among FSWs in 3 local government areas within the State. The estimated target population for the study was 460 and this project used the minimum prevention package intervention (MPPI). Peer educators were selected and trained among the FSWs to reach out to their peers using cohort session. Data were documented using various monitoring and evaluation tools, entered on the District Health Information Software version 2 and analyzed using Microsoft Excel. Results: A total of 68 community dialogues were held with 1,466 influencers participating in the process. In addition, 601 peers were registered, while 18 persons benefitted from 27 income generation activities aimed at capacity building for FSWs. A total of 642 persons were counseled, tested and shown their results, with 15 persons tested positive resulting in HIV prevalence of 2.3%. Although 10,560 condoms were distributed however, these numbers was below the number of condoms required during the intervention. Conclusion: This intervention was a success. However, more needs to be done with regards to condom distribution and supply among FSWs since there is a crucial role for FSWs to play in the plot of taking the HIV prevalence of Plateau State even further down
This study examined the relationship between knowledge of HIV transmission and prevention and HIV counselling and testing uptake among young people in Nigeria. The study is a quantitative research guided by one research question and one hypothesis. The target population comprised young people in Nigeria ages 15 to 24 years because the focus of this study was to identify the factors affecting HCT uptake among young people in this age cohort. The representative sample was obtained from the updated master sample frame of rural and urban zones developed by the National Population Commission in Nigeria. This master sample frame was a national survey that comprises all 36 states in Nigeria [2]. Probability sampling technique was used to obtain a sample of 10091 respondents (ages 15 to 24 years) for the study. The multistage cluster sampling was used to select suitable young people with known probability. Data were collected throughout Nigeria between September and December 2012 from 32,543 households (rural = 22,192; urban = 10,351) using structured and semi-structured questionnaires. The individual questionnaires asked about household characteristics, background characteristics of the respondents. Data were analyzed by inputing them into SPSS v21.0 for analysis [4] and then coded them for each participant. The data were summed using descriptive statistics. Frequencies and percentages; measures of central tendencies were used to answer the research question while nonparametric test such as chi-square was used to analyze non-normally distributed data at 0.5 level of significance. Results of data analysis indicated that the cognitive factors of knowledge of HIV prevention and knowledge of HIV transmission were statistically significant predictors of the likelihood of having HCT uptake. It was among others recommended that stakeholders, authorities, and providers of health services in Nigeria should strive to increase the rate of HCT uptake among young people ages 15 to 24 years.
FACTORS ASSOCIATED WITH HUMAN IMMUNODEFICIENCY VIRUS COUNSELLING AND TESTING ...Razak Mohammed Gyasi
Since 2003, the HIV Voluntary Counselling and Testing (VCT) has been identified as one of the key strategies in the HIV/AIDS prevention, control and care programmes in Ghana. However, utilization of this service is low among Ghanaian youth. This study examined predictors associated with VCT utilization among youth in Ghana. This study utilized quantitative and qualitative data in a cross-sectional survey in three sub-metropolitan areas in Kumasi. Using a multi-variate regression, evidence from 120 respondents showed potential factors associated with VCT utilization. The qualitative data were subjected to a content analysis through direct quotes. The results suggest that less than 30% of the youth had ever tested for HIV through VC. Women were more likely to avail themselves for counselling testing than men. Psychological and emotional trauma experienced by the seropositive, lack of confidentiality, proximity to VCT sites, HIV-related stigma inter alia, were found to be strongly associated with HIV VCT in the study prefecture. VCT utilization among the youth in Ghana was low and affected by HIV/AIDS-related stigma and residence. In order to increase VCT acceptability, HIV/AIDS prevention and control programs in the country should focus on reducing HIV/AIDS-related stigma.
FACTORS ASSOCIATED WITH HUMAN IMMUNODEFICIENCY VIRUS COUNSELLING AND TESTING ...Razak Mohammed Gyasi
Since 2003, the HIV Voluntary Counselling and Testing (VCT) has been identified as one of the key strategies in the HIV/AIDS prevention, control and care programmes in Ghana. However, utilization of this service is low among Ghanaian youth. This study examined predictors associated with VCT utilization among youth in Ghana. This study utilized quantitative and qualitative data in a cross-sectional survey in three sub-metropolitan areas in Kumasi. Using a multi-variate regression, evidence from 120 respondents showed potential factors associated with VCT utilization. The qualitative data were subjected to a content analysis through direct quotes. The results suggest that less than 30% of the youth had ever tested for HIV through VC. Women were more likely to avail themselves for counselling testing than men. Psychological and emotional trauma experienced by the seropositive, lack of confidentiality, proximity to VCT sites, HIV-related stigma inter alia, were found to be strongly associated with HIV VCT in the study prefecture. VCT utilization among the youth in Ghana was low and affected by HIV/AIDS-related stigma and residence. In order to increase VCT acceptability, HIV/AIDS prevention and control programs in the country should focus on reducing HIV/AIDS-related stigma.
Achievements and Implications of HIV Prevention of Mother-toChild Transmissio...QUESTJOURNAL
This intervention provided HIV prevention services to women of reproductive age in Plateau State, Nigeria. A total of 9,258 women were reached, exceeding the target of 7,460. Structural interventions included 85 community dialogues and 17 income generation activities. Behavioral interventions included distributing 87,028 condoms and providing HIV education to 5,079 peers. Biomedical interventions saw 5,606 women receive counseling, testing and results, with 44 (0.8%) testing positive for HIV. While the intervention helped reduce HIV burden, future programs need to improve coverage and extend services to more local government areas.
Attitude of the youth towards voluntary counselling and testing (vct) of hiv ...Alexander Decker
This document summarizes a study on the attitudes of youth in Accra, Ghana toward voluntary counseling and testing (VCT) for HIV/AIDS. The study found that while knowledge of HIV/AIDS was high, awareness and use of VCT services was low. Most respondents were unaware that VCT services existed or where they could access them. Of those aware of VCT, very few had utilized the services themselves. Fear of knowing their HIV status appeared to be a major barrier preventing youth from seeking VCT. The study concluded that efforts must be made to increase awareness and use of VCT, especially among youth, through expanded information and education campaigns.
This document discusses gender dimensions of HIV/AIDS among young girls in the context of achieving the Millennium Development Goals. It provides background on MDG 6, which aims to combat HIV/AIDS, malaria, and other diseases. It notes that young women ages 15-24 are particularly vulnerable to HIV infection due to various biological and socioeconomic factors. Statistics about HIV prevalence, condom use, and access to treatment in Bangladesh are presented. The document also discusses programs and interventions supported by various organizations to prevent HIV and achieve universal access to treatment.
Achievements and Implications of HIV Prevention Programme among Men who have ...inventionjournals
Background: Targeted interventions among men who have sex with men (MSM) could have a considerable effect in slowing the spread of HIV epidemic. This paper therefore presents the achievements and implications of HIV prevention programme among MSM in Bayelsa State, Nigeria Methods: The project was an intervention study carried out among MSM in Bayelsa State, Nigeria. The calculated sample size for this project was 155 MSM and snowball sampling technique was used for their selection. The project adopted the minimum prevention package intervention (MPPI) and data collected with output indicators were entered into the District Health Information Software (DHIS) 2, exported into Microsoft Excel and analysed using same. Results: The overall target population reached during this intervention was 381 MSM given a target reached of 245.8%. A total of 35 community dialogues were held within the duration of the intervention and 49 influencers participated. The number of peers registered during the intervention were 203 and out of the total number of condom (20582) required for this intervention, only 15235 (74.0%) were distributed. A total of 185 (91.1%) of the registered peers were reached with all the three stages of MPPI and 381 (245.8%) were reached with HCT. Among these, 17 (4.5%) were tested positive to HIV. Conclusion: This study showed an HIV prevalence of 4.5% among men who have sex with men in Bayelsa state at the time of the intervention. Given this high HIV prevalence, it is vital to enact more targeted and evidencebased prevention programs for these men.
Achievements and Implications of HIV Prevention Programme among Female Sex wo...QUESTJOURNAL
Background: Plateau State, Nigeria with HIV prevalence rate of 7.7% as at 2010 had among the highest HIV and syphilis levels in Nigeria, earning itself a reputation of being one of the 12 + 1 states contributing the highest HIV prevalence in Nigeria and described as “hot zone” of HIV infections. Factors responsible for this were not unrelated to the high-risk activities of Female Sex Workers (FSWs). This paper therefore presents achievements and implications HIV prevention among FSWs in Plateau State, Nigeria Methods: This project was an intervention effort focused on delivering evidence-based HIV prevention activities among FSWs in 3 local government areas within the State. The estimated target population for the study was 460 and this project used the minimum prevention package intervention (MPPI). Peer educators were selected and trained among the FSWs to reach out to their peers using cohort session. Data were documented using various monitoring and evaluation tools, entered on the District Health Information Software version 2 and analyzed using Microsoft Excel. Results: A total of 68 community dialogues were held with 1,466 influencers participating in the process. In addition, 601 peers were registered, while 18 persons benefitted from 27 income generation activities aimed at capacity building for FSWs. A total of 642 persons were counseled, tested and shown their results, with 15 persons tested positive resulting in HIV prevalence of 2.3%. Although 10,560 condoms were distributed however, these numbers was below the number of condoms required during the intervention. Conclusion: This intervention was a success. However, more needs to be done with regards to condom distribution and supply among FSWs since there is a crucial role for FSWs to play in the plot of taking the HIV prevalence of Plateau State even further down
This study examined the relationship between knowledge of HIV transmission and prevention and HIV counselling and testing uptake among young people in Nigeria. The study is a quantitative research guided by one research question and one hypothesis. The target population comprised young people in Nigeria ages 15 to 24 years because the focus of this study was to identify the factors affecting HCT uptake among young people in this age cohort. The representative sample was obtained from the updated master sample frame of rural and urban zones developed by the National Population Commission in Nigeria. This master sample frame was a national survey that comprises all 36 states in Nigeria [2]. Probability sampling technique was used to obtain a sample of 10091 respondents (ages 15 to 24 years) for the study. The multistage cluster sampling was used to select suitable young people with known probability. Data were collected throughout Nigeria between September and December 2012 from 32,543 households (rural = 22,192; urban = 10,351) using structured and semi-structured questionnaires. The individual questionnaires asked about household characteristics, background characteristics of the respondents. Data were analyzed by inputing them into SPSS v21.0 for analysis [4] and then coded them for each participant. The data were summed using descriptive statistics. Frequencies and percentages; measures of central tendencies were used to answer the research question while nonparametric test such as chi-square was used to analyze non-normally distributed data at 0.5 level of significance. Results of data analysis indicated that the cognitive factors of knowledge of HIV prevention and knowledge of HIV transmission were statistically significant predictors of the likelihood of having HCT uptake. It was among others recommended that stakeholders, authorities, and providers of health services in Nigeria should strive to increase the rate of HCT uptake among young people ages 15 to 24 years.
FACTORS ASSOCIATED WITH HUMAN IMMUNODEFICIENCY VIRUS COUNSELLING AND TESTING ...Razak Mohammed Gyasi
Since 2003, the HIV Voluntary Counselling and Testing (VCT) has been identified as one of the key strategies in the HIV/AIDS prevention, control and care programmes in Ghana. However, utilization of this service is low among Ghanaian youth. This study examined predictors associated with VCT utilization among youth in Ghana. This study utilized quantitative and qualitative data in a cross-sectional survey in three sub-metropolitan areas in Kumasi. Using a multi-variate regression, evidence from 120 respondents showed potential factors associated with VCT utilization. The qualitative data were subjected to a content analysis through direct quotes. The results suggest that less than 30% of the youth had ever tested for HIV through VC. Women were more likely to avail themselves for counselling testing than men. Psychological and emotional trauma experienced by the seropositive, lack of confidentiality, proximity to VCT sites, HIV-related stigma inter alia, were found to be strongly associated with HIV VCT in the study prefecture. VCT utilization among the youth in Ghana was low and affected by HIV/AIDS-related stigma and residence. In order to increase VCT acceptability, HIV/AIDS prevention and control programs in the country should focus on reducing HIV/AIDS-related stigma.
FACTORS ASSOCIATED WITH HUMAN IMMUNODEFICIENCY VIRUS COUNSELLING AND TESTING ...Razak Mohammed Gyasi
Since 2003, the HIV Voluntary Counselling and Testing (VCT) has been identified as one of the key strategies in the HIV/AIDS prevention, control and care programmes in Ghana. However, utilization of this service is low among Ghanaian youth. This study examined predictors associated with VCT utilization among youth in Ghana. This study utilized quantitative and qualitative data in a cross-sectional survey in three sub-metropolitan areas in Kumasi. Using a multi-variate regression, evidence from 120 respondents showed potential factors associated with VCT utilization. The qualitative data were subjected to a content analysis through direct quotes. The results suggest that less than 30% of the youth had ever tested for HIV through VC. Women were more likely to avail themselves for counselling testing than men. Psychological and emotional trauma experienced by the seropositive, lack of confidentiality, proximity to VCT sites, HIV-related stigma inter alia, were found to be strongly associated with HIV VCT in the study prefecture. VCT utilization among the youth in Ghana was low and affected by HIV/AIDS-related stigma and residence. In order to increase VCT acceptability, HIV/AIDS prevention and control programs in the country should focus on reducing HIV/AIDS-related stigma.
