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    HIV-tuberculosis co-infection is a global problem: resources need to be expanded and funding must be sustainable and predictable        PB IDI menyatakan bahwa kondom adalah alat kesehatan yang mampu mencegah penularan infeksi menular seksual (termasuk HIV) bila digunakan pada setiap kegiatan seks berisiko.        By enabling and empowering women to protect themselves and their partners with female condoms, we can begin saving lives and curbing the spread of HIV today.         Women need prevention now. They need access to the female condom and education on its use.        Indonesian AIDS Community (AIDS-INA) will use internet technologies for facilitating the dissemination and exchange of knowledge and experience in HIV/AIDS programme among all community members        Do you know that DFID provide £25 million in support of a large HIV and AIDS Programme in Indonesia started in 2005? Do you know where the fund have been allocated?        Apakah Menko KesRa atau Presiden SBY masih peduli terhadap penanggulangan penyakit menular, termasuk HIV-AIDS, TB, Malaria - di Indonesia? Indonesia sedang dalam kondisi sungguh sulit dengan dampak penularan yang terus meluas pada masyarakat yang miskin        Bila Konsep Akselerasi Upaya Penanggulangan HIV-AIDS di Indonesia tidak difahami dengan BENAR dan Berbasis evidence, maka TIDAK AKAN berhasil menahan laju epidemi HIV di Indonesia. Itu yang terjadi sekarang!        Further evidence to support a recommendation for exclusive breastfeeding by HIV-positive mothers in resource-limited settings        Deliver TB and HIV services in the context of fully functioning primary health care systems to ensure cases are detected, prevention is available and treatment accessible and sustained        Reach the most vulnerable populations with TB and HIV services Now!        The HIV service providers need to do : screening for TB and starting isoniazid preventive therapy if there is no sign of active TB.        To fight AIDS we must do more to fight TB (Nelson Mandella, 2004)        Violence makes women more susceptible to HIV infection and the fear of violent male reactions, physical and psychological, prevents many women from trying to find out more about it, discourages them from getting tested and stops them from getting treatmen        People at high risk of HIV exposure should be tested every three to six months in identifying recently infected people then we have to be able to counsel them to modify high-risk sexual behavior and desist from transmitting the virus        About half of new HIV cases occur when the person transmitting the virus is in the early stages of infection and unlikely to know if he or she is HIV-positive        HIV/AIDS Epidemic in Indonesia: not one ( single) epidemic but many (multiple) (riono, pandu)        Combating HIV-AIDS requires more than prevention and treatment. It requires improving the conditions under which people are free to choose safer life strategies and conditions.        Para pecandu yang butuh alat suntik (insul) steril, hubungi LSM setempat - Lihat pada Jejaring Layanan        Kurangi Dampak Akibat Bencana Napza dengan Upaya Pemulihan Pecandu yang komprehensif (metadon, Jarums steril, tes HIV dan Hep C, Pengobatan dan Dukungan)        Treatment without prevention is simply unsustainable! Pengobatan saja tanpa upaya pencegahan yang serius dan sistematik sama saja BOHONG!        1 Desember: keprihatinan global atas kegagalan kita!        Gunakan alat suntik steril untuk hindari penularan HIV dan Hepatitis        Pakai kondom pada setiap kegiatan seks berisiko, dapat mencegah penularan HIV        HIV tidak mudah menular dari satu orang ke orang lain        Komisi Penanggulangan AIDS (KPA) adalah institusi koordinasi BUKAN Pelaksana program atau Implementor!!        Profesi Kesehatan perlu terlibat dan dilibatkan secara aktif dalam upaya penanggulangan HIV-AIDS        Perluasan Masalah HIV-AIDS di Indonesia TIDAK mungkin dibatasi oleh wilayah administratif tertentu saja        Hindari diskriminasi dan stigmatisasi pada orang rawan dan orang yang telah terkena HIV        AIDS adalah kenyataan, lakukan tes HIV bila ingin tahu status anda        AIDS-INA - Sarana komunitas AIDS Indonesia untuk menyampaikan gagasan serta tukar informasi    


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  Universal access to HIV/AIDS treatment for injecting drug users: Keeping the promise 
Deskripsi: The introduction of highly active antiretroviral therapy (ART) in the mid-1990s brought new hope for people living with HIV/AIDS. ART promised to make a fatal disease a manageable chronic illness. In the early years access to such treatment was limited to those living in rich countries. The cost of medicines was prohibitive for most, the treatment regimens were complex with multiple side effects, treatment needed to be monitored by specialised physicians with access to sophisticated laboratories and other health services, and patients needed to be living in stable and supportive environments. Any belief that treatment was only feasible for the rich and privileged was shattered in 1997 when Brazil became the ?rst developing country to provide ART through its public health system.

