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ЕВРОПА И ЦЕНТРАЛЬНАЯ АЗИЯ

ВИЧ/СПИД И ТУБЕРКУЛЕЗВ ЦЕНТРАЛЬНОЙ АЗИИСтрановые разделы

Документ Всемирного банкаИнформационный центр в России

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Copyright Clearance Center222 Rosewood DriveDanvers, MA 01923, U.S. ATen. 978-750-8400, $aiKc 978-750-4470

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[Electronic Surveillance Case-Based Management System]6CCCP CTpaHbI 6bBMiero CCCPFCB rpyrinia CeMCeIHbIX BpaqegGDF BceMHpHbIA ieKapcTBeHHbIg cpoH, (Global Drug Fund)FDCTM rFo6aabHbiA qoHZi 60pb6bI co CrHHloM, Ty6epKyjie3oM 14 Ma1ispHefiHFA 3,AopoBbe sm Bcex (Health for All)BUItI BHpyc iMMyHoAec1HuHTa xenioBeKa

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Planned Parenthood Federation)IUATLD MexyiHapoHbimi C0103c i no 60pb6e c iy6epKyne30M H jierOmHbIMH

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cHcdHhiHc) Venereal Disease Research Laboratory (test for syphilis)B03 BceMH4pHaq opraHH33aLw 3,gpaBooxpaHeHHsI

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MacmTa6oB, HO TaKa5I cHTyaLHSI CTaBHIT rABOiHYIO 3agary: BO-rIepBbix, IIeHBJItbBHHMaHHe K HPOFH03ipyemOg 3arigeMIHH, qT06bi HOJHTHKH Ha rocygapCTBeHHOMYPOBHe rIOHIHManH, rTO oAmgae'r Hx CTpaHbI B 6ygymeM, IPIHHHMaS BO BHHMaHHeM1HPOBbIe cBH,leTeJIbcTBa pocTa BI4L-IH4eKmH; H4 BO-BTOpbIX, mIaHHpOBaTb, B KOH-

TeKCTe Kpaf4He OrpaHHWeHHbIX pecypCOB, pa3yMHbIe OTBeTHbIe MepbI rio B{I/CrHHJIyBO BCeM leHTFpabHOa3 aTcKom cy6-perHOHe. B L]eHTpaAbHof A3HH, KaK H B OCTajTbHbIXc-paHax EL,A, MacMTa6bI nIIHeMHH 3HaxnTeJIbHO HeJgooiAeHIsBaoTcq, O,gHaKO BcerIOHHiMaioT, rITO pacnpocTpaHeHie B1I4 yBemJrH4BsaeTCI BcjIe,g 3a a3rmeMHMmHnoTpe6IeHHsI HHbeKqHOHHbIX HaPKOThKOB (HHIH) 14 3a6OjieBaHi4A, nepegaiomuixcAIIOJIOBbIM niyTeM (HrInT) B 3TMX cTpaHaX. Ilo gaHHbIM OpraHIH3aHH EBpO-BW [Euro-HIV], B qeHTpaRbHoa3HaTcKHx cTpaHax OTMeqaeTCq pe3Koe yBeafHqeHme HCjieHHOCTHH noKa3aTeneA HHc)eKLxHH 3a riepH'og c 1996 rio 2001 rogbi (Ta6jl4Ija 1).

B HeKOTOpbiX cnyqa3ix poCT o6bSIcHAeTcq yJyqmeHHbIM Ha6JloA,eHHieM 3a BWI-HHcPeKiweA (3To qieHMie H3BeCTHO KaK apmetfiaKm omLimnocmu [reporting artifact),HO, TeM He MeHee, Bce gaHHbIe yKa3biBaEOT Ha pOCT 3qrImleMiH. CoriaCHO O)Hr4waAIbHbIMgaHHbIM, pacnpocTpaHeHHocTh BWI Cpeg B3pocAorO HaceiieHH KoJne6jieTcI OT 0,14%B Ka3axcTaHe go MeHee 0,01% B TanpmKHcTaHe, TypKMeHHicTaHe H Y36eKwIcTaHe(Ta6niina 2).

Bce lpaBiHTejIbCTBa nIpHI3HaioT, rrTO MacmTa6 KoHTpa6aHAbI HapKOTHKOB H4iHHbeKLAMOHHOfi HapKoMaHHH cTan yBe)IWH4BaTbC5 c 1995 roga, HO oco6eHHo pe3KOBbIpOC riocnie Haiaia BoeHHbIX AeAecTBH4Ii B A¢raHHcTaHe B 2001 rogy. Korga rpaHHUbI CTa,gKKCTaHOM H Y36eKIHcTaHoM 6bTIH OTKpbITbI, LxeHbI Ha HapKOTHKH cTai naraTa.

I

2 PASO'II g,OKHAg BCEMHPHoro SAHKA

1996 2001

noKa3aTenb noKa3aTenb

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HCM0'HUK: Hamers FF U Downs AM. BH4 B LieHTpanbHOA M BocTO9HOg EBpone. Lancet OeBpanb 28, 2003.

XOTS 6o0nbHCTBO 3apecICTPaPOBaHHbix cryqaeB 3apaxKeHHA BHH oTMeqeHO cpeg,LEnmi4L, ynoTpe6junlOaiIX HapKOTH2KH BHyrpHBeHHO (60-90%), npoi;eHT cjiyqaeB3apa)KeHHi HOCpegCTBOM reTepoceKcyanbHorO KoHTaKIa B nocnie,Hee BpeMqyBeju-riBaeTc, BO BCeM MHpe ioTpe6mivelIH iHiHbeKLu4OHHbIX HaPKOTHKOB (1114H),pa6oTHHm KommepcCKoro ceKca (PKC), MyXKHHbI, BcTyrIaiomge B rIOJIOBbIe KOHTaxTbI

C MyxKCqHlHami (MCM), 14 B Lle.IOM MOJIO,geCb CqHTaIOTCq rpyrrnaMm, rgae pIHCKBHI/CrlHJa HaH6o.nee BbICOK. tacTr4Hoe COBiageHHe rpynn IHH H PKC B 3TOM cy6-perloHe pacCMaTPHBaeTcq KaK gonoJIHETejIbHbIfA PHCK nepegZa-IE 3nr1,eMHH OTBbICOKO-y3I3BHMbIx rpynrn K YH3BIHMbIM rpyiriaM, TaKHM KaK MOJIo,eA(b. Boniee Toro,CayqagHbIl ceKc pa,H 3apa6oTKa, KOTOpbIM 3aHHMaiOTCR cTygeHTKH, H 6oneepacripocTpaHeHHaSi, 'eM ripHHiTo cqHiTaTb, romoceKcyanbHas npaKrTKa MoryT 6bITb,gOIOJIHEHTejibHbIMH 4)aKTopaMH pHCKa 6bicTporo pacripocTpaHeH we 3neM cpe,HMojiogexK B XejiOM. MonoRbIe nio,i, 6pocHBiMe yqe6y, KOTOpbIe oco6eHHo pHICKYIOTcTaTm HapKOMaHaMH EvH PKC, B03MO3KHO, 3aCiYXWBaioT 6onee LeneHarpaBneHHOrOBHiMaHHsI, qeM Mm ygeimeTcq B Hacros3inee BpeM3. Mo6mbHoe HaceIieHHe, HanpH4Mep,BO,lATemH rpy3OBHKOB, 6e30oMHbIe, 6e,KeHTubI, pa6oxe-MHtrpaHTmI H iKCHIIHHbI,

craBiuHe o6fexToM KOHTpa6aH)TbI, TaioKe OTHOCSTCS K BbICOKO-yA3BHMbIM rpyrnnaM, BTOM xHCJie H B COCegJHHX cTpaHax, TaKHX KaK KKTaE. CnegOBaTeIbHO, MOACHO OiAUgaTh,wTO PaCiPOCTPaHCHHOCTm BIPI cpe,gH qTHX rpynri yBejiH'HTCSI H B [UeHTpaJbHoEi A3HH.

Oco6yio TpeBory BbI3bIBaeT KOHTpa6aHga HapKOTE4KOB, a TaioKe ToproEi WeHHumamH

H JZeTbMH, KOTOpbIX BbIHYIfCaEOT 3aHH4MaThcSI ripocrHTyiefl. 3ainaoqeHHbIe H

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MH14eKL4HR

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anpe.nb 2003 r. B TaApiHKmCTaHe U Y36eKmcTaHe).

B"q/Cnf M 1 TYrEPKYnE3 B L4EHTPAnbHO1 A3Xmt 3

1995 1996 1997 1998 1999 2000 2001 2002 Bcero

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cmo'4HuK EBponefcKrm L,ewrp MOHHTOPMHra cnl a, ma MmHCepCTBa 3ApaBooxpaHeHMR LAeHTpanbHOZ A3uu.(lToroBan KOnOHKa COAep)K&iT AaHHbie Ha AeKa6pb 2002 roAa B Ka3axcTaHe, Mar 2003 r. B Kbiprbl3cKor4 Pecny6jlMKe,

anpenb 2003 r. B TaApmKUUcTaHe U UlOHH 2002 r. B Y36eKucraHe.)

