The implementation of pragmatic harm-reduction and other evidence-based public health care policies that are designed to reduce the harmful consequences associated with substance use and HIV/AIDS should be considered. HIV testing and treatment services also need to be made available in places accessed by drug users.
Injecting drug use is an increasing cause of HIV transmission, the number of countries in which injection of drugs has been reported has increased over the last decade. The high prevalence of HIV among many populations of injecting drug users represents a substantial global health challenge. Extrapolated estimates suggest that 15.9 million people might inject drugs worldwide. However, existing data are far from adequate, in both quality and quantity, particularity in view of the increasing importance of injecting drug use as a mode of HIV transmission in many regions such as South Africa [8]. Although injection drug use is low in South Africa in comparison with many other countries, with the increase over time in the use of substances such as heroin, the potential exists for this to change rapidly [9]. The rapid assessment undertaken with drug using commercial sex workers in Cape Town, Durban and Pretoria by Parry et al. in 2009 recognises the need for prioritising interventions recognising the role of drug abuse in HIV transmission, the issues of access to services, stigma and power relations [3]. Furthermore, a study by Dos Santos, Rataemane, Fourie and Trathen (2010) notes that limited strategic public health care policies that address substance use disorder syndromes complexities have been implemented within the South African context [10]. The study further emphasises the need for pragmatic and evidence-based public health care policies that are designed to reduce the harmful consequences associated with heroin use in particular, still needs to be implemented. According to Weich, Perkel, Van Zyl, Rataemane, and Naidoo (2008), medical practitioners in South Africa are increasingly confronted with requests to treat patients with heroin use disorders for example, but many do not posses the required skills to deal with these patients effectively [11]. The study by Dos Santos et al (2010) further discerns the need be make HIV testing and treatment services available in places accessed by vulnerable people as fear of stigma and discrimination often keep injecting users away from public health facilities [10]. According to Parry et al (2008) there is also a widespread lack of awareness about where to access HIV treatment and preventative services, and numerous barriers to accessing appropriate HIV and drug-intervention services such as long waits and appointments being cancelled without notice [4]. These authors further reiterate that multiple risk behaviours of vulnerable populations and lack of access to HIV prevention services could accelerate the diffusion of HIV.
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Consulting existing information within the South African context was the first step in the RAR process, much of this information has been included in the introduction of the article. Existing information included research articles and reports, reports prepared by health and drug services and information in the media. Reviewing the existing information assisted in the identification of possible gaps in the information, assisted in viewing information that can assist in monitoring changes over time and useful background information was gained from assessing the value or bias of findings.
Thematic content analysis was employed to analyse the interview information, such methods have been shown to be particularly valuable in the development of public health care interventions. Thematic coding was adopted in the analysis for the disaggregation of core themes, it is a multi-step process of during qualitative data analysis, that encompasses a process of relating codes (categories and concepts) to each other, via a combination of inductive and deductive thinking [19, 20].
HIV testing and treatment services in Pretoria need to be more widely advertised and made available in places accessed by vulnerable people. As corroborated in various studies, the fear of stigma and discrimination often keep (injecting) substance users away from public health facilities, and many drug users do now know where to access such treatment [10, 3]. Active systems for auditing and monitoring processes and gaining client feedback should be encouraged, while the implementation of pragmatic and evidence-based public health care policies, such as needle exchange programmes, designed to reduce the harmful consequences associated with drug use and HIV/AIDS need to be considered for high risk areas in Pretoria.
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Health Systems: this area offers prepares students for independent research on health system issues worldwide. Students receive an advanced level of interdisciplinary training in economics, political economy, organizational behavior, and evaluative science, along with a strong foundation of public health skills. Through coursework and applied research, students learn to integrate theories and methods from various disciplines and apply them to analyze critical health system issues.
This document contains two separate sections. The first section provides an introduction and background to the aims and objectives of the WHO/UNAIDS project on substance use and sexual risk behaviour. The second section contains the WHO Rapid Assessment and Response Guide for Substance Use and Sexual Risk Behaviour (SEX-RAR). This section aims to offer a complete package for undertaking rapid assessments on sexual behaviours associated with substance use, the associated adverse health consequences and the development of intervention responses. 2ff7e9595c
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