Achievements and Implications of HIV Prevention of Mother-toChild Transmissio...QUESTJOURNAL
This intervention provided HIV prevention services to women of reproductive age in Plateau State, Nigeria. A total of 9,258 women were reached, exceeding the target of 7,460. Structural interventions included 85 community dialogues and 17 income generation activities. Behavioral interventions included distributing 87,028 condoms and providing HIV education to 5,079 peers. Biomedical interventions saw 5,606 women receive counseling, testing and results, with 44 (0.8%) testing positive for HIV. While the intervention helped reduce HIV burden, future programs need to improve coverage and extend services to more local government areas.
Attitude of the youth towards voluntary counselling and testing (vct) of hiv ...Alexander Decker
This document summarizes a study on the attitudes of youth in Accra, Ghana toward voluntary counseling and testing (VCT) for HIV/AIDS. The study found that while knowledge of HIV/AIDS was high, awareness and use of VCT services was low. Most respondents were unaware that VCT services existed or where they could access them. Of those aware of VCT, very few had utilized the services themselves. Fear of knowing their HIV status appeared to be a major barrier preventing youth from seeking VCT. The study concluded that efforts must be made to increase awareness and use of VCT, especially among youth, through expanded information and education campaigns.
This document discusses gender dimensions of HIV/AIDS among young girls in the context of achieving the Millennium Development Goals. It provides background on MDG 6, which aims to combat HIV/AIDS, malaria, and other diseases. It notes that young women ages 15-24 are particularly vulnerable to HIV infection due to various biological and socioeconomic factors. Statistics about HIV prevalence, condom use, and access to treatment in Bangladesh are presented. The document also discusses programs and interventions supported by various organizations to prevent HIV and achieve universal access to treatment.
Achievements and Implications of HIV Prevention Programme among Men who have ...inventionjournals
Background: Targeted interventions among men who have sex with men (MSM) could have a considerable effect in slowing the spread of HIV epidemic. This paper therefore presents the achievements and implications of HIV prevention programme among MSM in Bayelsa State, Nigeria Methods: The project was an intervention study carried out among MSM in Bayelsa State, Nigeria. The calculated sample size for this project was 155 MSM and snowball sampling technique was used for their selection. The project adopted the minimum prevention package intervention (MPPI) and data collected with output indicators were entered into the District Health Information Software (DHIS) 2, exported into Microsoft Excel and analysed using same. Results: The overall target population reached during this intervention was 381 MSM given a target reached of 245.8%. A total of 35 community dialogues were held within the duration of the intervention and 49 influencers participated. The number of peers registered during the intervention were 203 and out of the total number of condom (20582) required for this intervention, only 15235 (74.0%) were distributed. A total of 185 (91.1%) of the registered peers were reached with all the three stages of MPPI and 381 (245.8%) were reached with HCT. Among these, 17 (4.5%) were tested positive to HIV. Conclusion: This study showed an HIV prevalence of 4.5% among men who have sex with men in Bayelsa state at the time of the intervention. Given this high HIV prevalence, it is vital to enact more targeted and evidencebased prevention programs for these men.
The document summarizes the key points from a quarterly review meeting of India's National AIDS Control Programme. It provides an overview of the program, highlights achievements in reducing HIV infections and AIDS-related deaths, and outlines the vision and targets to end AIDS by 2030. Key agenda items discussed establishing ART centers in all medical colleges, eliminating mother-to-child HIV transmission, implementing the HIV/AIDS Prevention and Control Act of 2017, and achieving the 90-90-90 fast track targets to diagnose and treat people living with HIV. Support was requested from states to help scale up HIV testing, treatment and care.
Impact of syndromic management of sexually transmittedAlexander Decker
The document summarizes a study that investigated the impact of syndromic management of sexually transmitted infections (STIs) among out-of-school female youths in Sagamu, Nigeria. An intervention training on syndromic management lasted 4 weeks for 80 female youths. Based on pre- and post-test analysis, syndromic management was found to have a significant impact on treating urethra discharge symptoms and abnormal vaginal discharge symptoms, but no significant impact on genital ulcer disease or lower abdominal pain symptoms. The study concludes that syndromic management can help address STIs and related issues among youths if properly implemented.
The document describes a research grant application to assess the impact of an education intervention program on care and support for people living with HIV/AIDS receiving antiretroviral therapy at BPKIHS in Nepal. The principal investigator is an associate professor in the Medical-Surgical Nursing Department. The project aims to evaluate knowledge, attitudes and practices regarding care and support for PLWHA, develop an education package on care and support, provide the education intervention, and evaluate its effectiveness. The application reviews literature on the HIV/AIDS situation in Nepal and caregiver burden for PLWHA.
Madridge Journal of AIDS (ISSN: 2638-1958); HIV-related stigma is a global issue. Its perpetuation varies in magnitude across and within countries, and serves as a major barrier to HIV prevention efforts.
Malaria in under five children and help seeking behavior of mothers in calaba...Alexander Decker
This document summarizes a study on malaria in children under five years old and the help-seeking behavior of mothers in Calabar, Nigeria. The study found that most mothers brought their children to health facilities due to fever, but many had waited over a week to seek care. While most mothers were aware of malaria, many initially treated their children at home with remedies like sponging or herbal enemas. The study concluded that a mother's help-seeking behavior impacts the outcome of a child's illness, and that addressing factors like cost, transportation, and the role of fathers could help reduce child mortality from malaria.
This document provides information from the HIV and AIDS Data Hub for Asia-Pacific on data availability and population size estimates of people who inject drugs, men who have sex with men, transgender people, and male sex workers across several countries in Asia and the Pacific region. It includes tables and charts with the countries where data is available from sentinel surveillance surveys, behavioral surveys, and population size estimates. It also provides references for the estimates and surveys.
The document provides information about HIV/AIDS in Bangladesh. It notes that the first HIV case was detected in 1989 and that Bangladesh currently has a low HIV prevalence rate of less than 1%. While the incidence of HIV/AIDS is currently low in Bangladesh, the country remains vulnerable to an epidemic due to risk factors like injecting drug use, commercial sex work, men having sex with men, and lack of awareness. The document also outlines preventive measures taken like information campaigns, education programs, increasing condom use, and interventions targeting at-risk groups.
Achievements and Implications of HIV Prevention Programme Among Out of School...inventionjournals
Background: The increasing number of sexually transmitted infections including HIV/AIDS among the youths in sub-Saharan Africa indicates that successive efforts towards preventing the scourge remain inadequate in the continent. Preventing the spread of HIV infection among youths aged 15 – 24 years is critical to reducing the incidence of new HIV infection. This paper therefore presents HIV prevention programme among Out of School Youths (OSYs) in Kogi State, Nigeria. Methods: This intervention was carried out among out-of-school youths in 7 randomly selected Local Government Areas (LGAs) in the state with a total target population of 19, 600 OSY. One hundred and twenty (120) OSY comprising (68 males and 52 females) were recruited and trained as Peer Educators. Activities carried out included structural, behavioural and biomedical interventions using the Minimum Prevention Package for Intervention (MPPI) strategy. Data were documented using various monitoring and evaluation tools and entered in the DHIS2 platform. The data were later exported into Microsoft Excel and analysed using same. Results: Three hundred and three community dialogues were held within the 2-years period with 672 participants and 25787 peers recruited by the peer educators resulting in 131.6% of the estimated target population. A total of 8812 of out of school youths were counselled, tested and received results for HIV. Among these, a total of 175 (2.0%) were tested positive. Conclusion: Effective implementation of minimum prevention package for intervention in HIV/AIDS prevention programme carried out in these communities could be attributed to the dialogues held at the commencement of the project. However, there are still shortfalls in attainment of the expected results. It is therefore recommended that there be increased integration of services and decentralization of MPPI activities to primary health care centers and rural communities, stepwise supervision and monitoring of HIV prevention activities be strengthened and engagement of all tiers of governance to engender political commitment and ownership of the HIV response with a view of ensuring sustainability of these programmes.
This document summarizes a study that compared comprehensive HIV/AIDS knowledge and acceptance attitudes among male youth aged 15-24 in Ivory Coast, Cameroon, and Gabon. The study utilized nationally representative demographic and health survey data from each country. A total of 6,576 male youth were included in the analysis. The study found low levels of comprehensive HIV knowledge and acceptance attitudes in all three countries. Multivariate analysis identified factors associated with knowledge and attitudes. Comparisons between countries found that Gabonese and Cameroonian youth were more likely than Ivorian youth to have comprehensive HIV knowledge, while Ivorian and Cameroonian youth had more accepting attitudes than Gabonese youth. The study concluded comprehensive knowledge and acceptance
The document discusses India's primary health care system and proposes a model of Comprehensive Primary Health Care (CPHC) to achieve Universal Health Coverage. It outlines key challenges faced by the current primary health care system such as understaffing, supply issues, and over-reliance on private sector. The proposed CPHC model involves establishing "Health and Wellness Centers" at village level which will provide expanded services including management of non-communicable diseases. It emphasizes strengthening human resources, ensuring drug and diagnostic access, use of ICT, continuity of care, and community engagement to achieve the vision of comprehensive and affordable primary health care for all.
The document summarizes HIV epidemiology among men who have sex with men (MSM) globally and in Asia Pacific. Some key points:
- HIV prevalence among MSM ranges from under 1% to over 25% depending on the country/region, with most of Asia and Africa over 5%.
- HIV is increasing among MSM in many countries as prevalence declines elsewhere, with urban areas often having much higher rates.
- Condom use and HIV testing is low among MSM in most areas. Criminalization and stigma also limit data collection and access to services.
- MSM population size estimates vary widely but are often in the hundreds of thousands to millions in Asia Pacific countries.
This document provides an overview and analysis of progress towards universal access to reproductive health and family planning based on key indicators. Some key points:
- Globally, contraceptive use has increased to two-thirds of married women, but 12% still have unmet need. The most common methods are female sterilization and IUD.
- Over 80% of married women's family planning needs are satisfied globally, but less than half in Africa.
- 15.3 million adolescent girls give birth each year. Adolescent contraceptive use and access to family planning services lag behind other age groups.
- Disparities exist based on location, education, and wealth. Rural, less educated and poorer
HIV AIDS & PREVENTION PROGRAMS , BY BR. SARATH THOMAS, sarathcthomas@gmail.comSarath Thomas
The document discusses HIV/AIDS in India, providing statistics on infections and deaths. Approximately 172,000 people died of AIDS in India in 2009, with 2.4 million estimated to be living with HIV. Most infections are among adults aged 15-49. Key factors contributing to the spread include labor migration and low education levels. States with over 100,000 infections include West Bengal, Gujarat, Bihar and Uttar Pradesh. The National AIDS Control Program and organizations like NACO and KSACS implement prevention and treatment programs, including targeted interventions, condom promotion, counseling, care for at-risk groups, and prevention of parent-to-child transmission.
Socio-Economic Effect of HIV/AIDS on Orphans and Vulnerable Children in Nyami...paperpublications3
Since the first case of HIV/AIDS was reported in Kenya in 1984 the numbers of those infected have risen and many people have since died or are living with the HIV/AIDS since the epidemic started in 1980s in the drug injecting people and the homosexuals. These deaths have resulted in Orphans and Vulnerable Children (OVC). This was a descriptive cross-sectional study, with one of the objective of finding out the socio-economic effect of HIV/AIDS on Orphans and Vulnerable Children in Nyamira district. A sample of 384 people participated in the study. The people were through simple random selected from Bonyegwe sublocation of Nyamusi division. Semi-structured interview schedules were used in data collection from the households. To remove ambiguity, the research tools were pre-tested to both HIV/AIDS organizations and householders not in the sample population but with similar characteristics. The research tools were refined and used on the actual sample population. Text, graphs, figures and tables were used in data presentation. The study indicates that those people who had not attained any level of formal education were (17%). The study revealed that householders (40%) had higher proportion of secondary education as compared with members of HIV/AIDS organizations (37%). Most of the members of HIV/AIDS organizations (89%) indicated that farming is their main source of income and a cushion for food security as compared with householders (63%). The ministry of health should strengthen provision of PMTCT services at the ANC clinic so that we prevent more cases of orphans and vulnerable children. The study suggests that in future all mothers who test positive for HIV virus should be put on treatment in order to reduce defaulters at the same time reach sustainable coverage in the provision of HIV/AIDS services to the orphans and vulnerable children in the society.