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iiiogei, xa4Bywiix c BHtI/CrIH OM cocTaBwHer OKOJIO 90 TbICSlN. Ha OCHOBaHHHn1pOrHO3a go 2005 roga, aTa LuHpa jocTHrHer 1,65 M OHa, eci He 6yTyrnpe,grIpHH3ITbI CnaJKeHHbIe yCHimm no LenjeBbIM BMemaTejubCTBaM.' ,OIg6HbIfi pOCTMo>KeT MmeTh KaTacTpOoMH'ecKEHe nocne,gcTBim Hw ,gOMOXo3s1f4CTB H CHbHO noBJIHH1T

Ha rocygapcTBeHHbie paCXOAbI Ha MeJHIHHCKOe o6cRnYMBaHHe.

nOAXOAbl o6u4ecTmeHHoro 3ApaBooxpaHeHmq B I4eHTpaIIbHOA A3mm:paHHme ycmnhnIlpaBHTeJIbcTBa Ka3axcTaHa, KbIprbI3CKoA Pecry6inHm, Ta,rKpcTaHa H Y36eKHcraHayrBepgwJH CTpaTerHH 60pb6bI c BW1/CrIIaoM, rIWorTObrieHHbIe HpH COgeAcCTBHHiUNAIDS2. B 3TEX CTpaHaX CO3gaHbI MecBegOMCTBeHHbIC KOMHCCHH BbICOKOrO ypOBHq

,JIA KOOPgHHaHgiH ocyuecCTBineHIH 3EX crpaTerHid. B LypKMeHHcTaHe CHTyaiHA MeHeeonpegejieHHaM, HO TeMaTHwiecKaA rpynna UNAIDS B HacTorHiee BpeMS OKa3bIBaeTcogekcTBHe ripaBHTenJbCTBY B rO,iorOTOBKe CTpaTerHH. CTpaTerHH rpegyCMaTpiBaioTMexcBeJgOMCTBeHHbuif ro,ixoJI H o6OCHOBaHHbIe, goKa3aTejibHbIe BMeIiaTejibCTBa 2NM60pb6bI C 3ngHeMHefi (Boju, 1998; B3eppoy3, 2001 [Ball 1998, Burrows 2001]): co3JJaHHeA03OPHOrO 3IHHHag3opa, CHHKeHHe Bpega3 , IIpoHIaKTHiKa H neqeHie HIrIl, a TaioKeo6yqeHHe MOJ1OgbIX riogefI B LxeI0M. Bo Bcex cTpaHax npiHHiTO 3aKOHo,gaTejibCTBo rO

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1. http://wwwusaidgov/regions/europe_eurasia/car/briefers/hivaids_prevention.htnil. MapT2003 r.

2. UNAIDS (2001). OTBeTHbIe MepbI rio 60pb6e c BW{/CrIH,oM, HflfIf 1H HapKOMaHmeg BcTpaHax LfeHTpaAbHofl A3m-i HpH cogeficTBHH UNAIDS. AnMaTbI: UNAIDS - LeHTpanbHaM A3mA.

3. CiivweHie Bpe,a - TaK Ha3biaioTcq riporpaMMbI ayrpH-i, ripe.;ycMaTpHBaiomi-He o6yCeHHeno npHHui]iHfy "paBHbfi paBHOMy", KOHCyJIbTHpOBaHH4e H TeCTHpoBaHHe, o6MeH HrIi Ho6ecrie,qeHme Bipe3epBaTIsaMn BbICoIKo-y33BHMbIx rpyrn. DTH HOprpaMMbI OKa3aIHCb BeCbMa34eICeTHBHbIMH H aKOHOMHqHbIMI B pa3BHBaIOH]HXCK H pa3BMbZI CTpaHax (CM., K ripHMepy,Cogpy)KecTBo ABcTpanmm 2002. OKynaeMocTm HporpaMM o6MeHa Hirn mh IHpHLsOB B ABcTpaJiH[Commonwealth of Australia 2002. Return on Investment in Needle and Syringe Programs inAustralia]).

4 PArO'-04ii ,OKJ1Aq BCEMWPHOrO SAHKA

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nporpamma DOTS 6bvIa iipHOcTaHOB3IeHa H3-3a rpax<gaHCKOA BOirHbI (Ta6jniua 5).rHoKa3aTeRb ycneInHocTm4 ieqeHHI Ty6epKyjie3a B LeHTpajibHoa3HaTcKHx cTpaHax,peaAH3yioiTHx DOTS, BARTeTcC CKpOMHbIM. KbIprbI3CKaM Pecny6.nHa - cTpaHa, nepBofl

BHegp4BmasI DOTS B perHoHe, MmeeT HaHjiyimii4 rioKa3aTeJIb yCCemHOCTH TInexeHHS,KOTOpbIIi, TeM He MeHee, B 1999 ro,gy 6bulI HlDKe yCTaHOBjieHHOfi B03 LenH B 85ripOUeHTOB H3JIeieHH4A riaUmeHTOB, BriepBbIe 3apeHCTp1 pOBaHHbIXm neeH

(Ta6jiHqa 6). BjiHIHHe neKapcTBeHHOfl YCTOfIHBOCTH H BHT-HH4eKLAHH goAXHo 6b1m

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BVM/CnfgJ TYEEPKYnE3 B L4EHTPAnbHO1 A3mm 9

1996 1997 1998 1999 2000

Ka3aXCraH DOTS DOTSoTcyTCTByeT oTcyTCTsyeT 4 100 100

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ANM BHe,peHH5 nporpammbi DOTS Plus, KOTopaA rpegyCMaTpBaeT ipOOJDKeHHeneqeHHA no nporpamme DOTS H npHmeHeHiHe npenapaToB BToporo pwga. O,HaKo 3TOMO)KeT OKa3aThCl npexKgeBpeMeHHbIM, IP1EHHMSaR BO BHHIMaHHe, xTO rporpaMMa DOTSHe 6bvTaIOIJIHOCTbIO peaIIs3oBaHa, a cHcTeMaTH4ecKoe Ha6jiiogeHHe 3a MJY-Ty6epKyjie3oM oTcyTcTByeT. KpoMe Toro, HCI1OJIb3yeMbIieBO MHorHX cTpaHax 6CCCPripoToKojibI Tie1eHH5 He OCHOBaHbI Ha AOKa3aTebH MHo i HeijHCKofi rIpaKT1Ke.CjIegOBaTejbHO, CymecTByeT P14CK C03gaHH5 yCTOfEHMBOCTH K ripenapaTam BToporop3qa, KaK 3TO HpO330UIAO C nIpenapaTami nIepBoro p5,a H3-3a HX HeIipaBHAbHOrOipHMeHeHH5H, ITO npHBe,AeT K C03gaHEI0 AOrIOJIHHTeJbHOf irIpO6jieMbI XH

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rOA perncrpaqitN na4Wefros

1995 1996 1997 1998 1999

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COCTOHHHe CHiCTrM 3gpaBOoXpaHeHHq B ILeHTpaibHo0 A3H yXygzHOCb B riaHeHa,g3opa 3a 3a6oAeBaHIAMn, a TaioKe oxBaTa neqeHHem IHHeKLWOHHbIX 3a6ojieBaHHA.3To yxyruneHie B HeMa0of cTeneHH oripegleJmeT ycrieMHOCTm iipoiHjiaKnwecCKHXMeponpHIIi, fOCKOJIbKy iieqeH4e KFrIrfIf, oco6eHHO 313BeHHbIx 3a6oneBaHHA, TaKixKaK cHI¢unHc H niaHKp, Heo6xoWMo gvm npegoTBpau1eHHH pacnpocrpaHeHnAs BUM.Bonxee Toro, xopoEmo HaiaIKeHHbIe CHCTrMbI neqeHHA HrIrIll BKyne C Ao6poBoAbHbIM

KOHCYJIbTH4pOBaHHe H TTCTHIpOBaHHeM Ha BM Bcex naLWeHTOB qBOTCA BaXKHOlicocTaBwuonXeA B ,gene npo4H.uaKTmiaI (Boc H gp., 2002). PIHCK pacnpocrpaHeHiui BMal-anorHqeH pHCKy pacripocTpaHeHH .ApyrHx rIrIrFI.

