Kazakhstan Gulnara Darbekova (1), Nadezhda Kozachenko (1), Irina Mingazova (1), Alexander Solodov (1), Natalia Kartashova (1), Zita Lazzarini (2,3), Patricia Case (4), Scott Burris (5,3) (1) Public Association CREDO, Karaganda, Kazakhstan (2) University of Connecticut Health Center, USA, (3) Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities, USA, (4) Fenway Community Health Center, USA, (5) Temple University Beasley School of Law, USA This research was supported by NIDA/NIH Grant # 5 R01 DA PI: LAZZARINI, ZITA. The findings and conclusions expressed are those of the authors and not necessarily of NIH, NIDA, or the US Government. The development of RPAR was supported by the International Harm Reduction Development Program of the Open Society Institute in Public Association CREDO CREDO Legal climate for HIV prevention work with injection drug users in Temirtau, Kazakhstan Republic of Kazakhstan, Karaganda, NGO “Credo” Figure 1: Attitudes of Law Enforcement Agencies to IDUs Figure 2: Availability of HIV testing and counseling & drug treatment services Background. Temirtau, Kazakhstan, is a city of 170, 000 in northern Kazakhstan. There were 1,322 prevalent cases of HIV reported (9/06) with 75% attributable to injection drug use (IDU). Previous research has shown that laws and law enforcement practices are important factors influencing: the spread of HIV-infection among IDUs; related risk behaviors; and availability and efficiency of prevention measures. Kazakhstan, like all the countries of CIS, has reformed its drug law and policy, trying to influence the HIV/AIDS epidemic. But law enforcement practices have had results different from those planned by the law-makers. Due to the fast spread of HIV and drug-addiction, the situation is becoming critical. Local information on laws, policies and law enforcement practices are necessary to influence the situation locally and to develop the strategy of local preventive measures against HIV/AIDS. Methods. Using a research method called Rapid Policy Assessment (RPA), a team of local researchers from NGO “Credo” collected written laws and policies, conducted 3 focus groups, interviews with key informants including health care providers, lawyers, law enforcement representatives, NGO staff (N=26) and injection drug users (N=14) to learn how the law, policies and their implementation influence health risks among IDUs. The Temirtau RPA was conducted in RESULTS 1. Police, especially low ranking officers, often hold negative attitudes towards drug users, characterizing them as criminals likely to commit crimes in addition to drug use. Interview subjects reported … IDUs are the constant focus of police attention (harassment, detention, threats and arrest). Police will stop intoxicated persons, or coerce commercial sex workers to provide information to the police. 2. Drug treatment is available, but it falls short of “best practices”. Interview subjects reported … Substitution therapy is not available; No 12-Step programs Drug treatment only available in Narcological Centers; only detox and talk therapy 3. Narcological Centers provide mandatory drug treatment and require “Registration” as a drug user. Interview subjects reported … “Registered” drug users are subject to discrimination in employment and other stigma. Drug users are reluctant to participate due to long term consequences of registration 4. Obstacles to HIV testing include “informal” charges for care. Interview subjects reported … Although HIV tests are supposed to be free (by regulation), clinics charge for drawing blood. CONCLUSIONS Although drug law reform and official government policies aim to reduce drug use and the spread of HIV, in practice, law enforcement, the official mechanisms for drug treatment, and even some public health interventions are creating barriers to the government’s goals. Interventions that could reduce these barriers include: education of police regarding drug use, drug users and their rights; expansion of drug treatment to include opiate substitution therapy, 12-step programs, and a wider range of treatment sites; elimination of “registration” of drug users and enforcement of laws against discrimination; and government intervention to ensure real “access” to public health programs such as HIV counseling and testing.