Adolescents and utilization of family planning services in rural community of...Alexander Decker
This study examined family planning services utilization among adolescents in a rural Nigerian community. 400 adolescents ages 10-19 completed questionnaires. Over two-thirds reported family planning services being available, with main sources being health centers, chemists, and pharmacies. Reasons for service selection included low cost, privacy, and proximity. While most adolescents were sexually active and knowledgeable about contraception, condom use was low and many were unconcerned about pregnancy or STDs. The study concluded family planning services were available but underutilized, with worrisome attitudes towards unprotected sex among adolescents in the community.
This document summarizes a seminar on using mobile technologies to advance healthcare and services. It discusses how mHealth uses mobile devices like phones and PDAs to facilitate health information sharing, clinical decision-making, and chronic disease management. Examples of mHealth projects around the world show benefits like increased access to care, more efficient service delivery, improved disease diagnosis and tracking, and expanded medical education. The document also outlines mHealth initiatives in various countries and regions, challenges to mHealth implementation like low network coverage, and ways to advance mHealth through collaboration, financing, and developing technology-friendly policies.
Kenya has one of the worst HIV/AIDS epidemics in the world, with an estimated 1.5 million people living with HIV. While HIV prevalence peaked in 2000 at around 6.3%, access to treatment has increased, with over half a million adults now receiving antiretroviral therapy (ART). However, access remains low for children, with only 20% of the estimated 170,000 children eligible for treatment receiving it. The Kenyan government aims to further increase access to treatment and reduce new infections through its National HIV/AIDS Strategic Plan.
This document provides background information on HIV/AIDS and disease surveillance services. It discusses how HIV first emerged in the 1980s and has since spread globally. Disease surveillance involves the ongoing systematic collection and analysis of data to monitor disease spread and inform prevention and control efforts. The document then reviews studies on HIV prevalence in various countries and age groups. It also discusses theories relevant to disease surveillance and HIV control, including how education and awareness building can impact prevention efforts.
Balancing demand, quality and efficiency in nigerian health care delivery systemAlexander Decker
The document discusses several challenges facing Nigeria's health care system that reduce progress and universal access to health care. Some key issues include inadequate health facilities and infrastructure, poor human resources and management, low government spending on health, and high out-of-pocket costs for citizens. Nigeria's health indicators, such as maternal mortality and child mortality, are among the worst in the world. Many factors contribute to these problems, including a lack of integrated disease prevention and treatment systems, shortages of essential drugs and supplies, and inadequate supervision of health care providers. Overall, the health system in Nigeria faces significant issues that must be addressed to improve quality, access, and efficiency of care.
The document summarizes India's AIDS Control Programme. It discusses the structure of the HIV virus and symptoms of AIDS. It provides statistics on HIV prevalence in India and outlines the objectives and components of the National AIDS Control Programmes Phases I-III. The key goals of NACP-III are to halt and reverse the HIV epidemic by preventing new infections and increasing access to treatment, care and support for those living with HIV/AIDS. The programme focuses on high-risk groups through targeted interventions and scaling up general population interventions.
This document summarizes the status and management of HIV/AIDS in India. It finds that India has an estimated 2.4 million people living with HIV, with high prevalence states accounting for over half of infections. The epidemic is concentrated among high-risk groups and spread primarily through unprotected sex and injection drug use. The national response involves targeted interventions for high-risk groups, STI management, condom promotion, blood safety programs, counseling/testing, and care/treatment. While prevalence is declining overall, some low prevalence states are seeing rises, emphasizing the need to sustain prevention efforts.
This document summarizes the status of the HIV/AIDS epidemic in India. Some key points:
- India has an estimated 2.4 million people living with HIV, with prevalence highest in the southern and northeastern states.
- The epidemic is concentrated among high-risk groups like sex workers, clients of sex workers, men who have sex with men, and injection drug users.
- Unsafe sex, lack of condom use, and injection drug use fuel transmission. Migration and the low status of women also increase vulnerability.
- The national response involves targeted interventions for high-risk groups, care/treatment, and prevention education through NACP programs.
The document summarizes the key points from a quarterly review meeting of India's National AIDS Control Programme. It provides an overview of the program, highlights achievements in reducing HIV infections and AIDS-related deaths, and outlines the vision and targets to end AIDS by 2030. Key agenda items discussed establishing ART centers in all medical colleges, eliminating mother-to-child HIV transmission, implementing the HIV/AIDS Prevention and Control Act of 2017, and achieving the 90-90-90 fast track targets to diagnose and treat people living with HIV. Support was requested from states to help scale up HIV testing, treatment and care.
Impact of syndromic management of sexually transmittedAlexander Decker
The document summarizes a study that investigated the impact of syndromic management of sexually transmitted infections (STIs) among out-of-school female youths in Sagamu, Nigeria. An intervention training on syndromic management lasted 4 weeks for 80 female youths. Based on pre- and post-test analysis, syndromic management was found to have a significant impact on treating urethra discharge symptoms and abnormal vaginal discharge symptoms, but no significant impact on genital ulcer disease or lower abdominal pain symptoms. The study concludes that syndromic management can help address STIs and related issues among youths if properly implemented.
The document describes a research grant application to assess the impact of an education intervention program on care and support for people living with HIV/AIDS receiving antiretroviral therapy at BPKIHS in Nepal. The principal investigator is an associate professor in the Medical-Surgical Nursing Department. The project aims to evaluate knowledge, attitudes and practices regarding care and support for PLWHA, develop an education package on care and support, provide the education intervention, and evaluate its effectiveness. The application reviews literature on the HIV/AIDS situation in Nepal and caregiver burden for PLWHA.
Madridge Journal of AIDS (ISSN: 2638-1958); HIV-related stigma is a global issue. Its perpetuation varies in magnitude across and within countries, and serves as a major barrier to HIV prevention efforts.
Malaria in under five children and help seeking behavior of mothers in calaba...Alexander Decker
This document summarizes a study on malaria in children under five years old and the help-seeking behavior of mothers in Calabar, Nigeria. The study found that most mothers brought their children to health facilities due to fever, but many had waited over a week to seek care. While most mothers were aware of malaria, many initially treated their children at home with remedies like sponging or herbal enemas. The study concluded that a mother's help-seeking behavior impacts the outcome of a child's illness, and that addressing factors like cost, transportation, and the role of fathers could help reduce child mortality from malaria.
This document provides information from the HIV and AIDS Data Hub for Asia-Pacific on data availability and population size estimates of people who inject drugs, men who have sex with men, transgender people, and male sex workers across several countries in Asia and the Pacific region. It includes tables and charts with the countries where data is available from sentinel surveillance surveys, behavioral surveys, and population size estimates. It also provides references for the estimates and surveys.
The document provides information about HIV/AIDS in Bangladesh. It notes that the first HIV case was detected in 1989 and that Bangladesh currently has a low HIV prevalence rate of less than 1%. While the incidence of HIV/AIDS is currently low in Bangladesh, the country remains vulnerable to an epidemic due to risk factors like injecting drug use, commercial sex work, men having sex with men, and lack of awareness. The document also outlines preventive measures taken like information campaigns, education programs, increasing condom use, and interventions targeting at-risk groups.
Achievements and Implications of HIV Prevention Programme Among Out of School...inventionjournals
Background: The increasing number of sexually transmitted infections including HIV/AIDS among the youths in sub-Saharan Africa indicates that successive efforts towards preventing the scourge remain inadequate in the continent. Preventing the spread of HIV infection among youths aged 15 – 24 years is critical to reducing the incidence of new HIV infection. This paper therefore presents HIV prevention programme among Out of School Youths (OSYs) in Kogi State, Nigeria. Methods: This intervention was carried out among out-of-school youths in 7 randomly selected Local Government Areas (LGAs) in the state with a total target population of 19, 600 OSY. One hundred and twenty (120) OSY comprising (68 males and 52 females) were recruited and trained as Peer Educators. Activities carried out included structural, behavioural and biomedical interventions using the Minimum Prevention Package for Intervention (MPPI) strategy. Data were documented using various monitoring and evaluation tools and entered in the DHIS2 platform. The data were later exported into Microsoft Excel and analysed using same. Results: Three hundred and three community dialogues were held within the 2-years period with 672 participants and 25787 peers recruited by the peer educators resulting in 131.6% of the estimated target population. A total of 8812 of out of school youths were counselled, tested and received results for HIV. Among these, a total of 175 (2.0%) were tested positive. Conclusion: Effective implementation of minimum prevention package for intervention in HIV/AIDS prevention programme carried out in these communities could be attributed to the dialogues held at the commencement of the project. However, there are still shortfalls in attainment of the expected results. It is therefore recommended that there be increased integration of services and decentralization of MPPI activities to primary health care centers and rural communities, stepwise supervision and monitoring of HIV prevention activities be strengthened and engagement of all tiers of governance to engender political commitment and ownership of the HIV response with a view of ensuring sustainability of these programmes.
This document summarizes a study that compared comprehensive HIV/AIDS knowledge and acceptance attitudes among male youth aged 15-24 in Ivory Coast, Cameroon, and Gabon. The study utilized nationally representative demographic and health survey data from each country. A total of 6,576 male youth were included in the analysis. The study found low levels of comprehensive HIV knowledge and acceptance attitudes in all three countries. Multivariate analysis identified factors associated with knowledge and attitudes. Comparisons between countries found that Gabonese and Cameroonian youth were more likely than Ivorian youth to have comprehensive HIV knowledge, while Ivorian and Cameroonian youth had more accepting attitudes than Gabonese youth. The study concluded comprehensive knowledge and acceptance
The document discusses India's primary health care system and proposes a model of Comprehensive Primary Health Care (CPHC) to achieve Universal Health Coverage. It outlines key challenges faced by the current primary health care system such as understaffing, supply issues, and over-reliance on private sector. The proposed CPHC model involves establishing "Health and Wellness Centers" at village level which will provide expanded services including management of non-communicable diseases. It emphasizes strengthening human resources, ensuring drug and diagnostic access, use of ICT, continuity of care, and community engagement to achieve the vision of comprehensive and affordable primary health care for all.
The document summarizes HIV epidemiology among men who have sex with men (MSM) globally and in Asia Pacific. Some key points:
- HIV prevalence among MSM ranges from under 1% to over 25% depending on the country/region, with most of Asia and Africa over 5%.
- HIV is increasing among MSM in many countries as prevalence declines elsewhere, with urban areas often having much higher rates.
- Condom use and HIV testing is low among MSM in most areas. Criminalization and stigma also limit data collection and access to services.
- MSM population size estimates vary widely but are often in the hundreds of thousands to millions in Asia Pacific countries.
This document provides an overview and analysis of progress towards universal access to reproductive health and family planning based on key indicators. Some key points:
- Globally, contraceptive use has increased to two-thirds of married women, but 12% still have unmet need. The most common methods are female sterilization and IUD.
- Over 80% of married women's family planning needs are satisfied globally, but less than half in Africa.
- 15.3 million adolescent girls give birth each year. Adolescent contraceptive use and access to family planning services lag behind other age groups.
- Disparities exist based on location, education, and wealth. Rural, less educated and poorer
HIV AIDS & PREVENTION PROGRAMS , BY BR. SARATH THOMAS, sarathcthomas@gmail.comSarath Thomas
The document discusses HIV/AIDS in India, providing statistics on infections and deaths. Approximately 172,000 people died of AIDS in India in 2009, with 2.4 million estimated to be living with HIV. Most infections are among adults aged 15-49. Key factors contributing to the spread include labor migration and low education levels. States with over 100,000 infections include West Bengal, Gujarat, Bihar and Uttar Pradesh. The National AIDS Control Program and organizations like NACO and KSACS implement prevention and treatment programs, including targeted interventions, condom promotion, counseling, care for at-risk groups, and prevention of parent-to-child transmission.
Socio-Economic Effect of HIV/AIDS on Orphans and Vulnerable Children in Nyami...paperpublications3
Since the first case of HIV/AIDS was reported in Kenya in 1984 the numbers of those infected have risen and many people have since died or are living with the HIV/AIDS since the epidemic started in 1980s in the drug injecting people and the homosexuals. These deaths have resulted in Orphans and Vulnerable Children (OVC). This was a descriptive cross-sectional study, with one of the objective of finding out the socio-economic effect of HIV/AIDS on Orphans and Vulnerable Children in Nyamira district. A sample of 384 people participated in the study. The people were through simple random selected from Bonyegwe sublocation of Nyamusi division. Semi-structured interview schedules were used in data collection from the households. To remove ambiguity, the research tools were pre-tested to both HIV/AIDS organizations and householders not in the sample population but with similar characteristics. The research tools were refined and used on the actual sample population. Text, graphs, figures and tables were used in data presentation. The study indicates that those people who had not attained any level of formal education were (17%). The study revealed that householders (40%) had higher proportion of secondary education as compared with members of HIV/AIDS organizations (37%). Most of the members of HIV/AIDS organizations (89%) indicated that farming is their main source of income and a cushion for food security as compared with householders (63%). The ministry of health should strengthen provision of PMTCT services at the ANC clinic so that we prevent more cases of orphans and vulnerable children. The study suggests that in future all mothers who test positive for HIV virus should be put on treatment in order to reduce defaulters at the same time reach sustainable coverage in the provision of HIV/AIDS services to the orphans and vulnerable children in the society.