BonpocbI JgOOhiHHTejIbHOrO 4,HHaHCHPOBaHHS[ KaCaIOTCq HeoXBa-eHHbIX H,CIeAoBaTenbHo, BbICOKO-y33BHMbIx rpyrnn HacejieHH4I. MHrpaHTbI, Mo6HTbHbIe rpyrnnm,PKC H gpyrie TpygHoAoCTynHbIe rpynnbI 3aqacryio )iHieHbI npaBa Ha MeJHi1HCKoeo6CyIcHsBaHHe, nE6o B cH.ry cBoero per4cTpaiAmoHHoro craTyca H COUHaRbHOHH3O IUHH, mI6o no H1pHIHHe "HerocTenpHHMHocTH" MeAHLiHHCKHx yqpegeHi.KpoMe Toro, KOPPYrIHI B CHCTeMe 3g1paBoOxpaHeHIHs MO>KeT BbIHyA2Ta Y.3BHMbIerpynrbl HeCTi paCxo,Db B BHAe B3HITOK HAlH "KOHBepTOB" ripexqe, qeM yCJryrH 6ygyTipCeoCTaBjieHbI. KJIHHHKH ApyIeJuIo6Horo OTHOUiCHH K MOjioAemK riOKa He CTraHIIIIpOKO IIpHHITbhIM MeTogoM pa6oTbI C nO.gBep>KeHHOf pHCKy MOJIOgeXb1O.CJIegOBaTenJbHO, BbICOKO-yA3BHMbIe rpynribl, B03MOXHO, He noliyqaIOT HaAjIexKanero.Ie,qeHHI OT MUM, Ty6epKy.ue3a HIH ocAIoxHeHHEi, CBA3aHHbIX c BUML. Ty6epKyAe3 HBUM Tpe6yloT TIgxaTCjIbHOrO nociieAyioiigero BegeHHR naLUHeHToB, H eCJIH TaKHeriaLuIeHThI He MOryT HAlH He XOTHT IIOJib3oBaTbCI MegU,4HCKHMH yCCyraMm, pa3OBbeTCI

eKapCTBeHHa YCTOTIOCTh (H K ripOTHBOTy6epKyne3HbIM, H K aHmpeTpOBHpyCHbIMnpenapaTaM), TeM CaMbIM oc.noxaiaH 60pb6y C 9ThMI4 1HHpeKLtWOHHbIMH 3a6o0eBa-HIIHMI4 BO BCM MmHpe. ATIH pemerHI-u 3TOg npo6neMbl Heo6xogHMbI TaKe CXeMbIq)HHaHCHpOBaHHH, KOTOpbIe noA2ep)KBaHoT 6opb6y c HH4peKLU{OHHbIMH 3a6oneBa-HHEIHM KaK o6axecTBeHHoe 6niaro. HeAocTaToqHo npocrO BHiegpiTb CHCTeMy MegH-UHHCKoro CTpaxoBaHHS4; cKopee HyxKHa CHCTeMa qHHaHCHPOBaHHSI KpHTH'4ecKorO

MeAHLMHHCKOrO BMemaTerbcTBa Aim ycTpaHeHHA npo6AeM 3gpaBOOXpaHeHHSrAo6anbHoro 3HaqeH4HA. BCeMHpHOMy 6aHKy Heo6xogHMo ygeiiHTh cepbe3HoeBHHMaHHe 3TOH rioTpe6HocTH irpH pa6oTe Hag ciHcTemaMMH qHHaHCIpoBaHHA BceKrope 3.paBooxpaHeHHa. rlpHBaTH3aLjI B KOHTeKCTe 6opb6bI C 3apa3HbIMH3a6ojieBaHH3MI HMeeT orpaHH'eHHyIO rlojie3HOCTb, a HeoCTaTOHoe qHHaHCH-

pOBaHHe capMaUeBTHiecKog oTpaCMi B gaHHOM ciyMae co3AaeT cepbe3HoenpenL5TCTBHe Ai H6opb6bI c BUM/C-I4,A oM H Ty6epKyjie3OM.

PEKOMEHJqAL41L

PeKOmeHAa4mH no 6nHxmaiwumm mepOnpF ATHMA

npasume.nbcmsaM cmpam pezuoHa

1) COBepmeHCTBOBaHHe cHcTeiMI Hazg3opa. PerI4OHaJbHbIe npaBHITejIbcTBa,npn coge1icTBHH IOCAI AP m CDC, gommbI pacnmpHTb Hm4 i-a1qaTco3IAaHHe .A030pHorO 3ar ng3opas no BW1/CrI4Ay H YCOBsepieHcTOBaTh

ciCTeMy Hag3opa 3a H4rIrlI, Ty6epKyjie3oM, MJW-Ty6epKyjie3oM H peaAm3aiwegflporpaMMbi DOTS. JJla,iee, Heo6xoAHMo 3HaTh 6onbmne o pacnIpocTpaHeHHocmpICKOBaHHOrO nIoBegneHi cpe,gi IHHH iH PKC, o riepejiHBaHn1 HenpOBepeHHOfiKPOBH H o paCnpOCTpaHeHHocTrH BHEI cpe,H BbICOKO-ySI3BHMbIX rpyIrI, TaEKX

KaK PKC, ;KeHU~HHbI, CTaBUiHe o6'BKToM ToproBJIH, MHirpaHTbi, BO,ATrejHrpy3OBHKOB ("gaAbHo6o9mHm") H gp. TbKOri HoCpCeACTBOM yiymeqmeHM CHCTrMHag3opa MOxHO ruaHHpOBaTh 34¢4eIrHBHbIe BMemaTe.ibCTBa H OijeHHBaTb UXpe3y.nbTaTmI, a TaioKe 6oaee TOxHO 3HaTh O pa3BTHH 3niiLmeMH BHI4/CrIH;la Hi6opoTmcA C Hefl.

2) IIpmIzTe H pea7n3aJ~m cTpaTerHH 6opib6m c BH'q/CfHHoM, HHHH iiTy6epKyAe3oM. IHpaBirreJIbCTBa Ka3axcTaHa, KbIprbI3CKOfi Pecny6irKH,TagmcraHa H Y36eKHcTaHa gOjDKHbI pacimHpHTm MacIIrTa6 peaEI43agHu

5. AO3OpHRfi 3an4Ha230p nI03BOJIMeT Ha6Jmo,LaTh 3a 3nHrmeMie1i nocpeCTBom MajiOH BbI6p

onpegeiieHHbix no,grpyrm. 3,zgeCb MoryT ripOBOgHThCH c HcneHanbHbIe HCcjiegOBaHiEA

pacnpocTpaHeHHocTm BHH cpe,n BbICOKO-y33BHAMOrO HaCeiieH5I, HanpHiMep, rITH, aHQHmHMHbIf

iH HecBR3aHHbIi aliaiuH3 KpOBH, nonyleHHof ,Ji ,ApyrHx jieineg, HarlpHMep, AOHOpCKOf4 KpOBil, aTalOKe pery1IApHoe TeCThPOBaHiie BOeHHbiX miiH JIH1, HaXO,a51iHXCS no, OrleKo()creiani3HpoBaHHbix yqpex(geHHH.

13

14 PAO'4LM gOKumg BCEMHPHOrO rAHKA

rIpHHgTbIX CTpaTerHI4 nIo BMH/CrI4My, YTO6bI OcTaHOBHm pacnpoCTpaHeH4eBT4H; BCe IInpaBieThbCTBa ,gOjDHbI H3bIcKaTb H BbiejiHTh ,gOCTaTOqHOe4cHHaHCHpOBaHHe gmS peajIH3agLU riporpaMMbi DOTS. rlpaBHTembCTBO'IypKMeHHcraHa ,gonXCHo KaK MO)KHO cKopee npi-HmTb CTpaTermno noBWI/CIHITHy, noiroToBneHHyIo ripii cogeIfcTBHH UNAIDS.

3) YCHaeHHle pa6oTmI C BMCOKCO-yJ3BHMMIMH H EY3BHMlIMH rpynnaMH.Heo6xo1HMo 6bICTpO HapaMHBaTm ycwHn r no npo4EvaKTHKe BHI/CrIl4TAacpe,gH BbICOKO-y3I3BHMbIX rpylir, TaKHx KaK 111IH, PKC, MCM, a TaioKe cpe,HMOJIO,mX mIOpgefi, oco6eHHo 6e3pa6oTHblx HH HaXoA5IIWXCH no, OIIeKoficne9HaMl3HPOBaHHbIX y1pexqeHHA. flpaBHTejIbcTBa He gOJDKHbI nOiuoaBaTbcsHICK5UIeICHIIO BKJIagbIBaTh 6OJIbimHe cpe,cTBa B MaCCOBOe TeCTHpOBaHHeHaCeIeHHfI (HOJIb3a OT Koroporo 6y,Aer Mana rio cpaBHeHIHO c 3aTpaTaMH HKoTopoe MowKeT cTaTm Ws KOrO-HH6yzb HSTHOM n03opa) H .neqeHHeaHpeiptTpOBHpyCHbIMI ripeniapaTamEi A0 TeX nOp, HOKa He 6yTyr TOjtHbIMo6pa3oM BHeApeHbI IIpOTOKOBbI JIeqCHHA, CiHCTeMbI MOHHITOpHHHra H ageKBaTHbICnpocHicfaKrHmecKHe Mepbi.

4) YAoBaeTBopFnreabHaz peanmuH3H cTpaTermH DOTS. Bce IIpaBHTejIbcTBaIOJDKHbI HaripaBHTh yCH3H Ha paCumTHpeHHe MacmTa6oB peaIH3au4Hnxporpammbi DOTS B CBOHX CTpaHaX, B TOM qHCJIe B TnopbMax, H Ha gOCTmKeHHeyAOBJIeTBOpHTreTbHbIX pe3yjJbTaTOB. rIpaBHirejIbcTBa Ka3axcTaHa H KblprbI3cTaHaAOJxlHbI OThioxHT npiHMeHeHHe npOTHBoTy6epKyjie3Hbix riperiapaTOB BTOPOFOpsga go Tex nop, rioKa He 6yAyT riojiyqeHbi yzoBi¶eTBopiTemIbHbIe pe3y.bTaTbI OTBHegxpeHH cCpaTerHH DOTS H i-ioKa He 6y,yT rIojyqeHbl gaHHbIe o peaAH3aTnporpamm DOTS Plus B iHHAOTHbIX paAOHaX.