Despite the leadership of Brazil few other developing countries (exceptions included such countries as Argentina, Botswana, Chile, Senegal, Uganda and Thailand) committed to a similar public health response thereafter. As HIV-related mortality and morbidity plummeted in most high-income countries with the rapid expansion of ART, ever-increasing numbers of people were dying in low-and middle-income countries. Such disparities in access to life-saving treatment galvanised a global movement in support of rapid treatment scale up. On 22 September 2003, the World Health Organization (WHO), the UNAIDS Secretariat, and The Global Fund to Fight AIDS, Tuberculosis and Malaria declared the lack of access to ART as a global health emergency. In response, WHO and the UNAIDS Secretariat announced a global target to provide ART to three million people in low-and middleincome countries by 2005, the “3 by 5” target. A multi-partner response followed in many countries, involving governments, civil society, technical agencies and donors. In the 2 years of the initiative those receiving ART in low-and middleincome countries increased from an estimated 400,000 at the end of 2003 to 1.3 million by the end of 2005 (WHO, 2006). The success of “3 by 5” did much to mobilise political commitment for treatment scale-up, leading to a declaration from G8 leaders in July 2005 to support countries to scale
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  Access, adherence and structural barriers in Asia and the former Soviet Union 
Deskripsi: Abstract
Offered proper support, injection drug users (IDUs) can achieve the same levels of adherence to and clinical bene?t from antiretroviral treatment (ARV) as other patients with HIV. Nonetheless, in countries of Asia and the former Soviet Union where IDUs represent the largest share of HIV cases, IDUs have been disproportionately less likely to receive ARV. While analysis of adherence amongst IDUs has focused on individual patient ability to adhere to medical regimens, HIV treatment systems themselves are in need of examination. Structural impediments to provision of ARV for IDUs include competing, vertical systems of care; compulsory drug treatment and rehabilitation services that often offer neither ARV nor effective treatment for chemical dependence; lack of opiate substitution treatments demonstrated to increase adherence to ARV; and policies that explicitly or implicitly discourage ARV delivery to active IDUs. Labeling active drug users as socially untrustworthy or unproductive, health systems can create a series of paradoxes that ensure con?rmation of these stereotypes. Needed reforms include professional education and public campaigns that emphasize IDU capacity for health protection and responsible choice; recognition that the chronic nature of injecting drug use and its links to HIV infection require development of ARV treatment delivery that includes active drug users; and integrated treatment that strengthens links between health providers and builds on, rather than seeks to bypass, IDU social networks and organizations. © 2007 Elsevier B.V. All rights reserved.

Keywords: Drug users; HIV treatment; ARV; Chemical dependence treatment; Human rights; Asia; Former Soviet Union
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  Antiretroviral HIV treatment and care for injecting drug users: An evidence-based overview 
Deskripsi: Abstract
AIDS-related mortality and the rate of progression to AIDS have dramatically decreased since the advent of highly active antiretroviral treatment (HAART). The overall bene?t from antiretroviral HIV treatment has, however, been lesser in HIV-infected injecting drug users (IDUs) than in other patient groups (e.g. men who have sex with men). Poorer outcomes in HIV-infected IDUs are related to a variety of factors, including increased rates of non-HIV-related deaths, hepatitis C, delayed access to effective treatment, lower adherence to care and treatment regimens, continuation of illicit drug use, depression and negative life events. The available evidence strongly suggests the need for the large-scale implementation of comprehensive treatment and care strategies for IDUs that include both treatment of drug dependence and HAART. © 2007 Published by Elsevier B.V.

Keywords: HIV treatment; Injecting drug use; Review
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  Adherence to HIV treatment among IDUs and the role of opioid substitution treatment (OST) 
Deskripsi: Abstract
In the era of highly effective anti-retroviral therapy (ART), data show a signi?cant difference in treatment outcomes between injecting drug users (IDUs) and non-IDUs. Factors that may contribute to suboptimal treatment outcomes in IDUs include delayed access to ART, competing comorbid diseases, psychosocial barriers and poor long-term adherence to ART.

This review describes and compares several studies on adherence to ART and its correlates in HIV-infected individuals in general, then IDUs and ?nally those IDUs on opioid substitution treatment (OST). It highlights how ongoing drug use or OST can modify the pattern of these correlates.

