In Kazakhstan, the HIV epidemic is largely confined to the injection drug user (IDU) population. Cultural stigma and discrimination discourage this population from seeking information on HIV testing, treatment, and prevention. The present study was designed to assess perceived barriers to seeking and accessing voluntary counseling and testing (VCT) and to examine factors that could account for those barriers. Participants were selected by a respondent driven sampling technique and were administered a standardized, face-to-face survey. The final sample included 1,071 IDU in Kazakhstan in 2006. Within the sample population, the mean age was 32.4 years (SD= 7.618), 80.4% were male, and 70.1% had reported being previously tested for HIV. A logistic regression model was developed to determine the influence of twelve common perceived barriers to HIV testing behavior. Three distinct barriers including fear of a positive result, the perception of more immediate problems, and inconvenient testing center hours predicted testing behavior. This analysis hopes to contribute to the development of HIV preventive approaches that may aid in creating effective programming and outreach efforts within the IDU population in Central Asia.

Early during the human immunodeficiency virus (HIV) epidemic, the stigmatizing of individuals who were identified with the acquired immune-deficiency syndrome (AIDS) became a serious concern. HIV/AIDS stigma consequences include discouraging individuals from seeking voluntary counseling and testing (VCT) and from disclosing their seropositive status to sexual partners, family, and friends. Injection drug users (IDUs) have been an important risk group for HIV/AIDS and are highly stigmatized. Therefore, increased understanding about the correlates of stigma among this HIV/AIDS risk group is necessary in order to design and implement better preventive measures, programming, and surveillance systems. The purpose of this analytic study was to evaluate the relationship between injection drug use behavior and reported stigma among IDUs in Kazakhstan to determine if length of time using injection drugs is predictive of self-reported stigmatization. A cross-sectional survey of IDUs in Kazakhstan was conducted in 2007 using a Centers for Disease Control and Prevention (CDC) Sentinel Surveillance System Survey and an additional appended survey that focused on questions related to VCT in the presence of stigma. Demographic data collected from 1043 participants included age, gender, nationality, city or location, highest education level attained, and current occupation. Additional questions assessed participants' length of time injecting drugs, perceived discrimination or stigmatization, knowledge on how HIV/AIDS is acquired, and single syringe sharing behavior and handling practices. Descriptive statistics were used to summarize general findings about the population. Linear regression models were constructed and bivariate analyses were conducted to determine the association between self-reported stigmatization scores and all variables. Statistical significance was determined by One-way analysis of variance (ANOVA) and T-tests, using 95% confidence intervals and p = 0.05. Selected variables were further analyzed using Tukey-Kramer's test. A linear regression model was developed to include variables with significance at the p = (0.05 level) to obtain a final parsimonious model. This analysis revealed that length of injection drug use, knowledge about ways of contracting HIV/AIDS, and the interaction these two variables held, were significantly associated with self-reported stigmatization. In general, it was found that the longer an individual continued to be an IDU, the lower self-reported stigmatization he or she experienced. Participants demonstrated they were very knowledgeable about ways in which HIV is contracted. Further analyses participants' understanding of how HIV is contracted aided them in feeling less stigmatized. This finding provides a compelling account since public health interventions against HIV/AIDS typically include the increase of knowledge via healthy behavior promotion.

Recent advances in HIV antiretroviral therapy and the availability of prophylaxis for opportunistic infections, combined with the opportunity to prevent perinatal HIV infection, underscores the value of early diagnosis of HIV infection. HIV antibody home test kits offer individuals the opportunity to collect a blood sample, send it anonymously to a laboratory, and receive counseling and referral over the phone. Home HIV testing may reduce barriers to testing that have precluded individuals from learning their HIV serostatus, and if seropositive, from taking advantage of efficacious therapeutic and preventive regimens. This study employed a randomized-controlled prospective field trial design to determine if the availability of home testing increased HIV testing relative to traditional counseling and testing among injecting drug users in three HIV prevention/drug treatment contexts; methadone maintenance, hospital-based detoxification, and syringe exchange. Theoretical correlates to HIV testing were also evaluated. Multivariate analyses demonstrated that participants randomized to home testing were 2.2 times more likely than those randomized to traditional counseling and testing to test for HIV antibodies in this study after controlling for demographic, HIV risk, and theoretical variables. No differences were observed between testing methods with regard to obtaining HIV test results. The relationship between HIV testing and test type was moderated by drug treatment context and history of homeless, with home testing resulting in increased testing among methadone participants and persons without a history of homelessness. Analyses of theoretical variables suggested that prevention education stressing the benefits of HIV testing, personal risk of HIV infection, and efficacy of available treatments could increase HIV testing among injecting drug users. Participants randomized to home testing were more satisfied with testing and telephone-based counseling than were those receiving traditional testing and face-to-face counseling. Home testing was associated with increased testing perhaps due to reduced barriers to testing. To further reduce barriers to testing and to increase testing among injecting drug users, consideration should be given to incorporating oral fluid testing and rapid result capability in home test kits. Counseling could be made available as needed, delivered by telephone, and contingent upon the volitional control of the testing consumer.

Testing and diagnosis of hepatitis B (HBV) and C (HCV) infection is the gateway for access to both prevention and treatment services, and is a crucial component of an effective response to the hepatitis epidemic. Early identification of persons with chronic HBV or HCV infection enables them to receive the necessary care and treatment to prevent or delay progression of liver disease. Testing also provides an opportunity to link people to interventions to reduce transmission, through counselling on risk behaviors and provision of prevention commodities (such as sterile needles and syringes) and hepatitis B vaccination. These are the first WHO guidelines on testing for chronic HBV and HCV infection and complement published guidance by WHO on the prevention, care and treatment of chronic hepatitis C and hepatitis B infection. These guidelines outline the public health approach to strengthening and expanding current testing practices for HBV and HCV, and are intended for use across age groups and populations.

Over the past two decades, population mobility has intensified and become more diverse, raising important questions concerning the health and well-being of people who are mobile as well as communities of origin and destination. Ongoing concerns have been voiced about possible links between mobility and HIV, with calls being made to contain or control migrant populations, and debate linking HIV with issues of global security and surveillance being fuelled. This volume challenges common assumptions about mobility, HIV and AIDS. A series of interlinked chapters prepared by international experts explores the experiences of people who are mobile as they relate to sexuality and to HIV susceptibility and impact. The various chapters discuss the factors that contribute to the vulnerability of different mobile groups but also examine the ways in which agency, resilience and adaptation shape lived experience and help people protect themselves throughout the mobility process. Looking at diverse forms of migration and mobility – covering flight from conflict, poverty and exploitation, through labour migration to ‘sex tourism’ – the book reports on research findings from around the world, including the USA, the UK, sub-Saharan Africa, Australia, Central America and China. Mobility, Sexuality and AIDS recognises the complex relationships between individual circumstances, population mobility and community and state response. It is invaluable reading for policy makers, students and practitioners working in the fields of migration, development studies, anthropology, sociology, geography and public health.

The EMCDDA's 10th scientific monograph, entitled Harm reduction: evidence, impacts and challenges provides a comprehensive overview of the harm reduction field. Part I of the monograph looks back at the emergence of harm reduction approaches and their diffusion, and explores the concept from different perspectives, including international organisations, academic researchers and drug users. Part II is dedicated to current evidence and impacts of harm reduction and illustrates how the concept has broadened to cover a wide range of behaviours and harms. Part III addresses the current challenges and innovations in the field. The core audience of the monograph comprises policymakers, healthcare professionals working with drug users, as well as the wider interested public -- EU Bookshop.