BceMupHoMy 6aHiKy U apyzuM 3auHmepecoeaHHbIM cmopoHaM1) PerHoHa.iBHie ceMxmapm. CTpaHoBbie pa3,e,,mi no BfI4/CrIHHy H

Ty6epKy.ne3y, a TaioKe HccjiegoBaHH5 no BWI/CrIMAy H ry6epIyAe3y BLeHTpajIbHog A3mH jgomicibi 6brrb Ipe,cTaB.ieHbl H- o6cyAeHbI HaperHOHanJbHbIX cemHHapax c yqaciTHeM 3aEHTepecOBaHHbIX CrOpOH, BKAlJOqaSInpe,grCTaBHTeJrfi periOHM1bHbIX fIpaBHTejTCTBx H OpraHH43aLlM-napTHepOB.

2) KOHcyaThTaL BHH,B3aHMoAeACThHe H yqacTme 3aHHTepecoBaHHhXCTOpOH. Heo6xo,HMo yny4inHTm CoriiaCOBaHHOCTh geiCTBHf BCex3aHHTepecOBaHHbIx CTOpOH, y'qaCTByIOIfIX B 60pb6e B BII{/CHPJoM, I4rIHIH1 HTy6epKyjie3oM B LleHTpajIbHof4 A3HH. I1OMMMO npe)viaraembix perHOHanbHbIXCeMHHapOB, BaHK H i-pyrme 3ai4HTepeCOBaHHbe CTOpOHbI AROJDKHbI OKa3aTb

cogekcTBme perHOHaJIbHbIM iipaBHTeJIbCTBaM B npOBeAeHHi gpyrHxKOHCyjibTaILHOHHbIX H KOOp,HHaJl-HOHHbIX MepOHpIHHTH, B KOTOpbIX rIpTMYryqacHe BCe 3aHrHepeCOBaHHbie CTOpOHbI H KOTopbIe 6ygyr cnoco6cTBoBaTmco3,gaHHIOrIojLTHmeCKoro H CoIH4aJIbHoro KOHCeHcyca, o6ecrie4HBaiomeroCKopeiIIiee ripHHATHe 3c4eKTHBHbIX cTpaTerHfi HipocHJIaKTHKH H 60pb6bI cBHI/CrIMoM, mIHrFn H Ty6epiyAIe3oM B LeHTpaJIbHOfi A3HH. CoBepiueHHooqeBHAHO, Trro Aim 60pb6bI C ABOiHOf 3nrieMHeCfi BWI/CrI1a H Ty6epKyjie3arioTpe6yeTC3i MHoroOTpaCIieBOn rOiXoxo. HTo6bI ipHBjeIqb BHHMaHHe3aHHTepeCOBaHHbIX CTOpOH B FpyrHX ceKTopax HyAHa IaIHupoKa$ cTpaTermAB3aHMoAeWcTBHs. OHIHHM H3 ripersTCTBHfl JIi MHOrOCeKToOpaVbHOrOCOpyHH-eCrBa ABJIeCST CTHrMa, KOTOpaAS BHO ripHCyrCTByeT B Cy6-perHoHe.CpegH KmIoi0eBbIX oTpaciefi - 3.paBooxpaHeHie, o6pa3oBaHHe, apMH4,rieHHTeHapHbIe yqpexeH H pbIHOK TpyAa. Bce OHH 6bIH ycrieIHO3aA,efCTBOBaHbI B rporpammax npoIaKTHKH BIH/CHIa H Ty6epKyJIe3a B

B"q/cnmg, I TYSEPKY.JE3 B L1EHTPAJ1bHOri A3wm 15

Apyrnx perHoHax, H cyiijecrByeT ,OcTaTOqHO OCHOBaHHf ZIA npHHHTAaHaJIo0HxIHbIX UIOAXO;0B B [JeHTpaAIbHOf Ami-.

3) HapauHBaHze InoreHixHaa. B qacTHOCTH, B cy6-peMOHe ecTbHeo6xo,HMOCTh B TeXHHqeCKoM o6y4eHHH. K rpHMepy, nOgrOTOBKaia6opaHToB, qTo6bI OH1 MOrTIH iymIIIie oripege.1Tb MJ-Ty6epKyAe3; o6yqeHHe

BpaMefh riepBEqHOrO 3BeHa TOMY, KaK pacII03HaBaTh, lIeqH4Tb 14 ,aBaTbcooTBeTCTByiouee HarIpa3JIeHHe Ty6epKy.ie3HbIM 60o.bHbIM; o6yqeHHeMeg,HLMHHCKI1X pa6oTHHKOB goCTo0HoMy o6paMeHHIo C JI1OAbM4, XUHBYII;HMI CBWIt/CrIH4OM, B COOTBeTCTBIIE C ripaBami 4eJIOBeKa; o6y"eHmenpenoOgaBaTeIiegi H y"HTCreiie TOMy, KaK paccKa3aTa o6 onaCHOcTH BIP-I; Ho6yqeHH4e Me,gcecTep IIpoBe,geHHI0 ,iKT cpe,H BbICOKO-yS33BHMbIX rpynn.06y"eHHe HOBbIM MeToqaM npOBepKH (CKpHHHHra) Ha BMW Heo6xo,HMoIIpOBeCTH B 6y,tyigeM, Kor1a 3TH TexHooiorHH 6ygyr pa3pa6oTaHbI H BHegpeHbI.

4) TexHIrneccoe coAeAcTBHe HI KpeAHToBaHHe. B pamKax npIOBOAHMOI Bccpepe 3gpaBooxpaHeHI pa6oTbi 14 4IHHaHcHpyeMblX BaHKOM rpOeKTOB Bcc)epe 3gpaBooxpaHeHi H gpyrHx o6nacTix, BaHK 6y,reT npogoAnKaTmcogefrcTBOBaTh perOHaHibHbIM npaBHTTehbCTBaM B npHHSHTHE Hy0oBReTBopwTenIbHog peaH3aiLHH CTpaTermgi 60pb6bI c B3H/CrIfHOM, urinrH Ty6epKyne3oM. B Ka3axcTaHe cJIegyeT ipOBeCTH npexiaraeMbIil alHJM3riporpamm no BlIHI/CrIMy H4 Ty6epKyne3y.6 B KbiprbI3cTaHe BaHK go.TDKeH

ripo,orncT pa6ory B ceKTope H Coge2cTBOBaTh peaJM3aqmm rlpoeicra`3gpaBooxpaHeHHe II", a TaioKe paccMoTpeTb B03MOKHOCTh rOgrOTOBKHnpoeKTa no BW{q/CrlHAy, CPl4HaHCHIpOBaH4e KOTOpOrO npegnOnaraeTCA 3a cqeTrpaHra MeVyHapogHoro areHTcTBa pa3BHnTHS (MAP). B Ta,g>KHCTaHenpe,qBapeiTeJmHasI pa6oTa no roAroTOBKe npoeKTa WH KOMnOHeHTa noBHN/CrHlAy, TaioKe 3a cT4eT rpaHTa MAP, yAKe Haqaiiacb H gomnxua 6biTbnpogoJDKeHa BO B3aHMoefliCTBmH c peajr1a3aqHeA rpaHTa r1'CTM. BTypKMeHHCTaHe BaHK gojDKeH npogornxcaT ciiegHTb 3a ,HHaMHKOAnoTpe6jieHHI HaPKOTHKOB, BHE/CrIIa, HIrIrH HI HTy6epKyne3a, a TaIoKepa3BHBaTh pe3yAbTaTbI pa6oTbI, HpOBOAlHMOf npaBH4TeJIbCTBOM, TeMaTHqecKorirpynnoi OOH H opraHH3asiMH-napTHepaMH no npoclaxma Ke Hi 60pb6e c3THM14 3a6ojieBaHHAMH. B Y36eKHcTaHe BaHK gojDKeH npogoJxcaTbco,eficTBoBaTh npaBiTe.eIbCTBy B riogrOTOBKe H4 peaniaLAM MeponpHufi noBHI/CrI44y, qHHaHCHpyeMbIx 3a cqeT rpaHTa MAP, Hi npoaojixaTmnopA,epXUBaTb meponpHawm no 60pb6e c Ty6epKyAe3oM B CTpaHe. 7

PeKoMeH8a%uu no 8anbHeOwuM uccaneOo6aHuwM1) B"/CIIIIX BaHK rOTOBHT K ny6.iHKauHH HccuiegoBaHe no BMI/CLI/ Hy B

LUeHTpanbHoi A3HH, rseIbo KOTOPOrO ABJBieTcT onpegenieHne cTpaTerHfl,o6ecnexMBaioii;Hx npoBegeHHe paHHHX H4 3 elCKrHBHbIX BMeiaTeCJIBCTB gm60pb6bI C 3nHgeeMHel Ha rocygapCrBeHHOM 4 perHOHaIbHOM yHpoye. YCHJIH54 OCHOBaHbI Ha MHpOBOAq OKa3aTejibHOA npaKTHKe, H B HHX HI4HHHMalOTy'acTEHe MecTHLIe napTHepbi. HIccjiegoBaHie TaioKe HMeCT i-eIb cnoco6CTBOBaTb

6. BceMHipHbIfi BaHK (npoeKTo oKymeHTa B CTrarixr paccMoTpeHHI5). KOHIIenTya1IbHbIe 3aMeTKHIESW no cTpaxoBaHnio, BWI/CIflIMy i4 ry6epKyne3y [The World Bank (draft under review). ESWConcept Note on Insurance, HIV/AIDS and TB Sector Work. Washington DC: The World BankECSHD].

