Papers by Anne Bergenstrom
Harm Reduction Journal, 2015
Pakistan is among four countries in Asia where the estimated number of new HIV infections has bee... more Pakistan is among four countries in Asia where the estimated number of new HIV infections has been increasing year by year ever since 1990. The Asian Epidemic Modelling (AEM), conducted in 2015, reconfirmed that the use of contaminated injection equipment among people who inject drugs (PWID) remains the main mode of HIV transmission in the country. The estimated number of PWID ranges from 104,804 to 420,000 PWID. HIV prevalence in this population is above 40 % in several cities, including Faisalabad (52.5 %), D.G. Khan (49.6 %), Gujrat (46.2 %), Karachi (42.2 %) and Sargodha (40.6 %), respectively. Harm reduction service delivery is being implemented through a public-private partnership led by the National and Provincial AIDS Control Programmes and Nai Zindagi with funding support from the Global Fund. Current programmatic coverage of the needle and syringe programme, HIV testing and counselling and antiretroviral treatment among PWID remain insufficient to control ongoing transmission of HIV in the country. While opioid substitution therapy (OST) is yet to be introduced, significant progress and coordination among various ministries have taken place recently to register buprenorphine in the dosage required for treatment of opioid dependence, and possible introduction of OST will greatly facilitate adherence to antiretroviral treatment among PWID living with HIV.
Doctoral thesis, UCL (University College London)., 2002
Journal of the Royal Society of Medicine, Jun 1, 1999
Aids Care-psychological and Socio-medical Aspects of Aids/hiv, Jun 1, 2000
The mood of nihilism that affected HIV is now changing. The availability of new therapies allows ... more The mood of nihilism that affected HIV is now changing. The availability of new therapies allows for cautious optimism--especially in relation to mother-to-child transmission of HIV and preventative interventions. This has prompted a widespread policy shift towards HIV testing in pregnancy. In this context, informed consent is an ethical issue which needs to be addressed. This study reports on two sets of data exploring consent policy and practices in UK antenatal clinics. The first is derived from an audit of obstetric clinics in the UK and Eire (n = 288), with a 91% response rate. The second provided the views on consent and testing of a cohort of pregnant women attending four London antenatal clinics (n = 697). It was found that written consent was more likely to be obtained in units with a universal HIV testing offer (p = 0.0005); 77.8% of women believed consent would be requested, but 17.7% believed they could not refuse an HIV test. Their views were contrasted with those held about other antenatal screening tests. The data show that the generally haphazard method of giving information and obtaining consent in antenatal HIV provision is probably counterproductive in terms of test uptake and the ultimate goal of minimizing maternal-fetal HIV transmission.
International Journal of Drug Policy
review of current situation and response and the way forward beyond 2015
The Lancet Global Health, 2017
Journal of the International AIDS Society, 2016
Between September 2012 and December 2015, a series of national and regional consultations, aimed ... more Between September 2012 and December 2015, a series of national and regional consultations, aimed at resolving a persistent dynamic of conflict between law enforcement agencies (LEAs) and civil society organizations (CSOs) working on issues of access to HIV services in high-priority countries for people who use drugs have been organized by the HIV/AIDS Section of the United Nations Office on Drugs and Crime, the Joint United Nations Programme on HIV/AIDS, the Law Enforcement and HIV Network (LEAHN) and other international organizations. The aim of these consultations has been to understand, at a national and regional level, the key points of tension between police and CSOs and how to overcome these tensions to enhance access to and uptake of services by key populations, including people who inject drugs, sex workers, men who have sex with men and transgenders. This commentary briefly describes the methods, process, content and key outcomes of these consultations held across diverse n...
Journal of Health Management, 2003
While there has been significant advancement in the knowledge on effective HIV prevention methods... more While there has been significant advancement in the knowledge on effective HIV prevention methods among injecting drug users (IDUs), and their demonstrated success, in particular the impact of availability and use of clean injecting equipment on reducing HIV prevalence among IDUs, in Australia, the US and the UK, progress made in implementation of actual interventions focused on IDUs in South and South-East Asia is less than satisfactory. This paper examines some of the critical issues related to the context and causes of inadequate drug-related HIV prevention programmes in Asia. It also raises questions relating to evidence-based interventions to be scaled up in the region, including the need for sufficient resources anda conducive policy and legalenvironment.