The aim is to extend all the experience acquired from these studies in order to optimise both access to care and adherence in those countries where HIV infection is mainly driven by IDUs and where ART and OST are only starting to be scaled up. The role of OST in fostering access to care and adherence to ART together with the promising results achieved to date using modi?ed directly observed therapy (DOT) programs for patients taking methadone, allow us to emphasize the ef?cacy of a comprehensive care model which integrates substance dependence treatment, psychiatric treatment, social services, and medical treatment. The review concludes by suggesting areas of future research targeted at improving the understanding of both the role of perceived toxicity and patient-provider relationship for patients on ART and OST. © 2007 Elsevier B.V. All rights reserved.

Keywords: Adherence; Anti-retroviral treatment; HIV; Substitution treatment; Injecting drug users
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  Access to HAART for injecting drug users in the WHO European Region 2002–2004 
Deskripsi: Abstract
Providing equitable access to highly active antiretroviral treatment (HAART) to injecting drug users (IDUs) is both feasible and desirable. Given the evidence that IDUs can adhere to HAART as well as non-IDUs and the imperative to provide universal and equitable access to HIV/AIDS treatment for all who need it, here we examine whether IDUs in the 52 countries in the WHO European Region have equitable access to HAART and whether that access has changed over time between 2002 and 2004. We consider regional and country differences in IDU HAART access; examine preliminary data regarding the injecting status of those initiating HAART and the use of opioid substitution therapy among HAART patients, and discuss how HAART might be better delivered to injecting drug users. Our data adds to the evidence that IDUs in Europe have poor and inequitable access to HAART, with only a relatively small improvement in access between 2002 and 2004. Regional and country comparisons reveal that inequities in IDU access to HAART are worst in eastern European countries. © 2007 Elsevier B.V. All rights reserved.

Keywords: Antiretroviral therapy; Access; HIV/AIDS; Injecting drug use; Europe
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  Directly observed therapy programmes for ART amongst injection drug users in Vancouver 
Deskripsi: Abstract
The introduction of highly active anti-retroviral therapy (HAART) has produced dramatic reductions in HIV associated morbidity and mortality. However, this success has not been replicated amongst injection drug users (IDUs) and other marginalised groups largely due to reduced uptake and lower rates of access and adherence to anti-retrovirals (ARVs). Multi-disciplinary programmes have been developed to help support ARV treatment and HIV care amongst IDUs. We retrospectively analysed the rates of adherence and plasma viral load suppression amongst participants in two clinic-based programmes that began enrollment in 1998. Of the 297 clients, the mean age was 40.5 years, 73% were males, 44% were of Aboriginal ethnicity, and 85% were Hepatitis C co-infected. One hundred and forty-two (47%) started therapy with a CD4 count below 200 mm-3, and baseline plasma viral load was over 100,000 copies/ml in 73 (25%). Treatment interruptions of greater than 2 weeks occurred in 41% of the participants during follow-up. The overall rate of adherence to treatment was 84.5% during periods when known interruptions were not considered. Plasma viral load suppression was attained by 29% during the ?rst ARV regimen, although 83% had at least one fully suppressed plasma viral load recorded during follow-up. All cause mortality was 21% during the period of observation. The programmes initiated in Vancouver demonstrate the positive impact that a comprehensive DOT programme can have on ARV adherence, as well as highlight the challenges that remain. © 2006 Elsevier B.V. All rights reserved.

Keywords: Anti-retrovirals; Directly observed therapy; HIV/AIDS; Injection drug use
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  Self-reported side-effects of anti-retroviral treatment among IDUs: A 7-year longitudinal study 
Deskripsi: Abstract
The introduction of potent anti-retroviral treatment (ART) has transformed HIV disease into a chronic condition with the prospect, for the patient, of strict adherence to effective but life-long treatments. Within this framework, a major issue that can negatively affect adherence is the side-effects of the treatment. To date, studies documenting how individuals HIV-infected through drug injection (IDUs) experience ART-related side effects are sparse.

Longitudinal data collected from the APROCO-COPILOTE cohort have been used to compare the experience of ART-related side-effects who have been HIV-infected via injecting drug use and non-IDU patients. A 20-item list was used to collect self-reported side-effects over a 7-year follow up period.

Of 922 patients, 15% were IDUs. At any given visit, IDUs reported a signi?cantly higher number of side-effects and had approximately twice the risk of reporting any side effect than non-IDUs. Most commonly reported side-effects were dry skin, fatigue, vomiting, bone troubles, insomnia. After adjustment for social conditions, depressive symptoms, use of sleeping pills and time since HIV diagnosis, IDUs reported experiencing signi?cantly more side-effects than non-IDUs. Whether or not this is related to sensitivity to pain or to other comorbidities is dif?cult to establish.

