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Available from: Alex Wodak, Sep 30, 2015
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    • "International Journal of Drug Policy (Maguet & Majeed, 2010, UNODC, 2010; Rehman et al., 2007 "
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    ABSTRACT: Theoretical work posits that drug-related risk behaviour increases during armed conflict; however, few studies have been conducted in conflict settings. The objective of this analysis is to determine whether conflict or local displacement impact risk behaviours among people who inject drugs (PWID) in Kabul, Afghanistan. Consenting PWID aged ≥18 years completed interviews at 3, 6, 9, 12, 18, and 24 months of follow-up. Quarters with peak conflict or local displacement exposure were defined and associations with injecting drug use and sexual risk behaviours analysed with generalized estimating equations. Of 483 PWID enrolled, 385 completed ≥1 follow-up visit (483.8 person-years) between 2007 and 2009. All participants were male, with 35% initiating injecting as a refugee. Sharing syringes (Odds Ratio (OR))=8.53, 95% Confidence Interval (CI): 2.58-28.2) and sexually transmitted infection (STI) symptoms (OR=1.72, 95% CI: 1.00-2.96) increased significantly during peak conflict quarters, while odds of STI symptoms (OR=0.06, 95% CI: 0.02-0.20) and arrest (OR=0.61, 95% CI: 0.40-0.93) were significantly lower during periods of displacement. Syringe sharing significantly increased during peak conflict periods amongst PWID in Kabul. Programming should include instruction for coping with conflict and prepare clients for harm reduction needs during conflict. Copyright © 2015 Elsevier B.V. All rights reserved.
    The International journal on drug policy 07/2015; DOI:10.1016/j.drugpo.2015.07.014 · 2.54 Impact Factor
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    • "It could be high: HCV is common in injecting drug users (36.6%) [4]; regional conflict in the last two decades has meant approximately eight million Afghan migrated to neighbouring countries, particularly Iran and Pakistan, where HIV is relatively common among injecting drug users [5]. With 5.7 million Afghan returning home during 2002-2006 the risk of an HIV epidemic is high [6]. In addition, illiteracy, poverty, and subjugation of women combined with political and social instability are likely to fuel an HIV epidemic in the country [7]. "
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    ABSTRACT: Health staff in Afghanistan may be at high risk of needle stick injury and occupational infection with blood borne pathogens, but we have not found any published or unpublished data. Our aim was to measure the percentage of healthcare staff reporting sharps injuries in the preceding 12 months, and to explore what they knew about universal precautions. In five randomly selected government hospitals in Kabul a total of 950 staff participated in the study. Data were analyzed with Epi Info 3. Seventy three percent of staff (72.6%, 491/676) reported sharps injury in the preceding 12 months, with remarkably similar levels between hospitals and staff cadres in the 676 (71.1%) people responding. Most at risk were gynaecologist/obstetricians (96.1%) followed by surgeons (91.1%), nurses (80.2%), dentists (75.4%), midwives (62.0%), technicians (50.0%), and internist/paediatricians (47.5%). Of the injuries reported, the commonest were from hollow-bore needles (46.3%, n = 361/780), usually during recapping. Almost a quarter (27.9%) of respondents had not been vaccinated against hepatitis B. Basic knowledge about universal precautions were found insufficient across all hospitals and cadres. Occupational health policies for universal precautions need to be implemented in Afghani hospitals. Staff vaccination against hepatitis B is recommended.
    BMC Infectious Diseases 01/2010; 10(1):19. DOI:10.1186/1471-2334-10-19 · 2.61 Impact Factor
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    ABSTRACT: Injecting drug users (IDU) now account for one in 10 new HIV infections world wide. Yet it has been known since the early 1990s that HIV among IDU can be effectively, safely and cost-effectively controlled by the early and vigorous implementation of a comprehensive package of strategies known as 'harm reduction'. This concept means that decreasing drug-related harms is accorded an even higher priority than reduction of drug consumption. Strategies required involve: explicit and peer-based education about the risk of HIV from sharing injecting equipment; needle syringe programmes; drug treatment (including especially opiate substitution treatment) and community development. Many countries experiencing or threatened by an HIV epidemic among IDU have now adopted harm reduction but often implementation has been too little and too late. Although coverage is slowly improving in many countries, HIV is still spreading faster among IDU than harm reduction programmes while coverage in correctional centres lags far behind community settings. The scientific debate about harm reduction is now over. National and international support for harm reduction is growing while almost all the major UN organizations responsible for drug policy now support harm reduction. Only a small number of countries, led by the USA, are still vehemently opposed to harm reduction. Excessive reliance on drug law enforcement remains the major barrier to increased adoption of harm reduction. Sometimes zealous drug law enforcement undermines harm reduction. A more balanced approach to drug law enforcement is required with illicit drug use recognized primarily as a health and social problem.
    AIDS (London, England) 08/2008; 22 Suppl 2(Suppl 2):S81-92. DOI:10.1097/01.aids.0000327439.20914.33 · 5.55 Impact Factor
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