7. BcemipHbiAfi BaHK (npoeKT goKyMeHTa B cTagzi-i noA1OTOBK4). KoHiAeriaiH npoeKTa [TheWorld Bank (draft under preparation). Project Concept Document. Washington DC: The WorldBank. ECSHD].

16 PArOLMomA gOKnAg BCEMWPHOrO SAHKA

rIomnEIrEecKoMy ganory BaHKa H onepaTHBHbIM HCCiiegOBaHHM no 6opb6e CBWI/CrIHJOM B UeHTpaAbHHOM A3HH, nIogepXHBa2 rnpH 3TOM permOHaJlbHoenapTHepCTBo MeXy lIpaBHiTejIbcTBaMHi, rpawAaHCKIM o6a4ecmoim, areHTcTBaMHiOOH H MHoroCTopOHHHMII II gByXCTOpOHHHMH areHTCTBaMH B geienpouHnaKTicKH BH{/CHHI,Aa, IUrIrI Ty6epKyne3a. B pamKaX 3TOIA pa6oTbI6bInH nIpOBe,eHbl cjieyioie KOHKPeTHbI HCCJIe,1OBaHHs:

(i) OgeHwa IIOTeHIJHa;mHOrO 3mnHAeeMnoAorHqecKorO H

3KOHOMHqeCKOiO BroIBlHNHHE .IHeMH BHI/CHH.a BIleHTpahiHoA AmImI. Hccine,oBaHne COgCpxHT olueHKy B03MOxCHOrO3Hii4eMHojiorHqecKoro H 3KOHOMHX.ecKorO Bo3,eiCTBH 3mHgeMmBWI/CrI4,Da B UeHTpabHOfi A3HH. BOJbIITIHCTBO 3aHHTepecOBaHHbICrOpOH coriiacMHAcb, rro yIacTme BaHKa npHgacT 60obMYIO LAeHHOCTbHaKorLIIeHHbIM 3HaHHHM IIHI nOMOUJH TaKoro MOAeJIIHpOBaHHH 3HigeMHH.B 3TOM MogeniH pa3pa6oTaH psg B03MOXMHbIX CLeHapHeB, 'TO IIOMO)KeTIpIH o6cy,geH4n c 3aCHTepeCOaHHbIM4 CTOpOHaMH rioTeHIAHa1ibHoro

B03gefCTB 3ni,24eMHH. 3To rocJyTr gOCTiDKeHHio riomnm'ecKoro HCOIUanJbHOrO KOHCeHCyCa ,IS npHHEr5 cKopeAmHXiX H. 3JeKTIFBHbIx mep60pb6bI c 3apoqaioweAcq 3riHeMIeHeA B cy6-perHoHe.

(ii) BuLBwiIeHHe ynyxgeHH]fi B cTpaTerEH, noIHTmKe H3aKoHo,aTe.cTBe, HapaBHeHHX Ha 6opb6y c anHzeMmek. 3rTo

CCJInegOBaHEHe ripogojDraeT aHanI3, co,gepwaau ICs B CTpaHOBbIXpa3,eiiax H, HaCKOJIbKO B03MOXCHO, onpe,geJi5eT Heo6XogHMbIfi o6feMc)HHaHCHpoBaHH. B HeM ,aHbI peKoMeH,aUiHH o BEIpa6oTKe,aJIbHe$IIIefi rIO.IHTmK, ripH 3TOM oco6oe BHHMaHH4e yeiieHO TiopeMHOMYHacezeHHio.

(iii) OlpezAeaIeHme KIViOqeBbIX 3aHTepeCOBaHHx CTOpOH. BHCCJIeAOBaHHH oipejeJieHbi KEtOiBbIe 3aHHTpecOBaHHbie CTOPOHbI H HXpOIb B 60pb6e C 3mHgeMHefi; ripexiownHbI ny yKpenJeHHA rapTHepcTBa

H noBbIImIeHH5 rIyBcTBa oTBeTcTBeHHOcTH 3a cTpaTerin no BHH/CrIMAy.(iv) OJgeHxa HHcTHTHyoiUHaahHMX Bo3MomKHocTwk. B paMKax

HCCJIeAoBaHH HqaHa OLeHKa IHCTITyIHOHaubHbix B03MOMKHOCTef

rocyg apcBeHHbIXcnya6 3,gpaBooxpaHeHHAI HcooTBercTByIonx HrII RAz60pb6bI c 3iHgemiI4eft. HccjiegOBaH-e AOHOJIHeHO yrny6JIeHHbIm alHaJI3OMnporpamm no BHL{/CrHlAy i Ty6epKyjie3y B Ka3axcTaHe.

(v) IIo,roToBsa iuiaHa yracTHa H B3aHMo,eficTBHE no BH'/CIH y BtIeHTpa.mbHoA A3HH. B rInaHe oripegenieHa cipaTerHa B3aHMozgeftcTBHsIxIvm BaHKa H ApyrHx 3aiHTepecOBaHHbI CTOpOH B OTHOmeHHHBM/CI-Ia B cy6-perHoHe. CTpaTerA B3aHMogeficTBH5 cnoco6crBoBana6bI cO3waHmHo nojiHTHnecKoro H4 coU4JIbHorO KoHceHcyca,rapaHn4pypouero cKopefimee pHHSITHe ripaBHTJeibcTBaMH H ApyrE-MHriiaBHbIMH 3aIHTepecOBaHHbIMI CTOPOHaMH 3(4eCeTHBHbIX crpaTerfnpo4uvlaKTMKH H 6Opb6bI c BH/CIIHAoM.

2) HIccjIeOBaHHe no Ty6epicyAe3y. BaHK peiiiHi npOBeCTH icCcAiOBaHHenpo6AeMbi Ty6epKyjie3a B UeHTpaAIbHOf A3HH BBHAy BaxHOCTH 3ToIi 3nH,geMHHcamofi no ce6e H ee CBS3H c 3nieMHef BHN/CrHHJa. 3,reCb TaioKe oco6oeBHHMaHHC 6y,geT y,xeJieHo HaCeiieHHIO TIOpeM.

3) HapicoMaHIa. HapKoMaHHI3 B IeHTpajIbHOfl A3m CTaia yKOpeHHBaHMCSI

3iBjieHieM. B 2002 ro,gy IoH,g Copoca/4Hcrmyr OT oKpbiToe O6MecrBoony6nHKoBan¶ nonHoMacmTa6Hoe HCcjieTOBaHHe o6 ycimHqx no 6opb6e cHapKOTHKaMHI B AqraHHCTaHe H L]eHTpaAbHOfl A3HI (Jlio6HH H gp., 2002). 3Ty

pa6oTy cuiegyeT np0o,OMMTh B 6ygyneM, MTo6bI cnegHTb 3a TeHReHHqMMH

B"q/cnf 1 TY6EPKYJ1E3 B LEHTPAJ1bHOO A3m 17

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Ty6epKynie3a [Mycobacterium 7Uberculosis] - H4H4)eKIHOHHbIM Bo36ygmTeZeM,cnoco6HbIM rip1BecHT K pa3BHmT14O aKTHBHOrO Ty6epKyjIe3a. B Mi4pe npe,WgnoJIoA-

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19

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3IgeMHg BW{/CIlI44a B CTpaHaX LjeHTpagbHof4 A3HH iioKa HaXo,gTCH Ha CaMOipaHHefi cTa,gi4m B Ka3axcTaHe, KoTopbIA 6o.mbme ,gpyr'x riocTpagan OT 3Toro3a6ojieBaHHJ, xMcJIo cuyqaeB BIxI, no oiAeHKaM, He ipeBbIiiaeT 4000. AO HegaBHeroBpeMeHEH B KbIprbI3CKofi Pecny6nEiKe, TagK>mcTaHe, ypKmeHHrcaHe H Y36eiKcTarHecryqaH BW-{ 6bum e,HHHxmbIM4. OQHaKo K KoHiLy 2002 ro,ia B nHri pecry6nmKax6bUIO 3aperHCTpHpOBaHO HOqTH 6000 BHM-HHL)HUpOBaHHbMI DiaBHbIM HOBO0OM Amcepbe3HOEi o3a6oqeHHocTH cRyKaT MapmpyrbI HapKoToproBaH, npoxoliiwe Tepe34eHTpajbHyio A3mo. OH4 cnoco6cTByEoT pocTiy iH beKLH0HHoro rnoTpe6nieHHAHaPKOTEIKOB B cy6-perHoHe; coriiacHo 3KcnepTHbIM oieHKaM, B peruoHe MoX(eTHaC'qHTbIBaTbC3I CBbIIIIe OInYMHJUI-OHa HioTpe6HTejiei HapKoT4KoB, H BCrIbIIIIKHCBSI3aHHOA c BEUM HHbeKgHOHHOfi HapKOMaHHH 3apermcpHPOBaHbI B Ka3axcTaHe,KbIprbI3CKOfl Peciy6jIKe, Y36eKHcraHe H Ta,gKH4cTaHe. B aTOM cy6-periioHe,6e3yCJIoBHo, cyuecTByeT pHCK pacnpocTpaHeHHsI 3nHAeMHH BIIx/CrIHAla B CHJIyPHCKOBaHHOrO noBegeHH4A noTpe6HTeieg HH1beKLXIHOHHbIX HapKOTHKOB (HIUH), a TaioKeH3-3a pocra xmcna UrIrIrI, PKC, MHipaLiEi H gpyrix q)aKTopOB pHcKa. B HacroqmeeBpeMA 3riHgeMHA cocpe,goToqeHa cpe,H rIHH H PKC, O,AHaKo OHa Mo)KeT pacnpocTpa-HHTbCSI (cKopee Bcero, TaK H rpOH309geT) Ha y3I3BHMbIe rpyriIIbI, TaKHe KaK MOJIOJexcb,Mo6HnbHoe HacenieHie H nOJIOBbIX iapTHepo npeIcTaBirTeiefl rpynri BbIcoKorop14CKa.