Adolescents and utilization of family planning services in rural community of...Alexander Decker
This study examined family planning services utilization among adolescents in a rural Nigerian community. 400 adolescents ages 10-19 completed questionnaires. Over two-thirds reported family planning services being available, with main sources being health centers, chemists, and pharmacies. Reasons for service selection included low cost, privacy, and proximity. While most adolescents were sexually active and knowledgeable about contraception, condom use was low and many were unconcerned about pregnancy or STDs. The study concluded family planning services were available but underutilized, with worrisome attitudes towards unprotected sex among adolescents in the community.
This document summarizes a seminar on using mobile technologies to advance healthcare and services. It discusses how mHealth uses mobile devices like phones and PDAs to facilitate health information sharing, clinical decision-making, and chronic disease management. Examples of mHealth projects around the world show benefits like increased access to care, more efficient service delivery, improved disease diagnosis and tracking, and expanded medical education. The document also outlines mHealth initiatives in various countries and regions, challenges to mHealth implementation like low network coverage, and ways to advance mHealth through collaboration, financing, and developing technology-friendly policies.
Kenya has one of the worst HIV/AIDS epidemics in the world, with an estimated 1.5 million people living with HIV. While HIV prevalence peaked in 2000 at around 6.3%, access to treatment has increased, with over half a million adults now receiving antiretroviral therapy (ART). However, access remains low for children, with only 20% of the estimated 170,000 children eligible for treatment receiving it. The Kenyan government aims to further increase access to treatment and reduce new infections through its National HIV/AIDS Strategic Plan.
This document provides background information on HIV/AIDS and disease surveillance services. It discusses how HIV first emerged in the 1980s and has since spread globally. Disease surveillance involves the ongoing systematic collection and analysis of data to monitor disease spread and inform prevention and control efforts. The document then reviews studies on HIV prevalence in various countries and age groups. It also discusses theories relevant to disease surveillance and HIV control, including how education and awareness building can impact prevention efforts.
Balancing demand, quality and efficiency in nigerian health care delivery systemAlexander Decker
The document discusses several challenges facing Nigeria's health care system that reduce progress and universal access to health care. Some key issues include inadequate health facilities and infrastructure, poor human resources and management, low government spending on health, and high out-of-pocket costs for citizens. Nigeria's health indicators, such as maternal mortality and child mortality, are among the worst in the world. Many factors contribute to these problems, including a lack of integrated disease prevention and treatment systems, shortages of essential drugs and supplies, and inadequate supervision of health care providers. Overall, the health system in Nigeria faces significant issues that must be addressed to improve quality, access, and efficiency of care.
The document summarizes India's AIDS Control Programme. It discusses the structure of the HIV virus and symptoms of AIDS. It provides statistics on HIV prevalence in India and outlines the objectives and components of the National AIDS Control Programmes Phases I-III. The key goals of NACP-III are to halt and reverse the HIV epidemic by preventing new infections and increasing access to treatment, care and support for those living with HIV/AIDS. The programme focuses on high-risk groups through targeted interventions and scaling up general population interventions.
This document summarizes the status and management of HIV/AIDS in India. It finds that India has an estimated 2.4 million people living with HIV, with high prevalence states accounting for over half of infections. The epidemic is concentrated among high-risk groups and spread primarily through unprotected sex and injection drug use. The national response involves targeted interventions for high-risk groups, STI management, condom promotion, blood safety programs, counseling/testing, and care/treatment. While prevalence is declining overall, some low prevalence states are seeing rises, emphasizing the need to sustain prevention efforts.
This document summarizes the status of the HIV/AIDS epidemic in India. Some key points:
- India has an estimated 2.4 million people living with HIV, with prevalence highest in the southern and northeastern states.
- The epidemic is concentrated among high-risk groups like sex workers, clients of sex workers, men who have sex with men, and injection drug users.
- Unsafe sex, lack of condom use, and injection drug use fuel transmission. Migration and the low status of women also increase vulnerability.
- The national response involves targeted interventions for high-risk groups, care/treatment, and prevention education through NACP programs.
Assessment of the level of awareness on AIDS/HIV in Johor, MalaysiaSriramNagarajan17
This document summarizes a study that assessed awareness of HIV/AIDS among 396 respondents in Johor, Malaysia. The study found that respondents had moderately high overall knowledge of HIV/AIDS, though some misconceptions remained. Most respondents knew that high-risk behaviors like needle sharing and unprotected sex can transmit HIV, but fewer were aware of risks from activities like tattooing or sharing personal items. While most knew there is no cure for HIV/AIDS, over half believed incorrectly that washing after sex prevents transmission. The study provides insight into awareness levels and information gaps regarding HIV/AIDS in Johor.
This document summarizes key statistics and trends related to the global AIDS epidemic from the UNAIDS 2013 report. Some of the key points include:
- There has been a 33% decrease in new HIV infections and a 29% decrease in AIDS-related deaths since 2001.
- Access to antiretroviral therapy has increased dramatically, with 9.7 million people in low- and middle-income countries receiving treatment by 2012.
- However, challenges remain, including inadequate access to treatment for many who need it, rising infections among men who have sex with men in some areas, and persistent stigma and discrimination. Ending the AIDS epidemic by 2030 will require continued scale up of prevention and treatment efforts.
This document summarizes a community-based cross-sectional study conducted in Kashmir, India that examined hepatitis B knowledge and vaccination status among the local population aged 18 and older. The study found that only 10.2% of participants had heard of hepatitis B prior to the study. Of those aware, 37.6% knew modes of transmission but knowledge of prevention methods was lower. Just 2% of participants had received the hepatitis B vaccine, with only 27% of those completing all three doses. Given these low levels of knowledge and vaccination, the study concludes there is a need for public health education campaigns in Kashmir to increase awareness and prevention of hepatitis B.
A bridge too near injecting drug users' sexual behaviourMd. Nakebul Kausar
This document summarizes a study on the personal profiles and health seeking behaviors of injecting drug users (IDUs) in Dhaka, Bangladesh. The study involved interviews with 120 IDUs attending a drug treatment center between March and September 2005. Key findings included: 1) Most respondents (60%) had little knowledge about diseases spread by injecting drugs or needle sharing, with only 17.5% mentioning HIV/AIDS. 2) Regarding protection, 29.2% mentioned not injecting drugs anymore while 34.2% mentioned using sterile needles/syringes. 3) The majority (60%) had never participated in a needle exchange program, with lack of awareness being a key barrier.
The influence of prevention of mother to-child hiv transmission campaigns on ...Alexander Decker
The document discusses mother-to-child transmission of HIV in Nigeria and prevention efforts. It notes that mother-to-child transmission accounts for over 90% of pediatric AIDS cases globally. To address this, Nigeria and other countries have implemented Prevention of Mother-to-Child Transmission (PMTCT) campaigns. However, the document aims to study whether these campaigns have effectively improved knowledge, attitudes and practices around PMTCT among Nigerian women. It finds that while campaigns have increased to some degree, overall knowledge, attitudes and practices regarding PMTCT among Nigerian women remains quite low. It recommends campaign messages be more clear, specific and convincing to better educate women and encourage improved PMTCT practices.
Gender,HIV/AIDs Transmission: Socio Economic And Socio Cultural Impact in Tan...Sandeep Singh
The document discusses the impact of HIV/AIDS in Dar es Salaam, Tanzania based on a survey of over 1,000 respondents. Key findings include: over 60% of respondents reported knowledge of Tanzanian HIV/AIDS prevention programs; 92% thought sex education should be provided to children before they become sexually active; and 74% believed HIV/AIDS leads to children becoming orphans. While 53% saw HIV/AIDS patients as a financial burden, many felt the infected should not be ashamed or expelled from communities. The study highlights impacts on health, education, agriculture, and children and calls for improved prevention efforts, sex education in schools, and amendments to marriage age laws.
This document is a demographic research proposal investigating the determinants of modern contraceptive use among unmarried female adolescents aged 15-19 in Malawi. It begins with an introduction that provides background on the sexual and reproductive health problems faced by this population and discusses Malawi's efforts to address this issue through youth friendly health services. The problem statement notes that while modern contraceptive use has increased, unplanned pregnancy rates remain high. The literature review covers sexual health issues, benefits of modern contraceptives, and factors influencing use worldwide and in Malawi. The objectives and research questions aim to examine the association and influence of various determinants on modern contraceptive use. The methodology section outlines the study design, data sources, variables, and analysis
Overview of the national Methadone Maintenance Treatment (MMT) program in Vie...Geraldine Cazorla
This document provides an overview of Vietnam's national Methadone Maintenance Treatment (MMT) program, including a discussion of its implementation process, key issues, and opportunities for scaling up. The author conducted surveys of key stakeholders and MMT clients/injecting drug users to analyze the program across four domains: legal framework, stakeholder responsibilities, financing, and technical factors. Key findings include contradictory responsibilities among government agencies, limited MMT supply and training capacity, challenges securing sustainable funding, and inconsistencies in legal frameworks. The author recommends clarifying roles, increasing resources, diversifying funding sources, and revising policies to address these issues and improve the national MMT program in Vietnam.
The document discusses the global and national status of the HIV/AIDS epidemic. Globally in 2014, there were approximately 36.9 million people living with HIV/AIDS, including 2.6 million children. An estimated 2 million were newly infected that year. In Asia and the Pacific region there are an estimated 5 million people living with HIV, with concentrations among people who inject drugs, men who have sex with men, and sex workers. In Nepal, HIV transmission is primarily through heterosexual contact, with over 50,000 people estimated to be infected as of 2012, including high-risk groups such as sex workers and labor migrants. Key factors influencing the epidemic in Nepal include poverty, gender inequalities, stigma, and lack of health
This document outlines the purpose and context of a research study on the impact of health education on HIV prevention in Canada. [1] The study aims to understand how education impacts various intervention programs and factors that help education be successful. [2] It will also seek to understand perceptions incorporated in education that help HIV education programs. [3] Key issues examined will include whether education targets at-risk groups and whether service providers are flexible in assisting people with HIV.
Healthcare seeking and sexual behaviour of clients attending the suntreso sti...Alexander Decker
A study of 185 clients with sexually transmitted infections (STIs) attending an STI clinic in Kumasi, Ghana found that 64% delayed seeking treatment for more than 4 weeks after symptoms appeared. 61% had previously sought treatment elsewhere before coming to the clinic. 80% had unprotected sex while symptomatic. The document discusses factors that influence healthcare seeking behaviors for STIs, including long wait times, stigma, lack of privacy, and attitudes of healthcare providers. It also examines sexual behaviors among STI patients, noting that most engage in unprotected sex during symptomatic periods. Understanding these healthcare seeking patterns and behaviors can help develop more effective STI prevention and control programs.
This document discusses non-communicable diseases (NCDs) in Somalia. It provides background on NCDs globally and in Africa, noting they account for over half of deaths worldwide and their treatment is expensive. The document then discusses the problem of NCDs in Somalia, where cardiovascular diseases and diabetes are increasing causes of death. The rationale for the study is described, focusing on identifying risk factors like lifestyle and diet that contribute to NCDs. The objectives are to assess NCD prevalence, risk factors, and their distribution in Somalia. Research questions and hypotheses relate to links between behaviors like smoking/inactivity and NCD risk.
Today we stand at a vital threshold. Within our grasp is the opportunity to end 30 years of suffering and death due to HIV/AIDS. Individuals and communities around the world have been mobilized toward prevention, and existing treatment can prolong life for many years. While we celebrate these successes, we reject any modicum of complacency. Now is the time to double down and finish the job. The world is fighting AIDS today just as it had previously fought to eliminate smallpox. For centuries, smallpox was a feared scourge that killed nearly half of those infected and maimed those that survived. A worldwide campaign to end the disease began in earnest in the late 1960s and by 1980 smallpox was officially eradicated.
Planet Aid anticipates the day when AIDS, too, will be stopped. To this end, we have been helping mobilize communities around the globe to increase HIV/AIDS prevention and care. With this special issue of the Planet Aid Post, we focus on the battle ahead. We also extend a warm welcome to those joining us on the forefront of this work,
This study analyzed data from over 18,000 pregnant women tested for HIV between 2005-2012 at a hospital in southern Odisha, India. The overall HIV prevalence was 0.66%, declining from 1.53% in 2006 to 0.34% in 2012. Most HIV-positive women were aged 25-29, married, from rural areas with low education/socioeconomic status. The declining prevalence suggests prevention campaigns promoting condom use and safe sexual behaviors are having a positive impact.