Journal of Health Management, 2003
... 2001). For example, the community-based SHAKTI project in another Muslim country, Bangladesh,... more ... 2001). For example, the community-based SHAKTI project in another Muslim country, Bangladesh, has shown reduced rates of STIs, HIV and injecting drug use among community members (Abdul-Quader 1997). Afghanistan ...
International journal of adolescent medicine and health, 1997
The Place to Be project has been set up in eight schools in London with a total of 2,406 children... more The Place to Be project has been set up in eight schools in London with a total of 2,406 children. One hundred and thirteen counsellors are involved in a survey on problems of emotional stress, their impact on social, behavioural and school functioning, on coping abilities, and the extent to which the child has benefited from counselling sessions. Feedback from counsellors and teachers point to the viability of the project, and that input supplements rather than intrudes on teacherchild interaction.
Sexually transmitted infections, 1999
The British journal of family planning, 1999
The prevalence of HIV infection in London is nearly threefold in women who seek terminations comp... more The prevalence of HIV infection in London is nearly threefold in women who seek terminations compared to women who carry to term. Despite the higher prevalence, HIV testing is not systematically offered to women attending termination of pregnancy assessment clinics (TOPCs). The Department of Health has given clear guidance on HIV testing in antenatal clinics and most London antenatal clinics have implemented policies on HIV testing. No similar guidance exists for TOP clinics. This paper describes the results from a study examining HIV testing and prevention issues for women attending five TOPCs in North London. Data on risk disclosure, HIV testing intentions and awareness of HIV infection and testing were analysed for 141 women who completed a self-administered questionnaire. Women who expressed an intention to have an HIV test were more likely to be from ethnic minority origin, to report that their partner intends to have an HIV test and to perceive it as easier to talk to their pa...
International Journal of Drug Policy, 2010
As countries in Asia strive to meet their universal access targets, harm-reduction programmes are... more As countries in Asia strive to meet their universal access targets, harm-reduction programmes are yet to be scaled up to reach effective levels of coverage. Resource tracking and estimation of resource needs and gaps is critical to inform the financing decisions of major donors of harm-reduction programmes in the region. This study aimed at estimating the financial resource needs and gaps for scaling-up harm reduction in the region, building on previous research conducted by the Independent Commission on AIDS in Asia. The overall resource need for achieving universal access in the target population in 2009 was US $0.5 billion, with NSP and OST accounting for nearly 70% of the overall regional resource need. A significant resource gap, approximately 90%, of the resource need in 2009, was identified for harm reduction in the region, representing less than 2% of the overall global resource need to address AIDS. Additional resources will be required to support the introduction and scaling-up of integrated, comprehensive harm-reduction programmes that provide a full range of services to reduce HIV transmission among people who inject drugs.
The International journal on drug policy, 2009
Sexual risk and STDs are relatively high among injecting drug users (IDUs) in Vietnam. We sought ... more Sexual risk and STDs are relatively high among injecting drug users (IDUs) in Vietnam. We sought to determine characteristics of sexually active IDUs and correlates of high-risk sexual practices among IDUs in Bac Ninh province in northern Vietnam. We used data collected for a community-based cross-sectional pilot study to identify correlates of recent high-risk sex (>1 sex partner and inconsistent/no condom use in the past year). Factors associated with high-risk sex were identified using logistic regression. Among 216 sexually active male IDUs, one third (n=72) had engaged in high-risk sex within the last year. IDUs who reported injecting with others more frequently, having someone else inject their drugs at last injection, sharing needles or sharing any injection equipment were more likely to have reported recent high-risk sex. Factors independently associated with high-risk sexual activity were not injecting oneself [AOR: 2.22; 95% CI (1.09-4.51)], and sharing needles in the p...
Substance Use & Misuse, 2008
Substance Use & Misuse, 2010
The HIV epidemic in Vietnam is concentrated primarily in injecting drug users (IDUs). To prevent ... more The HIV epidemic in Vietnam is concentrated primarily in injecting drug users (IDUs). To prevent HIV-1 super-infection and to develop effective HIV prevention programs, data are needed to understand the characteristics of high risk HIV-positive IDUs. In 2003, we conducted a community-based cross-sectional study among predominately male, out-of-treatment IDUs, aged 18-45, in Bac Ninh Province, Vietnam. Among 299 male participants, 42.8% were HIV-positive and among those, 96.9% did not know their status prior to the study. Thirty-two percent were HIV-positive and had high HIV behavioral risk (having unprotected sex or having shared injecting equipment in the past 6 months). Injecting for ≥ 3 years, younger age, and pooling money to buy drugs were independently associated with being at high risk for transmitting HIV. IDUs who purchased >1 syringe at a time were less likely to have high HIV behavioral risk. Structural interventions that increase syringe accessibility may be effective in reducing HIV risk behavior among HIV-positive IDUs. Study limitations are noted in the text.