rJnABA 2

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21

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II 92 cHiyqaA Ha 100 Tmic. HaceJIeHHA B 15 cTpaHax 6bIBmero CoBeTcKoro COIo3a.

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Ho gaHHbIM CrHI UeHTpa,B 2002 rogy xmcno MCM ripegrlo0jox0KTeAbHoCOCTaBnBSLo oKoiono 20 Ticqxi. KpoMe Toro, ripHMepHO OT 20 go 50 TbIC3m 2KeHrUJH3aHHM2AHCb KoMMepeCCKHM CeKCOM; H3 HHX oKonio 30 HpOUiHTOB TaloKe rioTpe6mmiAHH'beKLJOHHbIe HapnK0THKH -B o6MeH Ha ceKc, H 1IpHMepHO 1 npoieHT MOKeT 6bITb

36 PASO4MA OKnAg BCEMWPHOrO SAHKA

3apa,KeH BUl. 3inHeMHfl B1/H/CrIHAa ocjioxumeTCq paCIIpOCTpaHeHHeM H IIJIOXHMneemeHErem iHHeKumfi, nepegaiouAHxcs rOJIOBbIM nyreM (rIHIrl), cpe,H 3THx rpyrn iE,CJIe,llOBaTeJIbHO, cpegH iniiipoKorO HaceIieHH5. Komnmecmo 6oRbHbIx CHcHJHCoMB03pOCJIO C MeHee 10 Ha 100000 HaceIieHH3 B 1986-1993 roAaxgo 270/100000 B 1997rojy, 3aTeM B 2000 rogy nocTeiieHHO CHH3HJOCb jo 160/100 Tbic. (UNAIDS 2002).CornacHo oT'eTaM UNICEF (2002 r.), B 2000 rogy 6buxo BbHBneCHO 320 cziyqaeB UHHHHa 100000 HaCejieHHS4 (CHcIwIHC H roHope3i), -TO ABnIeTCSi CaMbIM BbICOKHM fIOKa3a-TeJIeM B cTpaHax ELtA, H npe,gc'ra eT co6o0 6o0ee qeM 200-rIpoleHTHbIfi pOCT3a6ojieBaeMocTH CHfqH1HCoM c 1990 roia (Carinfonet 2000). CorilacHo O4)HLHaJIbHbIM,gaHHbIM, B 2000 rogy c JiHimc 6bur BbiaBeH y 1 npolueHTa AOHOpOB KPOBH, y 1ripoileHTa 6epeMeHHbIx wKeHIIHH H y 2 rIpoLieHTOB 60JIbHHqHbIX naiWeHToB; B 2001rogay cH4)H.Ic 6buI o6HapyweH y 5 IIpOiLeHTOB 3aKioqeHHbIX B Kamepax i1pegBapH-TeJIbHOrO 3aKioqeHHA. Ho gaHHbIM KOKHO-BeHeponorHqecKHX AHcnaHcepoB, 75rpoiLeHTOB PKC crpagaeT KaK MHHHMyM O,HHM 3a6oneBaHHeM, nepegaioMHMc31rojioBbIM nyTeM. B 1999 rogy 6o0ee 19000 naIHeHToB c paHHefi cTagHeti cHC)HAca6bLDm roCnHTaA13HpoBaHbI, TO CCToaBMHo 6onee 400000 KoAKo-gHefi. rpoiLeHTmnogeft, riOceTHBIIIx I T MeTmHIUHHcKHe yqpexqeH HA HO nIoBO,y 3apa)KeHH cHHH-

IH4COM, cocTaBHA MeHee 30%, rioCKoJIbKy 60nbIImHHCTBO MoKeT .ietmrbcs 6e3 rocnH-TaJIH3aiAHi, XOTH 3aTpaTmI Ha TaKoe iemeHHe BbICOKH. TeM He MeHee, rocniiTajiH3aTLHsno nOBO)ly cHcEHIHca 3KOHoMHqecKHU He344eKTHBHa H He HYXKHa npfl CyleCTBOBaHHH

6o0ee COBpeMCHHbIX MeTO,gOB IieqeHHEi.11peABaprTeJIbHbIe pe3yJIbTaTbI 03OPHoro 3nHAHag3opa (gaHHble co6paHbI ,epe3

CHCTeMy JIKT) B OT,creJbHbiX rpyrinax HaCeJIeHHs noKa3bIBaiOT, TO paCnpOCTpaHeH-HOCTb BUM B KaparaH,ge cocTaBimeT oKono 5 nppOUeHTOB, B r. YpaAbcKe - 2 ipoieiHTa HB AjiMaTI - 0,3 npoiueHTa. O,IHO HCcAe,AOBaHme noKa3ano, xITO B KOHlet 2001 roga 0,5npoiLeHTa PKC 6bLiH BHI-1HHcPHIHPOBaHHbIMH (H3 4000 PKC, npomIe,giHxCKPHHHHr), OIAHaKO PeCny6nHKaHCKHA CnHI IeHTp coo6iiaeT, rTO HH)HIUMpOBaH KaKMHHHMYM 1 npoiUeHT PKC. O,HaKo aTH gaHHbIe OTXpairT pacnpocrpaHeHHOCTbcpe,AH rpynn BbICOKOrO pHcKa, a He Cpe,gH HaceiieHH5i.

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KOHTaKTbI, He HOJIb3y3SCb ripe3epBaTHBOM; perynipHoe RCHIOtb3OBaHHIe npe3epBaTHBOB

He npeBbiruaeT 20 ipoieHTOB. 3To coriiacyercsi C npegocCaBMeHHbIM H caMimHoiponieHHbIMH AaHHbIMH 0 TOM, Crpa,;aJIH JH OHH Korga-mi6o MrIHr (20 ripoUeHToB).Ho nOnyqeHHbiM ,gaHHbIM, 6onee rIO.IOBHHbI PKC He nOJIb3yioTcI npe3epBaTi BaMH He3HaIOT O gpyrHx crioco6ax npocHAaKTicKi BUM. Onpoc, npOBegeHHbLf B AnMaThI,noKa3ani, qTo 80 ripoUeHTOB MCM He HCIIOJIb3yioT npe3epBaT4Bbi, 25 npoIeHToBHImeoT UHHH, 10 iipOLeHTOB ynoTpe6jmioT HHbeKUHoHHbIe HapKoTHKH H TOnbKo 30npoixeHToB HMieoT ,IAOCTaTo'HbIe 3HaHHR o cnoco6ax nepegaM14 BUMLI. HoIzo6HoePHCKOBaHHoe nOBegeHHe o6ecrie'IHBaeT pacipocTpaHeHHe BUMQ OT IHUH/PKC HamIHpOKme CjiOH HaceiieHHR, eCJHl He HpHHSITb 344oeKrHBHbIX mep ,L.I CHHMKeHHA TaKHX

pHCKOB.

