title: Barriers to accessing drug treatment in Russia: a qualitative study among injecting drug users in two cities.
abstract: OBJECTIVE
  To assess factors influencing access to drug treatment among injecting drug users (IDUs) in two Russian cities.
  
  
  METHODS
  Eighty-six qualitative interviews were conducted with IDUs in Volgograd and Barnaul in 2003. IDUs were recruited through local drug treatment services, needle exchanges, and drug user networks.
  
  
  RESULTS
  Three main barriers to treatment assess were identified: financial constraints, fear to registration as a drug user, and perceived low efficacy of available treatment services. Registration of drug users was associated with loss of employment, breaches in confidentiality. and stigma. Some participants did not think that drug treatment services could respond appropriately and effectively to their treatment needs.
  
  
  CONCLUSIONS
  These findings highlight the importance of environmental factors in mediating IDUs access to drug treatment, which might suggest the need for social and structural interventions. Access to drug treatment services should be enhanced by reducing the financial burdens of drug treatment and minimizing the stigma associated with drug user registration. Russia should shift from a highly medicalised model of treatment toward a more holistic approach that recognises the diversity of treatment needs among IDUs. These priorities are especially timely given the urgent need to integrate drug treatment as part of wider HIV prevention responses in Russia.
authors.affiliation: Centre for Research on Drugs and Health Behaviour, Imperial College London, UK; Mental Health NHS Trust, UK.
authors.forename: Natalia
authors.initials: N
authors.lastname: Bobrova
authors.forename: Tim
authors.initials: T
authors.lastname: Rhodes
authors.forename: Robert
authors.initials: R
authors.lastname: Power
authors.forename: Ron
authors.initials: R
authors.lastname: Alcorn
authors.forename: Elena
authors.initials: E
authors.lastname: Neifeld
authors.forename: Nikolai
authors.initials: N
authors.lastname: Krasiukov
authors.forename: Natalia
authors.initials: N
authors.lastname: Latyshevskaia
authors.forename: Svetlana
authors.initials: S
authors.lastname: Maksimova
mesh_terms: D000293:Adolescent; D000328:Adult; D002391:Catchment Area, Health; D004777:Environment; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012426:Russia / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000534:rehabilitation*