Islam and harm reduction
International Journal of Drug Policy
Volume 21, Issue 2, March 2010, Pages 115–118
A. Kamarulzamana(a), S.M. Saifuddeenb(b)
(a) Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Lembah Pantai, 59100 Kuala Lumpur, Malaysia, adeeba.kamarulzaman@gmail.com
(b) Yayasan Ilmuwan, D-0-3A, Setiawangsa Business Suites, Taman Setiawangsa, 54200 Kuala Lumpur, Malaysia
Abstract
Although drugs are haram and therefore prohibited in Islam, illicit drug use is widespread in many Islamic countries throughout the world. In the last several years increased prevalence of this problem has been observed in many of these countries which has in turn led to increasing injecting drug use driven HIV/AIDS epidemic across the Islamic world. Whilst some countries have recently responded to the threat through the implementation of harm reduction programmes, many others have been slow to respond. In Islam, The Quran and the Prophetic traditions or the Sunnah are the central sources of references for the laws and principles that guide the Muslims’ way of life and by which policies and guidelines for responses including that of contemporary social and health problems can be derived. The preservation and protection of the dignity of man, and steering mankind away from harm and destruction are central to the teachings of Islam. When viewed through the Islamic principles of the preservation and protection of the faith, life, intellect, progeny and wealth, harm reduction programmes are permissible and in fact provide a practical solution to a problem that could result in far greater damage to the society at large if left unaddressed.
Assessing the Quality of Life of HIV/AIDS Patients attending Anti-Retroviral ...RosyPurakayastha
This document describes a study that assessed the quality of life of 150 HIV/AIDS patients attending an anti-retroviral clinic using the WHOQOL-HIV BREF scale. The scale measures quality of life across 6 domains: physical, psychological, independence, social relationships, environment, and spirituality. A literature review found that HIV/AIDS negatively impacts quality of life in all domains. The study aimed to identify quality of life issues in these domains and how they relate to socio-demographic factors, to help allocate resources and address patient needs. Patients were interviewed using the WHOQOL-HIV BREF scale to measure their perceptions in each domain.
Factors contributing to hiv aids – related stigma and discrimination attitude...
Masters Thesis
1. Master of Public Health
Project Report
Department
of
Public Health
Effectiveness of Community-Based Outreach programs in reducing the
risks for HIV/AIDS transmission among Intravenous Drug User in a low
prevalence country, Bangladesh.
A Research Protocol
Dr. Raushan Akhter
Student 145400
This thesis is presented as part of the requirement for the award of the degree of Master of Public
Health of the University of Melbourne.
November, 2003
2. TABLE OF CONTENTS
1. Introduction …………………………………………………………….......... 3
2. Background of HIV/AIDS in Bangladesh…………………………………… 4
3. Surveillance data and Prevalence of IDUs in Bangladesh…………………. 5
4. Current situation of drug taking practices and risk factors……………….. 6
5. Interventions to reduce HIV among IDUs…………………………………… 7
6. Prevention programs among (IDUs) in Bangladesh………………………… 8
7. Barriers to reduce the risk behaviours among the IDUs……………………. 8
8. Aims and Objectives…………………………………………………………… 10
9. Goal……………………………………………………………………………. 10
10. Significance of this project……………………………………………………. 10
12. Materials and Methods………………………………………………………… 12
13. Protocol.………………………………………………………………………… 18
14. Ethical issues……………………………………………………………………. 21
15. Discussion……………………………………………………………………….. 21
16. Acknowledgments………………………………………………………………. 23
17. References……………………………………………………………………….. 24
Flow Chart ……… ………………………………………………………… 19
Table 1…………………………………………………………………….... 21
3. Introduction
The purpose of this project is to design a research protocol that will increase the knowledge level and reduce the
risky behaviours in order to prevent HIV and STD transmission among the high risk group population, the IDUs
in Bangladesh.
Background
Drug injecting is a global phenomenon, with huge significance for the health and social condition of drug
injectors and the communities in which they live. In 1992, the injection of illicit drugs had been reported from
over 80 countries (Stimson, 1993) and by 1995; reports of injecting had been received from 121 countries
(Stimson, 1996). Injecting drugs has existed in developed countries for many years, and may be found in many
sectors of the population. The more recent diffusion of injecting is occurring in the developing world. In many
developing countries injecting has already permeated a range of social groups in rural and in urban areas, among
slum dwellers and among hill tribes. Following this pathway, injecting is now spreading in countries that are
mostly poor in Asia and that are either in drug producing areas or along drug transit routes. As a result, Asia has
explosive rates of HIV/AIDS among the injecting drug users. The concentration and distribution of this injecting
reflects the social and cultural composition of the country, the groups in which injecting was first introduced and
the stage of diffusion of the practice (Stimson, et al. 1995).
Like many other developing countries, Bangladesh is under the same umbrella of the threat of a future
epidemic of HIV/AIDS. Recently, Bangladesh’s AIDS policy recognized that drug users must be active partners
in the fight against AIDS. Therefore, noting the efficiency of HIV transmission via shared needles, the policy
states: “Prevention of HIV is however possible if---drug users or community organizations are involved in
prevention…. [and] means of behaviour change (access to needles, syringes, bleach, condoms, etc.) are made
accessible, [and] options are offered to the IDUs as to how they will make a change in behaviour rather than a
single approach.” [Government of Bangladesh, “National policy on HIV/AIDS and STD Related Issues,” p-65,
2003]. As a result, programs and methods of reducing or preventing drug injecting risk behaviours needs to be
designed.
Country profile of Bangladesh
Bangladesh is the ninth most populous country in the world having 140.4 million people and 980.8
persons living per sq. km (UNAIDS, 2001). An estimated 70 million Bangladeshi live in absolute poverty.
Despite rapid gains in health status since independence in 1971, the primary health care sector is still very weak.
In this country, still 67 percent of rural children suffer from chronic malnutrition and less than 40 percent of the
population has access to modern primary health services beyond immunization and family planning [Family
Health International (FHI), 1997]. Moreover, only 25 percent of pregnant women receive antenatal care, and
4. someone with formal training attends 14 percent of births only. The maternal mortality of Bangladesh’s is 440
deaths per 1000, which is among the highest in the world (Pisani, 2002).
HIV/AIDS and Bangladesh
Bangladesh is at a critical moment in the course of its AIDS epidemic. The official government figures
suggest that the epidemic is not widespread. A total of 157 HIV positive cases have been reported in which the
male population predominates. So far, 17 HIV infected persons developed AIDS of which 11 have died
(Bangladesh Development Gateway, 2003). Whereas, The Joint United Nations Programme on HIV/AIDS
(UNAIDS) estimated that there are 13,000 HIV-positive people in the country and that HIV prevalence in the
population is less than a tenth of one percent (Human Rights Watch, 2003).
The information on HIV prevalence in Bangladesh is limited and data available is sporadic. Therefore, it
is not known exactly how many people are infected, but it is true that HIV is being detected among the population
especially among vulnerable groups. So far only scant data are available to provide accurate definitions of the
distributions or to quantify the prevalence of several risk behaviours and factors in Bangladesh. However, several
factors, mainly related to the country’s poor socio-economic background are influencing the epidemic (UNAIDS,
UNICEF and WHO, 2002). The factors making the Bangladesh situation particularly vulnerable to a devastating
epidemic are:
a) Low level of HIV/AIDS awareness:
Awareness of HIV/AIDS in the Bangladeshi population remains quite low. One recent survey found that
“Only 19 percent of ever-married women and 33 percent of currently married men had heard of AIDS” (The
Daily Star, 2003). As of July 2003 there was virtually no sex education in Bangladeshi schools. Recently, the
government announced a plan to begin offering sex education in public schools for the first time in 2004 (Agence
France- Presse, 2002).
b) High transit zone and high migration:
Bangladesh is surrounded by parts of India with high HIV prevalence –West Bengal to the west and
Northern India to the east and also a neighbor to the epidemics of Southeast Asia. Myanmar, formerly known as
Bhutan is estimated to have over 850,000 people infected. Again, there is a great deal of migration across
Bangladesh’s borders. Every year, it is estimated that about 74,000 Bangladeshi go abroad without their family
(Rahman, 1999). It is believed that non-marital sex is common during this period.
c) High incidence of premarital and extramarital sex:
The incidence of premarital sex is quite widespread in Bangladesh. The incidence is more in the lower
socio-economic class than in the higher. In addition, most of the long distance truck drivers go for sex with the
commercial sex workers even twice a month while they spend time away from their families. In one survey, 30%
of male clients at an STI clinic were found had sex with unmarried girls (World Bank and WHO, 2001).
5. d) Inadequate HIV/AIDS diagnostic facilities:
Unfortunately HIV testing facilities are rarely available in health clinics. Where there are facilities,
however are not usually accompanied by counseling.
e) Low condom use:
Many people still believe that condoms are only family planning device (Rahman, 1999).
f) Others:
Bangladesh also has a high rate of poverty, systemic gender inequality, and an inadequate health care
system, all of which have been seen in many settings to be contributing factors to the rapid spread of HIV
(Chowdhury, et al. 2003).
The combined influence of all of these behavioural and biological factors leads to a non-random and
discriminating spread of HIV in various sub-populations and the population as a whole. Therefore, if
Bangladesh’s campaign against AIDS is to succeed, an effective strategy addressing these high risk groups needs
to be implemented for prevention, before it is too late.
Surveillance data and Prevalence of IDUs in the country
The first national sentinel surveillance (1998-1999) revealed an overall HIV prevalence among the high
risk behaviour practicing sample population to be 0.4% and in second surveillance (1999-2000) it was 0.2%
among 400 sample size (Government of the People’s Republic of Bangladesh, 2000):. However, the sample
size of the two surveys were different and new categories of high risk population were included as sample in the
second survey. Whereas, the rate of injecting drug users (IDUs) was 25 and 20 per 1000 populations in the first
and in the second survey respectively. The study also found that 13% of the street based female sex workers had
injected themselves with drugs, although none of those had been tested positive for HIV (UNAIDS, UNICEF and
WHO, 2002)
Available data from Client Monitoring System of Department of Narcotic Control and other research
report showed that prevalence of injecting drug use (IDUs) is on the increase in many parts of the country. HIV
prevalence remains low in most high risk groups tested but is raising among Intravenous Drug Users (IDUs) and
brothel sex workers. Most injecting drug users in Bangladesh share needles. There are estimated 25000 IDUs
mainly in Dhaka, Rajshahi, and other towns including border areas. A considerable proportion of IDUs are clients
of sex workers and many IDUs are married, putting their family members at a higher risk of disease transmission.
Further, prevalence of STDs is quite high among drug users in general (Bangladesh Development Gateway,
2003). The highest prevalence of HIV/AIDS detected was 2.5% among 400 IDUs coming to detoxification
clinics, but could be higher in out-of treatment IDUs (UNAIDS, 2000). This year, the fourth sentinel surveillance
report showed four percent (4%) HIV prevalence among the injecting drug users in central Bangladesh, which
was disclosed at a press conference by the health ministry officials (The Daily Star, 2003).
6. However, surveillance findings nevertheless concluded that high level of behavioural risk factors for the
acquisition of HIV infection are very much existence at least among the sampled population. Moreover, it is
specifically clear from the surveillance that some groups of people who practice high risk sexual behaviour have a
large number of sexual partners averaging between 12 and 40 per year (Bangladesh Development Gateway,
2003).
Current situation of drug taking practices and risk factors in Bangladesh
The injecting of drugs is believed to have commenced in 1990 in Bangladesh and while the most popular
routes for taking drugs is reported as ingestion or inhalation, injecting does appear to be gaining popularity
(Hassan and Ahmed, 1999) and data recorded in treatment centers report an increase in the rate of injecting from
6% in 1993 to 17% in 1995 in a sample of 402 IDUs (Ray, 1998). In 1996, a Rapid Situation Assessment (RSA)
survey conducted in three major cities (Dhaka, Rajshahi, Chittagong) among 1750 participants reported that other
most commonly used drugs were cannabis, cough syrup (codeine based), sedatives and heroin, where as for those
surveyed in treatment centers the most commonly used drugs were heroin, codeine, cough syrup, buprenorphine,
cannabis and sedatives (Ray, 1998).
Further, the behavioural surveillance study of 1998-99 showed that for those who injected, the drug of
choice was buprenorphine which was frequently mixed in a cocktail of substances including diazepam,
promethazine hydrochloride and chlorpheniramine. Moreover in the northern part of the country, drug use,
including injecting, has been reported it is also common in several areas of the capital, Dhaka. One study showed
that heroin was used by only 2% of participants (n = 450), and was usually dissolved in lemon juice before
injecting (Hossain, 2000).
In 2000, a study in Dhaka reported the average number of injections per day was two in IDUs and the
sites were; 26% into the vein, 56% into muscle and the rest 18% used both the vein and the muscle (Mallick and
Gomes, 2000). Another earlier study reported that 59% always injected into the vein (Jenkins and Rahman, 1999).