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BM4/CrIMAH TYEEPKYnE3 B LAEHTPAnbHOA A3wm 37

HMeoT IIHHH. CoriacHo OT TeTy o geMorpacmH H 390pOBbe Ka3axcTaHa, 17% IOHOmefiH 33% geBymeK B BO3pacTe 15-19 JIeT He 3HaIOT O TOM, Kax ripe,OTBpaTHTh npegaaMyBM-HH)eKiei4HH, a 27% MyoKtHH H 65% )KeHII;4H He HIOJTb3yioTTCSI Hpe3pBaTHBaM4 BO

BpeM5 rlOJIOBBoro KOHTaKTa C HeIOCTOSHHbIMH4 napTHepaMH.L AaHHbIe UNICEFnogrBepqaioT, YTo 74% MOJIO,ZbIX nmojgef B BO3pacTe 15-29 fieT H 46% MOJIOJgbIX)KeHII;HH TOA) )Ke BO3paCTHOfl rpyIInhI OCBegOMjieHbI O rp3epBaTmax KaK O cpejgCBenpo4wiaKTiiKmi BIP-, H 54% Ka3axcTaHueB B BO3pacTe 15-49 .eT 1H3 6eAHefImix cjioeB

o6iecmTBa 3HalOT O HeO6xOAHMOcTh HCIIO.Ib3oBaHHI npe3epBaTHBOB giS 3aITb I OT3apaKeHHa BEHT. B 1999 rogy 17,5% MOJIOAbIX MY>KYHH B BO3pacTe 15-24 1ieT OTBeTnHJI,YTO y HUX HeCKOJhKO napTHepOB, B TO BpCMSA KaK 30% MypC'IHH H 16% KeCHMHH B

Bo3pacTe 15-59 nieT cKa3aA ,YTO HMeJIH IlOJIOBbIe KOHTaKThI co cJyrafiHBMH1napTHepaMH; 58% My1C4HH H 19% KHeHHH B BO3pacTe 15-59 iieT OTBeTMJH,qTO

HCHOJnb3yIOT ripe3epBaTHBbI. (UNICEF 2002).HaceIieHHe TiopeM BbI3bIBaeT oco6yo O3a6o-eHHOCTh KaK Y313BHMaq rpynna, rge

npicyrcTByeT MHOoKeCTBO q4aKTOpOB pHcKa 3apa)KeHHi4 BUM H oTKyga HH43HLHpO-BaHHbIe nonaga1OT B o6nyio macCy HaceiieHSI(Ta6nmnia 9). B 2001 rogy 3aKljoqeHHbiecocTaBnLH 25% 3apermCTpHpOBaHHbIX ciyaeB BWI/CrI4a, xqTo rOBOPHT o6 YPOBHe

3a6ohieBaeMocTH BW14/CrHHJOM B TOpbMaX B 0,5 npolneHTOB, MTO HecKOJIbKO Bbime,HeM OcJ)HuHaJbHbIe gaHHbIe. ro OUeHKaM MHHHCTepCTBa IOCTHLIHH, 3a6oJIeBaeMOCTb

BHM cpex4 rILH B TpbMaX cocTaBjneT 3% (CKPHHHHrnpouuiii 11117 xe,1oBeK).

rIpHMepHO 30% 3aKJUoqeHHbIX IpHHiMaIOT HH'beKIHOHHbIe HapKOTHKH, H HapKOTHKHnpogojnKaioT ocTaBaThC5L BrIOJIHe OCTYHbIMH B T1OpbMmaX IHCTpyMeHThI NM

HHbeKUHA He CTepHH3YOTc Hm HCnOJIb3yIOTC1 ,gO Tex riop, rioKa He cTaHyTr rOInHOCTbIO

HenpHrOAHbIMH. B HCCJiegOBaHHH, fIpOBegeHHOM B TIOpbMaX, TOJIbKO 4 npouieHTa3aKJo,qeHHbIX ,aaAH npaBHJbHbIg OTBeT Ha BOrIpOCbI 0 nyrix nepezaqH B4H H

cTepHnA3aIUHH HrJI. KpoMe Toro, B HcCAeROBaHHH rOBOp14TCI, 4To 6oflee riOJIOBHHbI

BCeX 3aKJiiOxiCHHbIX BCTHyalOT B rOMOCeKCYaJIbHbIe KOHTaKTbI 6e3 rlpe3epBaTHBa. TaKHMo6pa3oM, cpegH 3aKmioqeHHbIX 3a6ojieBaeMOCTb rFIrIrl BeCbMa 3HaqHTejIbHa. PaHbIue3aKnJoseHHbie nogBepranICb o6313aTejIbHOf nIPOBsepKe Ha BUM, HO 3Ta npaKTrKa 6buIanpeKpanueHa.

BKpaTqe, anH,emHA BxM/CrIa B Ka3axcTaHe B HaCToqrnmee BpeMA HMeeT

cnieAomHe xapaKTepHcTHKH:

T.ope?iMHoe HaceneHme, Y4PemAReHMR m PaCnPOCTPaHeHHOCTb BI4'B Ka3axcTaHe

1990 1995 2000 2001

3aKnlo'eHHbue 64490 65359 58424 67937HocHTenm BM4 0 0 218 446

PacnpocTpaHeHHocTb BM4 (%) 0 0 0,17 0,34

Hombue 3ainbo4ernbie 51018 51613 54211 56785Ocso6oXCAeHHMbe 23895 19354 33222 24544McnpasmTenbHbme Y4peXwAeHMN 54 60 74 75

T.opbMbi, rAe npeAyCMOTpeHO

coAepxcaHle 3aKmO*leHHblX

co CnMAom 4

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14CmOIHUK UH45opMa4uu: MmHMcTepcrso KKcTm4Hm.

38 PABOMWr lOKFlAg BCEMHPHOrO SAHKA

* KoHLieHTpaWua cpe,Al BbICOKO y5S3BHMbIX rpyrin HacenCeHH5 (FI14H, PKC), HO TamKeH 6bIcTpoe pacnpocTpaHeHHre Ha gpyrHe Yq3BHMbIe rpynnbi (3aK7IioqeHHbIe,MO)JOA1eKb, MHrpaHThI, BOAI4TeVIH rpy30BHKOB).

• HaFi6oAee pacipocrpaHeHHbIM cHoco6oM nepe,aaH A¶BJI5eTCSI HIcoIJb3oBaHHe14H¢HcHLpOBaHHbIX IimpiHLeB H i-ri rJI IIHHbeKiCUHOHHOM yIoTpe6neHHH HapKoTHI-KOB. Bepo5rnocTm npoomxKeHim 6bicTporo pacrpocTpaHeHHI cpegiH I14H OCeHbBbICOKa, IIOCKOAIbKy B CTpaHe MO0KeT HaCqHThIBaTbC31 OKOJO 450 TmIcHi noTpe6iH-Te.ieI HH'beKUHOHHbIX HapKOTH4KOB; HX nIOJIOBbIe napTHepbI TaioKe nO,ZBepraioTcsoco6eHHO BbICOKOMY pHICKy.

* reorpacpH'ecKaA KoHLxeHTpau{5. HaH6oniee nocfpagaBIImHMH IIBM[IOTCSI KaparaH-gIHHCKaJI, rIaBnogapcKaq H KycTaHaftcKas o6nacm, a TaioKe ropog7a AMmaTbI H4Ypanbcy. Ho Tenepb BO Bcex o6inac'rx 3aperHcTpHpOBaHbI cny1aH 3apaxceHHS BHI.

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CTpaTerun, nonNTHKa m npaBosaA OCHoBarlpaBirTebcmTBo Pecny6.4K Ka3axcraH npHBepxceHo geniy 60pb6bI c BW1/CrI,oM H Bnocne,zHee peM3i ycKopoII npOBe.AeHHe MeponpH5rg no 6opb6e c BUM. BbLTIAH rpH-HmI HauHoHaRbHaH cTpaTeriiA 60pb6bI c BUM/CHII44oM, pa3pa6oTaHHas ipH nori-gep,KKe UNAIDS, H iwT=eTH5m nporpaMMa. HagoOHaJbHaA cTpaTerH5 rIpaBHTenbcTBa- 3TO TURaTeJIbHO nogroToBBAeHHbIAi gOKyMeHT, yKa3bIBaiomHA Ha Heo6xogHMocThI1OBbIIiiHHS OCBegOMJneHHOCH o6igecTBa H BOBieqeHHA mHpOKHX MaCC HaCeiiCHHH,TaK KaK MHOrm'e, BKjiIOqaq ripe1cTaBrTejieA MeCTHbIX opraHOB BjiaCT4, He OCO3HaIoTMacmTa6oB npo6eMbi. C 1995 ro,ia B CTpaHe cyiiecTByeT MeKBegoMcTBeHHbIf KOOp-JAHaHL4HOHHbIfi KOMHTeT no CrIfHy no,z ripe,qceaTeIbcTBOM 3aMeCTHTe1LS riepeMbep-MIHHHcTpa. rlocnie Bo3o6HoBjieHi ero JgeHTegbHocTH, nepBoe OcpiuianbHoe 3ace,laaH4eKoMHTeTa COCTOSIOCb 11 Hio 2002 ro,za, nocBAWeHHoe Haqany peajuI3aIiHHHaLIOHaJbHOfi CTpaTermH. KpoMe Toro, MHHH4cTepcTBo IOTwHiE HIMHHHCTcpcTBOBHyTpeHHHXgeii pa3pa6aTbiBaIoT CBOH co6cTBeHHbIe oTpacneBbIe riporpaMMbi.

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B"q/Cn1g M TYEEPKYnE3 B LEHTPAM1HoI A3Mm 39

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TaKoe nOJIO)HTfeJIbHoe H3MeHeHHe KaK pe3ynbTaT BHegpeHH5 cTpaTernn DOTS BTiOpeMHOA crCTeMe.

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Ty6epKyne3 B TiOpbmax, Ka3axcTaH (a6conloTHoe 4Mcno u nOKa3aTenbHa 1 00 TbIC.)

