People Who Use NPS/Stimulants: Basic Needs and Barriers in Access to HIV Related Medical and Social Services in Moldova

Despite grand achievements on national, regional and international levels in response to the HIV epidemic, it remains a major public health issue. The representatives of Key Populations (KP) and their sexual partners have been disproportionately affected by the rise in HIV infections, which is further exacerbated by inadequate availability of integrated HIV prevention services.

In recognition of the importance of such issues, UNODC has focused its attention towards the implementation of consistent efforts aimed at creating a supportive environment for KPs which would contribute to the reduction of the number of new HIV infections among the targeted group. These efforts included developing an integrated approach to the provision of easily accessible HIV-related services, that would also cover people who use new psychoactive substances (NPS)/stimulants. To meet this objective, in 2020 UNODC conducted a pilot study in the Republic of Moldova in the two “Fast-Track Cities” (as defined within the framework of UNAIDS Strategy “Fast-Track: ending the AIDS epidemic by 2030”) – Chisinau and Balti, to assess needs and identify barriers for KPs which hinder their access to the HIV-related services. This pilot study demonstrated certain gaps in the available data on the accessibility of HIV testing and treatment for KP representatives who use NPS/stimulants and therefore justified the need to undertake a more extensive research.

Designated to fill in this knowledge gap, the presented paper is a strategic-level analytical report prepared by UNODC, whereby the main goal is to develop a better understanding of the basic needs of people who use NPS and/or stimulant drugs and the specific challenges that hinder their access to medical and social services on HIV prevention.

This paper is expected to fit within the scope of UNODC’s global HIV programme designated to assist countries in implementing evidence-informed and human rights-based interventions to prevent HIV transmission and to provide treatment, care and support to people living with HIV and AIDS. From a practical perspective, the results of the assessment are expected to support the formation of an evidence-based dialogue with key partners at the national and regional levels and help to determine the focus of advocacy efforts. This will support the government of Moldova in achieving the goals of the UNAIDS Strategy “90-90-90” and developing a better prevention strategy for the abuse of stimulant drugs and NPS among representatives of KP.

The main target audience of this report is government officials and civil society engaged in the development of national laws and policies related to the HIV/AIDS response. However, in order to increase the visibility of the problem, the paper will target a wider audience including international organizations, the private sector and the wider public.

The presented study employed a cross-disciplinary approach incorporating a desk review of the existing relevant literature accompanied with focus group discussions (FDG) and an anonymous online survey. The conducted assessment is based on a number of relevant guidelines and manuals, such as technical guide on “HIV prevention, treatment, care and support for people who use stimulant drugs” to develop an improved understanding of HIV-related health issues and medical and social services. In addition to that, whenever possible the authors of this paper engaged public and private partners, leveraging a broad set of expertise to make the report more informed and balanced contributing to greater feasibility of its objectives and goals.

From a methodological perspective, the presented report employed qualitative content analysis of primary data gathered from the focus group discussions (FDG) and an anonymous online survey. To ensure a gender perspective in the conducted research, the report ensured to incorporate the accumulated experiences of both male and female representatives of KPs in the focus group discussions. In total, this study engaged 218 KP representatives who use NPS/stimulant drugs. The results revealed that the majority of respondents are aware of the possibilities provided by health facilities, however, the services provide by NGOs are not equally visible or understood by many participants in this study. In addition, unethical behaviour of staff in public health facilities and high tariffs for services represent important barriers for KPs access to a range of HIV services. Finally, it was also pointed out that the existing educational, informational and preventive activities need to be more efficient, audience-oriented and brought closer to the immediate environment of KPs.

You can download the technical report AT THIS LINK.