Further research is needed to understand how substitution treatment can mediate the relationship between exposure to opioids and side¬effects. Providing appropriate care to reduce side-effects, thereby increasing adherence to ART in this population, remains a major challenge especially in those countries scaling up ART. Incorporating symptom management and improving access to analgesic medications within a model of comprehensive care for HIV-infected IDUs, could reduce the impact of drug-related and HIV-related harms and induce better long-term treatment outcomes and quality of life. © 2007 Elsevier B.V. All rights reserved.

Keywords: Side effects; Anti-retroviral treatment; HIV; Injecting drug users; Hyperalgesia; Pain
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  Integration and co-location of HIV/AIDS, tuberculosis and drug treatment services 
Deskripsi: Abstract
Injection drug use (IDU) plays a critical role in the HIV epidemic in several countries throughout the world. In these countries, injection drug users are at signi?cant risk for both HIV and tuberculosis, and active IDU negatively impacts treatment access, adherence and retention. Comprehensive strategies are therefore needed to effectively deliver preventive, diagnostic and curative services to these complex patient populations. We propose that developing co-located integrated care delivery systems should become the focus of national programmes as they continue to scale-up access to antiretroviral medications for drug users. Existing data suggest that such a programme will expand services for each of these diseases; increase detection of tuberculosis (TB) and HIV; improve medication adherence; increase entry into substance use treatment; decrease the likelihood of adverse drug events; and improve the effectiveness of prevention interventions. Key aspects of integration programmes include: co-location of services convenient to the patient; provision of effective substance use treatment, including pharmacotherapies; cross-training of generalist and specialist care providers; and provision of enhanced monitoring of drug–drug interactions and adverse side effects. Central to implementing this agenda will be fostering the political will to fund infrastructure and service delivery, expanding street-level outreach to IDUs, and training community health workers capable of cost effectively delivering these services. © 2007 Elsevier B.V. All rights reserved.

Keywords: HIV; AIDS; Injection drug use; Substance use; Tuberculosis; Health care integration; Health services; Prevention
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  Obstacles in provision of ART to drug users in Central and Eastern Europe and Central Asia 
Deskripsi: Abstract
Central and Eastern Europe and Central Asia is currently the region with the fastest growing HIV epidemic, mainly among injecting drug users (IDUs). This study explored access to anti-retroviral (ARV) treatment among IDUs and evaluated obstacles to gaining access to treatment. Semistructured questionnaires were collected from 21 countries from agencies which deliver services to IDUs (N = 55), including AIDS centres, drug treatment institutions and Non-governmental Organisations. Results showed that there was poor access to ARV treatment for IDUs. The major obstacles reported were: limited range of institutions for the provision of ARVs, lack of treatment due to high cost of ARVs, lack of clear policies and regulations in providing treatment for IDUs, lack of infrastructure and trained staff to provide treatment, and in some countries, absence of mechanisms such as methadone substitution programmes to support IDUs receiving ARV. There is a need for human and capital resources to bring ARV treatment to IDU populations in the region. Regulations and treatment protocols need to be developed to address this particular group of HIV positive clients to insure better adherence and monitoring of clients with HCV co-infection. Integration of provision of ARV treatment with drug treatment and low-threshold services is advised. Substitution therapy should be advocated for in countries where it is not available or where access is limited. Finally, more research needs to be conducted to understand what will work best in each country, region or setting. © 2007 Elsevier B.V. All rights reserved.

Keywords: Central and Eastern Europe and Central Asia; HIV; Drug users; ARV
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  Access, adherence, quality and impact of ARV provision to current and ex-IDU in Manipur (India) 
Deskripsi: Abstract
Objectives: This study aims to understand who is obtaining anti-retroviral therapy (ART) in Manipur, and to determine adherence, access, and impact amongst those who use it. It also explores the quality of these services, their impact and the level of user satisfaction.
Methods: A mixed method approach was used for this assessment involving direct observations, analysis of service statistics, and a semistructured survey (n = 226).
Results: Less than 5% of current injecting drug users (IDUs) were accessing ART (despite IDUs making up the single largest category affected by HIV in Manipur). Self-reported treatment adherence amongst patients is poor. Major factors in?uencing adherence are current alcohol use, the cost of ART, having attending any counselling in the last 6 months, income levels of below Indian Rupees (INR) 2000 and negative experience of side effects. Client satisfaction is associated with: duration of time spent with doctors, waiting time and how staff treat the patients. Service quality also requires improvement. A quarter of patients on ART perceive that it has bene?ted their health and report feeling well. Side effects were experienced by 61% of those on ART. Greater efforts to bring more active IDUs into treatment, whilst improving the manner in which ART is delivered in Manipur are required. © 2007 Elsevier B.V. All rights reserved.

Keywords: ART; IDUs; Adherence; Access; Manipur; India
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