Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Global Health. 2011 Jul 13;7:22. doi: 10.1186/1744-8603-7-22.
Despite massive scale up of funds from global health initiatives including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other donors, the ambitious target agreed by G8 leaders in 2005 in Gleneagles to achieve universal access to HIV/AIDS treatment by 2010 has not been reached. Significant barriers to access remain in former Soviet Union (FSU) countries, a region now recognised as a priority area by policymakers. There have been few empirical studies of access to HIV/AIDS services in FSU countries, resulting in limited understanding and implementation of accessible HIV/AIDS interventions. This paper explores the multiple access barriers to HIV/AIDS services experienced by a key risk group-injecting drug users (IDUs).
Semi-structured interviews were conducted in two FSU countries-Ukraine and Kyrgyzstan-with clients receiving Global Fund-supported services (Ukraine n = 118, Kyrgyzstan n = 84), service providers (Ukraine n = 138, Kyrgyzstan n = 58) and a purposive sample of national and subnational stakeholders (Ukraine n = 135, Kyrgyzstan n = 86). Systematic thematic analysis of these qualitative data was conducted by country teams, and a comparative synthesis of findings undertaken by the authors.
Stigmatisation of HIV/AIDS and drug use was an important barrier to IDUs accessing HIV/AIDS services in both countries. Other connected barriers included:criminalisation of drug use; discriminatory practices among government service providers; limited knowledge of HIV/AIDS, services and entitlements; shortages of commodities and human resources; and organisational, economic and geographical barriers.
Approaches to thinking about universal access frequently assume increased availability of services means increased accessibility of services. Our study demonstrates that while there is greater availability of HIV/AIDS services in Ukraine and Kyrgyzstan, this does not equate with greater accessibility because of multiple, complex, and interrelated barriers to HIV/AIDS service utilisation at the service delivery level. Factors external to, as well as within, the health sector are key to understanding the access deficit in the FSU where low or concentrated HIV/AIDS epidemics are prevalent. Funders of HIV/AIDS programmes need to consider how best to tackle key structural and systemic drivers of access including prohibitionist legislation on drugs use, limited transparency and low staff salaries within the health sector.
尽管包括全球抗击艾滋病、结核病和疟疾基金（全球基金）和其他捐助者在内的全球卫生倡议大幅增加了资金投入，但八国集团领导人 2005 年在格伦伊格尔斯达成的到 2010 年普及艾滋病毒/艾滋病治疗的宏伟目标尚未实现。在前苏联国家（FSU），仍然存在着获得艾滋病毒/艾滋病服务的重大障碍，该地区现在已被政策制定者视为一个优先领域。对 FSU 国家获得艾滋病毒/艾滋病服务的情况进行的实证研究很少，导致对可及性艾滋病毒/艾滋病干预措施的理解和执行有限。本文探讨了注射吸毒者（IDUs）这一关键风险群体在获得艾滋病毒/艾滋病服务方面面临的多重障碍。
在两个 FSU 国家乌克兰和吉尔吉斯斯坦，对接受全球基金支持服务的客户（乌克兰 118 人，吉尔吉斯斯坦 84 人）、服务提供者（乌克兰 138 人，吉尔吉斯斯坦 58 人）和国家和次国家利益相关者的有针对性样本（乌克兰 135 人，吉尔吉斯斯坦 86 人）进行了半结构式访谈。由国家团队对这些定性数据进行系统的主题分析，并由作者对调查结果进行比较综合。
艾滋病毒/艾滋病和吸毒的污名化是这两个国家 IDU 获得艾滋病毒/艾滋病服务的一个重要障碍。其他相关障碍包括：吸毒行为的刑事定罪；政府服务提供者之间的歧视性做法；对艾滋病毒/艾滋病、服务和权利的认识有限；商品和人力资源短缺；以及组织、经济和地理障碍。
关于普遍获得的方法常常假设服务的可用性增加意味着服务的可及性增加。我们的研究表明，尽管乌克兰和吉尔吉斯斯坦的艾滋病毒/艾滋病服务可用性有所增加，但由于在服务提供层面上存在多种复杂且相互关联的艾滋病毒/艾滋病服务利用障碍，这并不等同于更大的可及性。卫生部门内外的因素是理解艾滋病毒/艾滋病流行率较低或集中的 FSU 地区获得不足的关键。艾滋病毒/艾滋病方案的供资者需要考虑如何最好地解决获取方面的关键结构和系统性驱动因素，包括对毒品使用的禁止性立法、卫生部门内透明度有限和工资低。
