London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK.
Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06511, USA.
Harm Reduct J. 2017 Jul 10;14(1):43. doi: 10.1186/s12954-017-0168-8.
Kyrgyzstan, where HIV is concentrated in prisons and driven by injection drug use, provides a prison-based methadone maintenance therapy program as well as abstinence-oriented therapeutic community based on the 12-step model called the "Clean Zone." We aimed to qualitatively assess how prisoners navigate between these treatment options to understand the persistence of the Clean Zone despite a lack of evidence to support its effectiveness in treating opioid use disorders.
We conducted an analysis of policy documents and over 60 h of participant observation in February 2016, which included focus groups with a convenience sample of 20 therapeutic community staff members, 110 prisoners across three male and one female prisons, and qualitative interviews with two former Clean Zone participants. Field notes containing verbatim quotes from participants were analyzed through iterative reading and discussion to understand how participants generally perceive the program, barriers to entry and retention, and implications for future treatment within prisons.
Our analyses discerned three themes: pride in the mission of the Clean Zone, idealism regarding addiction treatment outcomes against all odds, and the demonization of methadone.
Despite low enrollment and lack of an evidence base, the therapeutic community is buttressed by the strong support of the prison administration and its clients as an "ordered" alternative to what is seen as chaotic life outside of the Clean Zone. The lack of services for Clean Zone patients after release likely contributes to high rates of relapse to drug use. The Clean Zone would benefit from integration of stabilized methadone patients combined with a post-release program.
吉尔吉斯斯坦的艾滋病主要集中在监狱中，其传播主要由注射吸毒引起。因此，吉尔吉斯斯坦为囚犯提供了一项基于监狱的美沙酮维持治疗方案，以及一个以 12 步模式为基础的、以戒毒为导向的治疗社区，称为“清洁区”。我们旨在从质化角度评估囚犯如何在这些治疗方案之间进行选择，以了解尽管缺乏证据支持其治疗阿片类药物使用障碍的有效性，但“清洁区”仍然存在的原因。
我们对政策文件进行了分析，并于 2016 年 2 月进行了 60 多个小时的参与式观察，其中包括对 20 名治疗社区工作人员、3 所男监狱和 1 所女监狱中的 110 名囚犯进行了焦点小组讨论，以及对 2 名前“清洁区”参与者进行了定性访谈。对参与者原话的实地笔记进行了分析，通过反复阅读和讨论来了解参与者如何普遍看待该方案、进入和保留方案的障碍，以及对监狱内未来治疗的影响。
我们的分析发现了三个主题：对“清洁区”使命的自豪、对克服一切困难进行成瘾治疗结果的理想主义，以及对美沙酮的妖魔化。
尽管“清洁区”的入组率较低且缺乏证据基础，但治疗社区得到了监狱管理部门及其客户的大力支持，被视为“有序”的替代方案，而“清洁区”之外的生活则被视为混乱。“清洁区”患者释放后的后续服务不足可能导致高复发率和重新使用毒品的情况。将稳定的美沙酮患者与释放后的方案相结合，将使“清洁区”受益。
