Drug Dependence Treatment from the HIV-AIDS Perspective
On April 1-2, UNODC Regional Office for Central Asia, in collaboration with the Ministry of Health, Ministry of Interior and the National Information and Analytical Center on Drug Control organized the national workshop "Effective Management of Healthcare for Drug Users: New Approaches" in Tashkent. This workshop was conducted within the framework of the regional project "Effective HIV prevention among vulnerable populations in Central Asia and Azerbaijan 2006-2010. The workshop was aimed at raising the awareness of participants of the evidence-based health and social protection interventions for drug users and the effective management of service delivery, discussing means for monitoring and evaluation of the accessibility of those services, the possibilities of integration of a wide range of services, tailored to the needs of drug users, at local level and agreeing on priority territories in the country for expanding the accessibility of HIV-related services for drug users with a focus on opioid substitution treatment. There were 34 participants representing the Ministries of Health and Interior (drug dependence treatment service providers), the National Information and Analytical Center on Drug Control, as well as local NGOs, international organizations and UN agencies.
The opening presentation made by Dr. Nina Kerimi, UNODC Regional Project Coordinator, was devoted to reviewing issues of accessibility of effective HIV-related services for drug users worldwide and discussing terms and definitions: what is meant by the effectiveness of an intervention, what are evidence-based interventions, and how to measure the accessibility of services for drug users.
Participants then received information on the actual accessibility of health services for drug users in Uzbekistan from the presentation made by Dr. Lyudmila Tursunkhodjayeva, Chief Narcologist, Ministry of Health. She focused her presentation on data related to registered drug users and those who have undergone treatment in narcological dispensaries/hospitals. Her presentation was complemented by two presentations, the latter giving more detail on narcological services in Tashkent-city (Dr. Yelena Popova, Deputy-Chief Doctor, Tashkent-city Narcological Dispensary) and Samarkand (Dr. Ludmila Artemova, Deputy-Chief Doctor, Samarkand Oblast Narcological Dispensary) with brief presentations from other provinces. The emotional discussion that followed these presentations revealed quite diverse opinions on what should be considered effective health care for drug users. The issue of access to opioid substitution treatment (psychosocially assisted pharmacological treatment of opioid dependence) was the most contentious one with Dr. Tursunkhodjayeva, being the chief specialist in national narcology, expressing her strong disapproval of OST as a method of drug dependence treatment.
A presentation by Dr. Sergey Dvoryak (Director, Institute for Public Health Policy Research, Ukraine) that followed the discussion highlighted the modern evidence-based methods of drug dependence treatment and case management, including the mainstreaming of HIV prevention and treatment among drug users. The presentation was met with appreciation and opinions were expressed that updates in clinical knowledge of narcologists were welcome.
The next day of the workshop started with a presentation of Mr. Makhmud Abdukhalikov, an independent lawyer, on the legal aspects ofaccess to health services for drug users. His presentation was mostly based on the legislative and policy analysis conducted in 2007-2008 within the framework of the UNODC project. Mr. Abdukhalikov gave examples, extracted from the current national legislation, of the legal obstacles that hamper access to the effective health-related interventions for drug users. He pointed out that some legal provisions open the way for human rights violations such as the lack of confide ntiality for registered drug dependent patients, discrimination on the basis of health status, etc. This presentation triggered another hot debate on human rights, medical ethics, and the letter and meaning of the national law and its actual implementation. A suggestion was made by UNODC to send out the country report on legislative analysis to all interested parties.
After that, components of a model of integrated services for drug users were presented by Dr. Kerimi and, as a group work, participants were asked to develop their own model of services suitable for use in the provinces with a high prevalence of drug use and HIV. The presented models developed by national participants demonstrated the need for more extensive trainings for narcologists for expanding their knowledge of the comprehensive package for HIV (and related harms) prevention among drug users and, in general, for improving their understanding of what is the public health approach to drug use and drug dependence. The group work generated common interest and discussion on which provinces to choose for the future piloting of the model of integrated services Three provinces were recommended as priority territories. After concluding remarks and a roundtable for participants' opinion on the value of the seminar, the session was closed. Although the seminar was charged with strong emotions and, at times its atmosphere became tense, all the participants found it very informative and useful, and expressed their interest to continue working with UNODC on developing further health and social protection services for drug users. UNODC will continue providing technical assistance to the Government of Uzbekistan in the area of HIV prevention among injecting drug users, which should eventually contribute to halting a fast growing HIV epidemic in the country.