Addas are shooting galleries, where most IDUs gather to inject, and where the drugs and the professional
injector can be found. It has been suggested that the professional injectors are able to maintain business through a
good supply of drugs, connections to wholesalers and by providing the injecting services. In 1999, in Rajshahi an
estimated 50 adda injectors and 94 addas were operating in the city. These facilities are often located in disused
buildings and lane ways but some also operate in hotel rooms (Hossain, 2000). In another study it was reported
up to 90 persons a day used a single adda injector, often for multiple injections (Jenkins and Rahman, 1999).
Further studies in the late 1990s reported widespread sharing of needles among all IDUs (60%-90%) and
the professional injectors did not sterilize their needles and syringes (Hossain, 2000). More over, it has been
observed that a needle is only changed when it becomes blunt and glass syringes are rarely changed or discarded
(Hossain, 2000). New needles add an extra expense that few poor IDUs can not afford, thus explaining the
reasons for the wide spread sharing (Jenkins, 1999). In addition, some people have been known to use syringes
rejected by hospitals [Society for Health Education, Agronomy and Self Sufficiency (SHEAS), 1996]. Though
7. there are regulations in place requiring a prescription to buy such equipment, this is often ignored. However,
cleaning of needles by those who shared their needles is rarely adequate. Methods include; using cotton or paper
or using distilled water to clean the needle (Mallick and Gomes, 2000). Some IDUs even use saliva to clean their
needles with the belief that this might destroy any poisons found in the blood (SHEAS, 1996).
Interventions to reduce HIV among IDUs
Specific behaviours associated with drug use that are risk factors for HIV transmission include shared use
of drug injection equipment and unprotected vaginal or anal sex with multiple sexual partners. For this reason,
interventions that can reduce the prevalence of these practices are critical components of a comprehensive AIDS
prevention policy. Therefore, different countries require different polices and prevention efforts which seem to be
most effective in changing behaviour among the IDUs.
Effective risk reduction programs for IDUs implemented in both developed and developing countries include:
A) Educational programs
B) Drug abuse treatment programs
C) Needle exchange programs (NEPs)
D) Community outreach programs
E) Over-the-counter syringe sale
F) Bleach distribution programs for needle cleaning, and
G) HIV counseling and testing
Injecting drug users can and do change their drug use behaviours under certain circumstances. However,
research indicates that while injecting drug users change their needle-sharing and cleaning practices, HIV
prevention efforts have not been successful in the realm of sexual behaviour, particularly with regard to condom
use (Riehman, 1996). Thus safer sex practices need to be incorporated with these methods. Further, it has also
been recognized that education and information alone may not cause a reduction in risky bahaviour among IDUs
(Riehman, 1996). Whereas, education combined with group interactions and exercises seems to be more effective
(McCoy and inciardi 1995; Jemmott, et al. 1992). In addition, there is a growing consensus that effective
prevention programs should include the promotion of treatment for reducing drug use, providing the means for
safer injection, and promoting safer sex (Riehman, 1996).
Therefore, it is clearly understood that for an effective prevention approach, comprehensive action would
be the best successful approach for preventing the spread of HIV, other blood-borne infections, and STDs in drug-using
populations. However, this approach might be difficult to implement and make it sustainable in a
developing country like Bangladesh, where health care facilities are poor; literacy rates are low and most
importantly where resources are not enough.
8. Prevention programs among Intravenous Drug Users (IDUs) in Bangladesh
In Bangladesh, the injecting drug user intervention is based on a harm reduction strategy to reduce the
spread of HIV and to minimize the negative health effects of drug injecting. Around 3,200 injecting drug users
(IDUs) are reached every day through this program. It has two major components:
a) Drop in centers:
There are seven Drop in Centers (DIC) only in the capital, Dhaka City. These are considered to be safe
places for the IDUs where they can come to socialize, take rest for sometime, seek referral services to drug
treatment, receive treatment for abscess, STDs, and other ailments. Community detoxification camps are
organized for those IDUs who want to get out of the drug habit (Begg, 1999).
b) Outreach services:
Twenty-six trained Peer Outreach Workers (POW) have been recruited for this task, who are current
injecting drug users. They work in addas, where IDUs gather. They train and educate IDUs about safer
practices and distribute condoms along with information on HIV/STD (Begg, 1999).
Barriers to reduce the risk behaviours among the IDUs in Bangladesh
Absence of sex education at home and in institutions
In Bangladesh, the educational curriculum does not have sex education for children or for adolescents.
Though the present curriculum of science in higher secondary level contains several reproductive health
componants, the information is incomplete, disordered and not in detail. For the youth, sex education is not
offered in government or out-of-school education programs. The prevailing socio-cultural norms inhibit the
disclosure of information about the sexual activities of adolescents, thus preventing obtaining accurate
information on their reproductive health [Shohojogi-AIDS (Bangladesh), 2002] As a consequence, of six million
adolescent students in approximately 14,000 secondary schools, 3.5 million male students are ignorant about
education on sex (Alochona Magazine, 2003). In Bangladesh, previously sex education has been geared toward
high risk groups, such as CSWs and drug users, because many projects are funded by foreign donors as part of
more general reproductive health programs. The result is that the general population sees sexual problems as
being a concern only those who engage in inappropriate sexual behaviour.
On the other hand, the adults in Bangladeshi society in general are reluctant to give sex education because
they feel this will increase the possibility of sexual activity, promiscuity and early pregnancy. According to the
parents, sex education might compromise the family honour by providing youth with information that will lead to
dangerous social consequences for girls. Through arranged marriages or an economic transaction via marriage the
parents try to control the sexuality of youth (Alochona magazine, 2003). Moreover, public health workers,
teachers or parents, who have the most contact with youth and who often can act as sex educators, are not well
9. trained. They often adopt a moralistic and didactic tone. This alienation of the larger society is one of the root
causes for the failure to initiate and institute sex education in the country.
Abuse against injection drug users (IDUs)
There are records of several cases that the injecting drug users (IDUs) are beaten and extorted by the police
and by mastans (committing robbery by force) in the country. Human Rights Watch gathered several reports of
police extortion of injection drug users. Further, Human Rights Watch was also told of several arrests of outreach
workers. Moreover, the police arrests are sometimes accompanied by violence. If the drug user refuses or fails to
produce the bribe that police demanded, they are tortured inhumanly while in police custody, and then transferred
to jail. (Human Rights Watch, 2003).
As a result, the injection drug user breeds fear rather than collaboration; they become further alienated from
figures of authority and from society in general, and it become more difficult for them to be participants or
beneficiaries of AIDS prevention and care programs.
Weakness of law enforcement system
The policy makers are sympathetic and supportive to needle exchange programmes which is (to be
believed) an important tool in the nation’s HIV prevention strategy. Even if they might appear to have
controversy at this stage, needle exchange is legitimate to implement. The policy goes further to recognize that
“there is overwhelming evidence of the high effectiveness of needle exchange programmes” [Government of
Bangladesh, “National policy on HIV/AIDS and STD Related Issues,” p-65), 2003]. However, strict
paraphernalia laws are restricting procurement of syringes and needles without prescription, or misuse of the law
(suspected people are arrested for carrying injecting equipment) increases the risk of sharing needles and therefore
of transmitting HIV. Police harassment is still going on, where high risk groups are suffering from beatings,
robbery of money and drugs, and reselling of drugs to drug users at higher prices by the law enforcement
department. Even death was caused due to excessive beating by the police force (Advocacy Guide for HIV
Prevention among IDUs, 2002). As a consequence, police are at the forefront of Bangladeshi public debate, and
there is an emergence for the reformation of the law enforcement system. Otherwise, the IDUs could not be traced
or contacted to make a change or reduce their risky behavioural practice. This would result in an increase in the
risk of sharing needles, rise of HIV transmission and ultimately the fight against HIV/AIDS in Bangladesh would
be undermined.
Scarce resources
There are major resource problems in Bangladesh, especially an acute lack of medical and public health
resources. In developed countries, the ability to extend a harm-reduction approach from the national level has
been helped by having relatively well developed social welfare systems and an educated population accessible
through a range of media (Stimson, et al. 1995). Whereas any long term intervention program for drugs or HIV
infection in Bangladesh is faced by problems of access to populations, with limited media coverage, poor
transport and communications, and most importantly fund shortages and low educational levels. As like other
developing countries, the per capita income and GDP are also low.
10. The health care system in the country is generally characterized by poor allocation of resources for service
development, lack of qualified personnel and poorly developed information gathering systems. The cost of
introducing some of the harm reduction measures that have been used in rich countries, for example: free syringes
and free treatment including substitute prescribing, cannot be borne in this country where urgent priority is for
other health problems (e.g. malaria, malnutrition, tuberculosis, dengue fever, arsenic toxicity) as well as non-health
sector ones (e.g. education, housing, sanitation, natural disaster and so on). However, in respect to different
social, bahavioural, cultural and political factors which mediate the spread of injecting drug use, we need to
introduce a cost-effective and sustainable harm minimization technology to combat the HIV/AIDS epidemic
before it is too late.
Aims and Objectives
Primary:
To design a community-based outreach HIV intervention trial in two locations of two district town in
Bangladesh.
To increase knowledge of HIV prevention practices
To reduce HIV- related drug and sex risk behaviour
Long term outcomes not addressed in this protocol
To reduce the risk of HIV/AIDS in the individual and in the community
To reduce transmission of STDs, and to provide STD referral (& management)
To enhance and strengthen the community, which will rely on outreach programs and a peer leader
approach to service delivery.
To promote an accessible, acceptable, cost-effective and sustainable strategy to reduce the risk behaviours
among the Intravenous Drug Users (IDUs).
To reduce drug-use related morbidity and mortality.
Goal:
The overall goal of this project is to design a protocol to improve knowledge and to reduce the risks for
HIV, and other blood-borne infections, and STDs in drug-using populations.
Significance of this project
Health and social consequences
High-risk practices are inevitably connected with serious health consequences. In South-East Asia the
prevalence of HIV-1 among IDUs in many sites reached 40% within one year of it first being identified (Stimson,
1994). The injecting behaviours are so risky that, for example in Myanmar, many injectors become infected with
11. HIV-1 within the first few weeks of starting to inject (Stimson, et al. 1995). HIV prevalence at this high rate is
sustained by the interaction between high-risk sharing behaviours, the high prevalence rate, and the many new
cases of infection that are at a highly infectious stage of HIV disease. Further, in Yunnan, high rates of sexual
transmission of HIV have been reported from injectors to their wives. In Southeast Asia, the epidemic spread to
high prevalence in Myanmar, Manipur and Yunnan occurred within three years of the outbreak in Thailand
(Stimson, 1994).
However, the social, cultural and legal environment of HIV among the IDUs is generally marked by
stigma, prejudice and a judgmental attitude, especially with regard to sexual behaviour. Moreover, the injection
drug users, who are already stigmatized by the society, often experience heightened degrees of discrimination as
compared to others living with the virus. Among them, homelessness, unemployment, low socioeconomic status
and high mortality are the adverse social consequences related to drug use. The linkage between injection drug
use, HIV and social stigma in the public imagination is so strong , that HIV has come to be understood as a ‘social
evil’ in this country. Therefore, in order to combat the HIV-related social stigma experienced by IDUs, it will be
important to find ways to de-link the disease, and those affected by it from the moral opprobrium associated with
the use of illicit drugs (Deany, 2000).
Unique setting for counseling and training through peer education
Community-based outreach workers are on the front-line in the local community, and they know where,
when, and how to contact even the most difficult-to-reach drug users in their neighborhoods. As a trusted and
recognized source of information, an outreach worker can help drug users understand their personal risks for HIV
and other blood-borne diseases and identify the preventive steps they need to take. As a peer, the outreach worker
can encourage drug users to stop or reduce using injecting drugs and enter drug abuse treatment (Needle, et al.
2003).
Moreover, they can provide referrals to drug users for drug-abuse treatment, for testing and counseling for
HIV/AIDS and other infectious diseases, and other community health, prevention, and social programs [National
Institute of Drug Abuse (NIDA), 1999]. Most importantly, outreach workers are a vital link to networking for
educational and risk-reduction information on HIV/AIDS, HBV, HCV, and other STDs, and disseminating and
distributing information and materials for behavioral change, including the HIV/AIDS risk-reduction hierarchy,
bleach kits to disinfect injection equipment, condoms for safer sex, and instructions for proper condom use and
disposal.
Effective strategy for behavioural change
Community-level interventions may be an important way to effect behavioural change on a broad scale.
NIH-supported researchers have investigated the impact of community-level approaches both in the United States
and abroad. More than 15 years of research on HIV/AIDS prevention with IDUs, crack cocaine users, and many
of their sex partners has shown that community-based outreach is effective for all types of drug-using risk groups,
in a range of local settings. Cumulative research from a 23-site study that followed 18,144 drug users (13,164
IDUs and 4,980 non-injecting crack users) reports that three to six months after participating in the intervention,
12. 72 percent of the IDUs either stopped injecting drugs or reduced their frequency of injection. Of those who
continued to inject, nearly 60 percent either stopped or reduced reusing or sharing their syringes. Twenty-six
percent of the crack cocaine users, including 8,184 IDUs who also used crack and 4,980 non-injecting crack users,
had stopped using crack cocaine at follow-up. Moreover, 25 percent of the 18,144 drug users who participated in
the study had entered drug abuse treatment at follow-up, many for the first time (NIDA, 1999).