Psychology, Health & Medicine, 1999
ABSTRACT HIV testing and prevention approaches aimed at women have mainly targeted women attendin... more ABSTRACT HIV testing and prevention approaches aimed at women have mainly targeted women attending antenatal clinics, even though pregnant women have been found to prefer pre-pregnancy HIV dialogue (Sherr et al., 1996). Surprisingly HIV testing policies and procedures are mostly absent in clinics approached by women who seek elective terminations, even though the prevalence of HIV in this group is threefold compared to women who carry to term (DoH, 1998)) Similarly HIV testing remains 'available on request' for women attending family planning clinics, many of whom report HIV risk behaviours (Radcliffe et al., 1993). In the light of increasing HIV seroprevalence in women of reproductive age, this study aimed to provide a systematic understanding of HIV testing and prevention issues for women attending both antenatal (ANC) (n = 794), family planning (FPC) (n= 145) and termination assessment clinics (TOPC) (n = 141) and to carry out a comparative analysis of the three groups of women in terms of their sample characteristics, HIV testing intentions, HIV knowledge, HIV risk factors and their appraisal of HIV provision. Women in all clinics showed low levels of HIV knowledge. Women in ANCs had the lowest overall HIV knowledge score (F = 3.211, p = 0.041). Fewer than one in four women across the groups were aware of the potential interventions to reduce vertical HIV transmission. Single or multiple potential risk factors were disclosed by over one in five women, TOPC attenders reporting most risks. Not surprisingly these women also reported greater worry about past risks and HIV testing as well as lower perceived control over staying HIV-negative in the future. They were the most likely group to agree that all clinic attenders should receive information about how to prevent HIV infection (chi2 = 10.028, p = 0.007). One in ten women were unsure if they have ever had an HIV test, women in ANCs being most likely to express an intention to test for HIV (36.0%), compared with women in FPCs (10.0%) and TOPCs (17.7%) (chi2 = 44.832, p = 0.0001). HIV risk exposure was prevalent but did not relate to HIV testing intentions. Many women in ANCs (67.2%), FPCs (74.2%) and TOPCs (73.3%) endorsed the offer of HIV testing to every clinic attender. Given the above findings it would appear that women attending reproductive health care clinics other than antenatal clinics agree with the offer of HIV testing and would welcome further information. Both FPCs and TOPCs are settings where HIV service provision aimed at women themselves could be enhanced. The uptake of HIV testing by women attending antenatal clinics remains moderate.
Psychology, Health and Medicine, 2001
Adherence in HIV care has generated much debate in relation to treatment regimens. However the co... more Adherence in HIV care has generated much debate in relation to treatment regimens. However the concept of adherence is not con ned to patient behaviour, and adherence to policy and procedures may also contribute to the effective implementation of preventive strategies. This study reviews adherence of Obstetric Units in the UK and Eire (n 5 256, 89% response rate) with regard to implementation of ante-natal HIV testing policies. A postal questionnaire was constructed to monitor policy and practice in all obstetric units in the UK and Eire. Ten per cent of units operated universal screening policies, 37% selective and the majority (54%) on request only. Universal offer of ante-natal testing was concentrated in London Units. Those utilizing selective policies rarely invoked all the CDC risk criteria as a basis for selection. Consent to test was verbal in 53%, written in 20% and unrecorded in the remainder. The provision of information varied and despite widespread midwifery training on HIV pre-and post-test counselling, doctors played a key role in result provision. The burden of HIV testing was rarely funded, with only 8% of units having a speci cally funded post. Having a funded post was signi cantly associated with HIV test uptake (f 5 7.99, p 5 0.0001) as was training of medical staff in HIV testing provision (t 5 4.1, p 5 0.0001). Auditing/evaluation was infrequent. As the Department of Health provides speci c guidance on the offer of ante-natal HIV testing, this audit shows that in order for such policies to be implemented ongoing audit and training as well as funding may facilitate the successful implementation of such policy. Adherence is a challenge generally.
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Papers by Anne Bergenstrom