Cost-effective intervention
Cost-effectiveness studies have reported that, community based outreach programs are a low-cost
intervention approach that permit ongoing contact with drug users and multiple opportunities to reinforce the HIV
risk reduction message. Sustained, well-designed strategies using a community-based model for HIV prevention
can lead to substantial reductions in health-care and social costs associated with the treatment and care of people
with HIV/AIDS and other infectious disease (CDC, 1993). Further, community-based outreach interventions
could help avert future medical costs associated with the care and treatment of HIV/AIDS (Pinkerton, 2000). In
addition, research has shown that the three complementary approaches that make up comprehensive HIV
prevention for drug users: community-based outreach, drug abuse treatment, and access to sterile syringe
programs are cost-effective.
The community-based outreach model is most cost-effective when its strategies are implemented among
the high-risk groups early in the epidemic, when the prevalence is low and using this model the greater number of
potential new infections in the populations can be averted (Des Jarlais, et al. 1995).
Materials and Methods
This study would be conducted in two district towns of Bangladesh. This intervention trial is developed
based on the review of different published articles on Intervention Studies on Intravenous Drug Users (IDUs)
implemented in various developed, developing and transitional countries. These cover the extent, nature and
strategies of preventions along with reducing the risk behaviours of HIV infection among IDUs. Reports on
national HIV surveillance, behavioural and sero-surveillance survey on STD and AIDS conducted by NGOs and
the Government of Bangladesh from the period of 1998 to 2002 were reviewed.
Subject recruitment
The primary means of recruitment would be from the government hospital register (containing all
demographic data, drug history, medical history, work history as well as family and other contacts) as most drug
users are serviced by government health care facilities. If sufficient sample size would not be available, then the
secondary method of recruitment would be through professional social workers who are familiar with the current
users hidden in the community. Study respondents would be opiate-addicted IDUs, injecting drugs at least once
during the previous week or month, 18 years of age or older, male or female and from any racial/ethnic
community would be the inclusion criteria for this study. The only basis for exclusion would be participants who
13. are enrolled in any other drug intervention program would not be considered for this study to minimize any
confounding or bias.
Sample group
The sample for the study will be obtained using targeting sampling procedures similar to those used in the
U.S. National Institute on Drug Abuse-funded evaluations of street outreach. Targeted sampling is a method
whereby representative samples of hidden populations such as IDUs are recruited in a systematic fashion (David,
et al. 2002), using this method a general survey will be done in the local community to identify homeless persons
who are illicit drug users not in treatment, and persons who are interested to receive confidential HIV counseling
and testing by giving their signature and informed consent and administering all relevant information about
demographics, HIV-risk behaviours and testing history, illicit drug use, and socio-sexual connections. It is
expected that respondents would be predominantly male, as prevalence of female IDUs users is still low to date.
Study location
Rajshahi Metropolitan City and Pabna Metropolitan City are the two districts which would be selected
for this study, because these are the narcotics smuggling routes in Bangladesh, which have attracted the drug-dealers
since 1980. At baseline, there would be no significance differences between the participants of the two
sites on demographic data like age, caste, marital status, and educational status. The general populations of these
two districts are mostly homeless or slum dwellers having low or no education, low income, and most importantly
are unemployed. Rapid urbanization, illiteracy and poor socio-economic conditions are the main features which
contribute to this risky bahavioural practice. Further, easy availability and cheap price increases wide spread use
of drugs among these groups in this region in comparison to other districts of the country.
Outreach team
The research team will consist of ex-drug users (identified from the renowned local community leaders,
who are familiar with the drug users and their milieu), professional social workers, and indigenous residents of
the selected communities. This team will recruit the IDUs and conduct program interventions. The hospital
registers containing the details of intravenous drug users (IDUs) would be contacted in each district in the six
months preceding the beginning the of study recruitment. Using these records, the outreach team will identify the
location and social organization of drug users (IDU population) to identify the appropriate respondents in each
district. IDUs that express interest in this study, and found to be eligible will be enrolled.
Enrollment & consent procedure
Eligible interested participants will be invited to attend a briefing session on the study, presented by a
staff member of the outreach team. Each participant will be given an opportunity to know anything about the
study, and then requested to sign the consent form. The baseline and follow-up questionnaires will include some
assessment used to characterize respondents ‘risk status’ (low vs. high). Respondents will be judged to be at low
risk, if during the previous seven days they did not used a syringe that someone else had just used without first
cleaning it with bleach or, if they did use a nonsterilized syringe, and they did so only with a regular sexual
partner who they believed to be HIV negative. Conversely, respondents would be judged to be high risk if they
14. used a syringe which was not cleaned with bleach and shared with someone other than a regular sexual partner or
with a regular sexual partner whose HIV status was either positive or unknown. Baseline data collected by the
questionnaire would be recorded immediately in a computer. After obtaining informed consent, interviewers will
take blood samples for HIV antibody testing using ELISA methods and confirmed by Western blotting. In the
meanwhile, participants will be assured about the maintenance of confidentiality of their risk assessment and
antibody testing. Further, extensive tracking information would be gathered to assist the outreach team and
interviewers in contacting IDUs for follow-up interviews. It can be mentioned here that concentration of this
study will be more towards the ‘high risk’ group participants as it will be expected that number of ‘low risk’
subjects will not be available or inadequate.
Community-based outreach group intervention trial
The principal elements of this outreach intervention trial are:
a) Providing AIDS education, raising awareness about drugs, HIV/AIDS and STD and their transmission in
general, HIV prevention activities
b) Basic risk reduction activities involving group training and counseling/face-to face communication
c) Delivering bleaching powder and
d) Distributing condoms
The educational session will be strengthened by providing a video or slide presentation demonstrating correct use
of bleach and condom and also supported by educational promotional literature for literate clients. Outreach
workers will also refer drug users to other available services in the community.
In this outreach model, clients would be provided at least three sessions in face-to face settings:
Session 1- raising awareness about drugs, HIV and other blood-borne disease transmission, correct techniques for
needle decontamination with bleach, and condom use.
Session 2- reinforcing the components of the first session and assisting clients in identifying their own specific
risk behaviours and understanding the strategies to reduce their HIV, STD and blood-borne risks.
Session 3- providing information about existing services and advising on social and medical problems.
Since clients need to be transferred to a different location for the testing, there might be a chance for loss of
subjects to this service.
Control group participations
A control group of current IDUs will be recruited in Pabna Metropolitan City, at which no outreach
services will be available; a sample of IDUs will complete the baseline assessment. A similar strategy would be
adapted for the recruitment procedure. After one year, the individuals would be followed-up to review the
progress. The purpose for this follow-up visit is for two reasons. Firstly, this will encourage the participants to be
in touch with the program as they will receive some money as intensives, and some materials (bleach and
15. condom) free of cost. Secondly, refresher training will be provided to strengthen or reinforce their basic
knowledge level and help them to change their risky behavioural practice.
Reasons for selection of these interventions in this trial
AIDS education
Since unprotected sex and risky injecting behaviour are the driving forces behind most HIV epidemics,
therefore, knowledge about AIDS/AIDS, the behaviours that spread it and the ways it can be avoided, are
important prerequisites for prevention of unsafe sex and injecting behavioural practices. Further, data has shown
that 60% of drug users in this country are unaware about AIDS and the mode of its transmission (Govt. of
Bangladesh, and UNAIDS, 2000). At present, Life Skills-Based Education (LSBE) is being adopted as a means to
empower young people in challenging situations. As LSBE enhances the quality of content by addressing issues
relevant to the lives of learners and is often applied to pertinent health and social issues which are not traditionally
included in the academic curriculum and which demand the adoption of positive behaviours by young people
(e.g., health, human rights, gender equality, peace). Therefore, one of the key defenses against the spread and
impact of HIV/AIDS is to ensure access to free and compulsory primary education of good quality and learning to
prevent and cope with HIV/AIDS among the high risk groups. Because, HIV/AIDS prevention programs that
have balanced with knowledge, attitudes and skills related to HIV transmission have proven more effective in
actually challenging behaviour than those that have focused on information alone. Further, skills-based programs
have proven more effective in delaying the age of first sexual intercourse, and increasing safe sex behaviours
among sexually active youth (e.g., increasing use of condoms, reducing of sexual partners) [WHO, 1999].
Training and counseling
These approaches can help IDUs to make an informed decision to reduce harmful behaviours by
understanding their risks for HIV, other blood-borne disease and identifying the preventive steps they need to
take. Counseling will help people to understand better and deal with problems, communicate better with whom
they are emotionally involved, improve and reinforce motivation to change behaviour and help people to learn
and deal with fear and anxiety. It can provide support at time of crisis, give protection from drug use and help
them cope with the consequences of an HIV infection by giving emotional support and referring them to relevant
services at individual level (Young people, HIV/AIDS, and substance use in Asia, 2002). It is means of ensuring
that information on AIDS is correct and consistent, and of assessing lifestyles, personal expectations, and
willingness and capacity to change behaviour. Analysis among the IDUs in Hong Kong, found a rising awareness
of risk factors and declining risk behaviour, when the IDUs were trained as interviewers and peer counselors to
educate injectors about harm reduction techniques. Similarly, Bangkok has also experienced some success in risk
reduction among IDUs after instituting AIDS education, training and counseling programs through community
outreach (Riehman, 1996).
16. Condom promotion
Condoms will be made easily accessible at a low price or sometimes free to the clients through a social
marketing approach in this setting. Their availability and affordability price to the target group will be ensured
whenever there is demand. In this context, different mass medias will be encouraged to stimulate people
addressing the potential users by motivating people to adopt condom use and sustain it for safer sex practice. In
the meanwhile, correct use of condoms will be taught through a life skilled-based training approach.
Use of Bleach
Bleach has long been recognized as an effective technique for sterilizing injecting equipment and it is
clearly an intervention to be used when injection drug users have no safer alternatives (Preventing HIV
transmission, 2003). This strategy is particularly appropriate in Bangladesh, where needles are in short supply and
bleach is a relatively inexpensive item compared to sterile needles. One important benefit to increasing
availability of bleach is that it can be used by the general population. This in turn could make provision to
injecting drug uses more acceptable in the eyes of government, the public and the funding agencies. With this
view, bleach distribution programs in San Francisco revealed that the IDUs who used bleach increased from 3
percent to 76 percent (Riehman, 1996). Similarly, in a program instituted in Churachandpur, Manipur, India found
knowledge of bleach as a disinfectant rose from 3 to 99 percent in one year, intention to use bleach increased from
2 percent to 79 percent, and actual use of bleach increased from 31 percent to 72 percent after one year (Riehman,
1996). Therefore, for Bangladesh where sterile needles are inaccessible and difficult to obtain for injecting drug
users (for economic, legal, and political reasons), bleach distribution needs to be considered as an active viable
and effective alternative.
Barriers / Constrains to implement other effective strategies
Needle Exchange Programs (NEPs)
In Bangladesh, there is not an adequate supply of sterile needles for hospital use. This makes it difficult to
argue government should fund for provision of sterile needles to a marginalized group such as IDUs. Moreover,
the government of Bangladesh is mostly dependent on donor contributions to implement other important health
problems; e.g, arsenic toxicity, tuberculosis, malnutrition, infectious diseases, etc. In these circumstances, it
would be difficult, and not feasible to spend an additional amount in this field. In addition, a range of negative
views about needle exchange programs would be expressed by various groups, including fundamentalists, law
enforcement officials, pharmacists, and drug treatment providers. Specific community concerns range from fears
that such programs would worsen already severe drug abuse problems and elevate existing high levels of crime to
concerns that such programs would promote immoral activities (Preventing HIV transmission, 2003). Further,
there are some negative outcomes that might result from NEPs which include an increase in improperly discarded
needles, an increase in drug injectors, or more importantly the perception that the government condones drug use
17. ((Islam, et al. 1999).Therefore, the high levels of concern about potential negative effects of needle exchange
programs would prohibit their use in the socio-cultural context of Bangladesh, despite the evidence supporting
them.
Needle sales over the counter
There is no national policy to prescribe and dispense injection equipment in Bangladesh, because, the
government does not view drug addiction as a high priority issue. Rather it is seen as a self-created problem.
Thus, due to this lack of supportive policy environment, the risk for disease transmission among the intravenous
drug users is partly the result of restricted access to sterile injection equipment. These legal or policy barriers to
availability or use of equipment compels sharing and reuse of syringes among the drug users. On the other hand,
physicians treating patients who use injection drugs do not consider protecting their patients from blood-borne
diseases by prescribing sterile injection equipment when appropriate, which in turn is due to absence of policy
responses for consideration towards the IDUs. Today, medical evidence has established that providing safe
injection equipment to injection drug users, although not a panacea, prevents HIV and other blood-borne
infections and does not increase drug abuse (Burris, et al. 2000). This evidence compels a reassessment of the
legality of providing injection equipment by prescription and selling them by pharmacists in this country.
Whereas, in an analysis of the legality of prescribing and dispensing syringes through the health care system, it
was found that both prescribing and dispensing sterile injection equipment are legal in many states (Burris, et al.
2000). Therefore, as long as there are legal barriers to access sterile injection equipment, the reduction of safer
injection practices among the IDUs would be far behind.
Drug treatment
Increasing access to drug treatment is a frequently recommended approach to slowing the spread of HIV
in IDUs. Whereas in Bangladesh, detoxification and rehabilitation programs are scarce, and only few drug users
have the resources to attend them. Again, recidivism is high for those receiving treatment, as occurs in most
counties of the world. A study in 1998-99 revealed that 99% of the participants who had made attempts to stop
drug use had failed to do so (Hossain, 2000). Moreover, the traditional approach to treating drug users is in the
psychiatric units of hospitals, which suffers from shortage of beds resulting a few being able to receive proper
treatment. Other problems include physicians being discouraged from offering their services to treatment centers
because they can lose their seniority if they are not properly released by the Ministry of Health and placed under
the Department of Narcotic Control (Hossain and Ahmed, 1999). Therefore, though studies have consistently
shown that participation in methadone maintenance treatment is associated with lower rates of drug injections, but
to date low priority is given from the policy planner and health directorate of Bangladesh to this intervention
approach.
18. Outcomes
From this study I will expect the following outcomes:
There would be significant improvement in knowledge, and in drug-related and sex related risk behaviour
following their participation in an outreach-based HIV risk reduction intervention trial after thirty-six months
follow-up among the intravenous drug users (IDUs) comparison to control group participation.
a) Awareness would be raised about drugs, HIV/AIDS and other STDs transmission and prevention activities
among the intervention groups.
b) Significant reduction in drug injection, multi-person reuse of syringes and needles, and other injection
materials (cotton, saliva, distilled water).
c) Improvement in use of injection equipment by cleaning with bleach,
d) Improvement of safer sex practices by using condoms.
Outcome measurement
Baseline assessment would be performed for both the groups, and data would be collected on socio-demographic
information, knowledge of HIV/AIDS and STD, and their prevention, and HIV-related risk
behaviours, both injecting and sexual. The baseline and follow-up interviews would be conducted by trained
researchers using a brief standard questionnaire and the outreach interventions in the outreach locations
(Rajshahi City Corporation). The intake period would be from June to August, 2004 and the follow-up would be
done three (3) consecutive times once in a year during the 36 month study period. Following the basic training
and counseling, then each participant would be asked to return for follow-up visits after one (1) year for refresher
training. On each of the visit participants will be interviewed using the same standard questionnaire, would
provide blood sample for serological tests, and receive face-to face HIV/AIDS and STD risk reduction health
education and counseling. They will also receive Taka 500/ ($US 8.62) for their travel cost and food allowances.
Further, bleach for cleaning injection equipment and condoms will be distributed for safer sex practices. After 36
months, follow-up data would be collected on knowledge on HIV and STD, drug and sex risk behaviour and
behavioural change, where the outcome would be measured on knowledge, HIV-related drug risk and sexual risk
behaviour.
Knowledge of HIV/AIDS and STD would be measured by completing a structured questionnaire format
consisting of basic concepts on HIV/AIDS and STD, and its risk behavioural practice. A structured questionnaire
would be developed for the training of the participants on basic concepts of HIV/AIDS, STD and other blood-borne
diseases. At follow-up, the comparison with the baseline would be categorized as improved with number
and percentage of participants and not improved or similar with number and percentage of participants.
Frequency of injection, would be evaluated grading from one to five times per week, one to twice daily, or
more times daily; a change in the frequency of injection at follow-up compared with the baseline would be
indexed as increase, and no change.
19. Sharing of needles and injection, would be assessed as no sharing, sharing less than once in a week, sharing
more than twice in a week, and sharing very often; a change in the frequency of sharing at follow-up would be
recorded as increased, and no change.
Similarly, use of bleach would be evaluated as always use, occasional use and no use. A change in the
behaviour to disinfect needles by using bleach at follow-up would be indexed as increased, and no change.
Sexual risk behaviour
Data of sexual risk behaviour would be collected on- numbers of sex partners, history of commercial sex, and
practicing safer sex by using condoms. Sexual risk behaviour at follow-up would be measured for the period
between baseline and follow-up interventions. Observation would be made for correct techniques for needle
decontamination with bleach and condom use.
Flow chart: Community Intervention Trial
Government hospital register Professional social worker
Potential IDUs
Inclusion:
Male, 18+ years & above, drug using in the last
week or month
Intervention (n = 260)
Education, training &counseling, bleach
delivering & condom distribution
1st year follow-up
2nd year follow-up
Assessment (3rd year)
Outcome: (n=181,including 30% drop out)
Knowledge improved - 40% to 65%
Reduction in risk behaviour - 28% to 48%
Exclusion: Female &children
Control ( n =260)
No outreach services
1st year follow-up
2nd year follow-up
Assessment (3rd year)
Outcome : ( n=181, including 30% drop out)
Knowledge improved - 40% to 45%
Reduction in risk behaviour- 28% to 33%
20. Sample size
I wish to hypothesis that the proportion with sufficient knowledge level on HIV/AIDS among the subjects will
increase from 40% (Govt. of Bangladesh and UNAIDS, 2000) to 65% after 3 years of program implementation,
then the resulting sample size becomes n = 90 in each group. Whereas, the HIV related risk behaviour would
increase from 28% ((Govt. of Bangladesh and UNAIDS, 2000) to 43%. During this three years, I presume that
the knowledge level and risky behaviours in the control group will improve by 5%. While, the government may
initiate programs for the IDUs at the national level. As a result, the total increase among the intervention group
becomes 48% and the control group becomes 33%. Therefore, the sample size is needed n = 181 in each group
and considering a 30% drop out by the completion of the project, and having a power effect 80%, the total sample
size needed n = 260 in each group.
Statistical Analysis
Calculation will be done by comparing pretest and post test questionnaires finding the proportion with sufficient
knowledge or risky behaviours in the intervention group with that of the control group. Relative Risk (RR) and p-value
will also be calculated. Again, as I will be assessing the intervention program, I will be analyzing
as intention-to-treat rather than per protocol.
Results:
Participants will be recruited using targeting sampling procedure from districts, Rajshahi Metropolitan
City and Pabna Metropolitan City who will be predominantly male. Because, it is expected that outreach would
not be able to identify female drug users as it is common knowledge that the prevalence of opiate use among
women in Bangladesh is still disproportionately small. Different data from serosurveillance reports of Bangladesh
also indicated that a negligible number of female IDUs were identified in their surveys. Hence, it is expected that
only male IDUs subjects will be recruited for this study.
At baseline, there should be no significance differences between the participants from outreach and control
locations on demographic data like age, marital status and educational level. Comparisons would be made
between the two groups for knowledge level, and HIV-related drug and sex risk behaviour. After 36 months,
follow-up data will be collected for 181 IDUs from outreach locations and 181 IDUs from control locations.
Comparison will be done between baseline data to third year follow-up data. This comparison will reveal whether
the participants from the outreach locations have statistically significant level of improved knowledge, and this
might lead them consequently to be engaged in significant protective behaviour and practiced injecting risk
reduction behaviour. Beside the knowledge level, we will test for statistically significance differences in the four
areas of HIV-related risk behaviours-(1) frequency of injection, (2) Sharing of injection and needles (3)Use of
bleach, and (4) Use of condom.
21. Table 1. Anticipated changes from baseline to follow-up in knowledge level and HIV-related risk behaviours of IDUs from community
outreach (O) and control (C) locations (N= 362)
Variables n Outcome
*
Percent
(%)
No change Percent
(%)
RR and 95%
Confidence
Interval (CI)
P-value
Knowledge of
HIV/AIDS and STD
O =181
C =181
118
81
65
45
63
100
35
55
1.45, (1.20 – 1.77) 0.0001
Risky behaviours:
a) Frequency of
injection
b) Sharing of
needles and
injection
c) Use of bleach
d) Use of condom
O = 181
C =181
87
60
48
33
94
121
52
67 1.45, (1.12 – 1.87) 0.0039
* Number of subjects achieving sufficient level of knowledge or reducing risky behaviours after 36 months.
Ethical issues:
Institutional ethics committee approval will be sought for the undertaking of this project. The ethics committees
from the Ministry of Health and Bangladesh Medical Health and Research Council (BMHRC) will be consulted.
All subjects will be provided with a detailed brief of the project and its aims, including the details of how their
personal information will be handled and maintained. Informed consent will be obtained from all subjects,
including an opt out clause without penalty or adverse treatment during the study period.
Survey Instrument:
The survey instrument is unlikely to cause the subjects any undue stress or be in anyway onerous on the subject’s
time. At the conclusion of the study, once all data has been collated and analyzed, all data in the survey
instruments will be destroyed by the study investigators.
Training and counseling:
This is an educational session which will impart knowledge to raise awareness about drugs, HIV transmission and
their harmful consequences and improving skills on correct techniques for needle decontamination with bleach,
and condom use. Apart from this bearing time consuming, this technique would not cause any undue harm or
damage to the subjects during or after the sessions.
Discussion:
The aim of this community-oriented model is to improve health by changing norms at the community level
through encouraging behavioral changes which will be facilitated by the behaviours and attitudes of peers.
22. Community outreach will provide substantial opportunities to contact and work with the hard-to reach group in
the population (IDUs).
The strengths of this project are many fold. Firstly, it is plausible that the interventions will be responsible
for the observed behavioural change. It is also plausible that reductions in injection risk behaviours led to
reductions in new HIV infections, given that HIV is a blood-borne disease, that drug injection exposes needles
and other injection equipment and paraphernalia to blood, and that blood from contaminated equipment is
conveyed to other users of that equipment. Thus, when IDUs stop or decrease reusing of dirty equipment, it is
logical that HIV transmission will also decrease. Further, an appropriate time sequence is allowed between
intervention and outcome which will strengthen outreach interventions led IDUs to change their behaviours.
Secondly, the program outcome would be achievable as the participants will be randomly assigned having the
same socio-demographic characteristics in two different areas.
Thirdly, the sample size is reasonable with a standard power effect to get the desired outcome.
Finally most importantly, this project will be cheap to implement in respect to Bangladesh’s current economic
situation where minimum resources will be required for the time period. This model can be used in a large scale at
the national level to prevent HIV/AIDS among IDUs.
However, some limitations of this study deserve mention. Although the researchers will try sincerely to
recruit and retain a representative sample of incomplete treated IDUs, attrition from baseline to follow-up might
render the sample less representative. The sample may consist only with the higher risk participants. Secondly,
female participants can not be covered in this study.
Other problems and obstacles may also be faced during the HIV intervention implementation in
Bangladesh. Firstly, the problem of injecting drug use is not yet considered as a priority area for AIDS
intervention in general. As such, the cooperation from different agencies would not be satisfactory to launch this
project. Secondly, current AIDS intervention focuses only on heterosexual transmission and targets commercial
sex workers. Other high risk groups of the population will be left out, who are also equally important for
intervention. Thirdly, there might be a great chance of police harassment when the addicts would be identified in
possession of syringes and needles. As a result, many drug users may stop carrying syringes when they go in
search of drugs. This will compel sharing practices at places outside of IDUs’ houses and in particular at dealer’s
locations. These community resistances to HIV intervention efforts will be attempted to be overcome by the
formation of a community advisory board composed of locally influential opinion leaders, who will exchange
dialogue with the law enforcement personnel to stop harassment to the addicts who possessed personal syringes. It
is expected that this bilateral cooperation will facilitate carrying of personal syringes by IDUs in the community.
However, one important area in which may need to be concentrated upon is that outreach workers might
be pressured to assist with the medical problems of IDUs where there is no supportive service or treatment
facilities for IDUs at the community level. Therefore, strengthening primary medical care for the IDUs is an
emerging concern. In addition, there is an urgent need to improve and expand HIV testing and treatment facilities
within the community.
23. Acknowledgments
I thank Dr. Mark Jenkins, Senior Lecturer of Epidemiology and Biostatistics Unit and Centre for genetic
Epidemiology, Department of Public Health for his continuous guidance’s and assistance to prepare this protocol.
I am also thankful to Professor Nick Crofts, Director, and The Centre for Harm Reduction and Deputy Director,
The Burnet Institute, for his resourceful materials and reference list which helped me to a great extent to develop
this project. Finally, I thank Dr. Catherine Bennett, Lecturer of epidemiology and Biostatistics Unit, for her
valuable feedback.
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