1997 1998 1999 2000 2001

lNcno yMepwHx OT ry6epKyne3a 1302 1218 345 175 174CmepTHocmb OT Ty6epKyne3a 880 820 300 140 130PacnpocrpaHeHhocrb 11903 12970 13697 10061 8060HoBble cny4aN ry6epKyne3a 5555 5061 5591 3434 3038

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46 PASOL4 gOK:I1Ag BCEMIPHoro EAHKA

1990 1995 2000 2001

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BVq/Cnlg1 M TYSEPKYJ1E3 B L4EHTPAflbHOI A3mm 47

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IlpaBHTeJIbcTBo 3aKynaeT npeIIapaTbi BToporo pla gVH rIIHJIOTHbIX npOeKTOB C2000 ro,za. OAHaKo ,gni 6bicTporo pacripocTpaHeHHA riporpamm JieteH4IA MJIYTB HeXBaTaeT ,AOJDKHOfi KJHHHiecKofi riO,rOTOBKH, .na6opaTopHoro noTeHLUHana guiaHaJUl3a x1yBCTBHTeJIbHOCTH K nperiapaTam H XopoIuHX pe3yJIbTaTOB peaJIH3atWHHcTaH,TapTHbIx HIPOTOKOJIOB DOTS. nIO3TOMY B03MoKHoe pa3BHTHe yCTOfNlHBOCTH KipenapaTaM BToporo psga BbI3bIBaeT TpeBOry. OAH14M H3 HaH6oAee BaKHbIX BOIIpOCOB

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BI4/CrI 10 H TYrEPKYJ1E3 B LEHTPAnbHOI A3mm 57

rogy DFID H rlpaBHTej.IbcTBo HHgepnaHAOB o6ecneqHIH 80% rioTpe6HOCTH Bnpe3epBaTHBax NIH BbICOKO-yI3BHMbIx rpynn, a HpaBI4TeIbcTBO OmcKog o60nacTHBbigeIHJIo 24000 gojuIJapoB CIIA Ha 3aKynKy npe3epBaTHBoB. PeniirH03Hoe coo6-ImecTBo co3gaeT nperpaAbI B aTof pa6oTe. XOTH peiIHrHO3HbIe iHAepbi o6H13aiH4Cb noz-gepKHBaTm rpaBa penppOAYirBHoro 3AOPOBbS H HpocpiAaKTHKy BWI/CHa, OHHBbICTYIIaOT HIPOTHB o6CyxqeHHR BOripOCOB 6e3aoIaCHoro ceKca H pa3gaH ripe3epBaTH-BOB B IIIKOJIaX. 4)OHg HapogoHace7ieHI4 OOH opraHH3OBaji Kpyrnbir CTOji c yqacTHempeJIHrIO3HbIx iiHgepOB H oxKHgaJI noniy'HT i4X oAo6peHHe 3aKoHa "O penpogyWMB-HblX ripaBax".

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IOCAJ, oKa3bIBaeT noggepAucy MeponpH5{HAM no npoc¢waKCrrKe BW/CrIILa BKbIprbI3CKOfi Pecny6nmKe B KOHTeKCTe peajul3agiH CBoefl CTpaTerMi B 4eHTpaJTbHOfA3HH, KoTopaS npeAycMaTpHBaeT Bb1geeieHHe 2 M I40nEIOHOB ,onmapoB CILA Ha npO-rpaMMbI CHIDKeHH4A Bpega B TeqeHHe 6m.DKafIiniIx ,gByX neT. IOCAIM TaioKe Co,gefCTByeTMepOnpHITHHM, OCyf;CcTBJieMbIM aMCpHiKaHcKmM LeHTpOM 60pb6bI Hi npo(4HAaKTHKH3a6oj1eBaHHA (CDC), BKino-iaSI o6yqeHHe COTpygHHKOB MHHHcTepcTBa 3apaBooxpa-HCHHAS MeTOgaM Jo3OpHoro 3nHriHa930pa. eienapTaMeHT Mew,4yHapoJHoro pa3BHTm(DFID) BbiCeEji nepBoHatIaJIbHo 2 MJIH. zoiui. ClIIA Ha nporpaMMbi CHmKeHXH5 Bpe,rxa HnoggepIcKy peCTpyKTypEH3aLHH cHcTeMbI HCHOJIHeHHH HaKa3aHHE. lmBeiLxapcKoeAreHTCTBO no COTpy,7HwmecTBy npeg7oCTaBHoIO 160 Tbic. IIIBeiuapcKHX qpaHKOB HanporpaMMy HHqopMMHpoBaHHH o6 ynoTpe6JieHHH HapKOTHKOB B OIIcKoE o6nacTH,KOTOpaH paCC'rITaHa Ha cTyAeHTOB H npegycMaTpHBaeT o6y"eHIIe yHTeReA. ArCHTCTBOOTKPbIJIO HHc)opMaLHOHHbIr iUeHTp "Payra", KOTOpbIA noggepAMBaeT 3Ty nporpaMMyB AwanI-A6aAcKoAG H BaTKeHCKOfi o6nacmmix.

,[JOHOpbI H H HIO yKa3biBa1OT Ha HeO6XOmHMOCTb pacmnpeHm nporpamm cHmvKenm-Bpe,ga c TeM, ro6bi oxBaTm 60% HaiH6ojLee YS3BHMb1X rpyrm (H1H, PKC) H o6ecneluTmgoinocpotnHyio ycmOwnmocm MeponpHHIA no npo4ivaKxrHKe H neiqeHimo BIH/CflI4AaB KbIprbI3CKOA Pecny6inme; npeAocTaBJH HH4JopMaiwio H4 o6y'eHRe no BW{/CIHIHAyTeM, KTo 6poci mIKoly; pemax npo6neMy cHmMbi; npeKpamaq yrOAoBHoe npeciie,oBaHie3a ynroTpe6neHne HapKoTmKoB; yMeHbmaIi nepeHaceJIeHHe TopeM; H rloNIepKHBaApacampei-le 3aMeCraTejnbHofl Teparni C IcnoJTb3oBaHI4eM MeTagoHa AJs ILMH.

OPuHaHcuposaHueB 2000 roAy B KbiprbI3CKOA Pecny6nHKe Ha 3gpaBooxpaHeHHH 6buIO BbIAejieHO 1,8%BBHI (12% rocygapcTBeHHbIx paCxoAoB), qTO cocTaBJuxeT MeHee 7 AOhaPOB Ha AyrnyHaceiieHHA. rIpaBHTeCJbcTBo coo6nxwro, TrrO B 2001 rogy BbqenMO OKOJIO 1 MHJInHOHaAO.TJaPOB CIIIA Ha peaJIH3aiAHio BTopofI iiporpaMMbi no BE IH/ClIMy, OzHaKO B paMKaX

58 PAro04MlI AOKJ1AA BCEMWPHOrO BAHKA

nepBoi iiporpamMMbI no BHI/CrIHy 6buio noiyreHo nInIIb 18% OT 3aruiaHIPOBaHHorocEHHaHC11poBaHHA, nO3TOMY ciie,yeT o6paTErrb BHHMmaHHe Ha ocBoeHHC Cpe,gCTB BpamKax BTOpof nporpaMMbI. (P1HaHCHPOBaHHe COBMeCTHOI riPOrPaMMbI FIPOOH H

UNAIDS cocTaBluo 250 TbIC. gojIapoB CIIIA rIporpaMMbI cHECeHHA BpeganOAz;ePXU1BaioTCS areHTCTBaMH OOH, cDOH,OM Copoca/IHciuTyroM OTKpbrToroO6MecrBa HI MeCTHbIMH BwiaCTniM ropoga OmI. rDo6aAbHblf (D)oH 60pb6bI co CrlIOM,Ty6epKyjie3oM H MaJipHiefi (oDCIM) ojgo6pHn BbVeJIeHHe rpaHTa B pa3mepe 5 MnH.,AOuJi. CIMIA Ha 60pb6y c B1I4/CrIHAoM 113 CyMMbI 17 MHiLIHOHOB ,ojnapoB, Ha

KoTopypo nIpaBrreJIbcTBo nogaBano 3aqBKY, HO,ZrOTOBieHHYO ripH COgefiCTBmH UNAIDS.3'To gornoinmir oAcHgaeMoe q)cHaHCH4POBaHHe 113 rocygapcrBeiHHbix H ,gpyrHxHrCTOqHHKOB (Bpa3mepe iipHMepHo 5 MHUOHOB oJIJapoB CIIA) Ha 2003-2007 ro,bI.

Ty6epKyne3: 3nHAemmonOrm'ieCKaR CmTrya4HmrIo pacnpocTpaHeHHOCTm Ty6epKyjie3a KbiprbI3CTaH 3aHMmaeT B'ropoe mecTo cpe,LteHTpaJIbHoa3HaTCKHX pecny6nnHK B Haqajie 1990-X rO,iOB 30-.neTH3vA TeH,reHUHq1 KCHi-DKeHHO 3a6oneBaeMocTH Ty6epKyAe3oM B KbIprII3CKof Pecn6n.Kiiie H3MIeH11iaCb BrIpOT11BOHOJIOXKHylO CTOpOHY, KaK H B gpyrHx crpaHax 6blBmero COBeTcKoro CoIo3a

(ra6Hiinia 16). C 1990 no 1999 rogbi excero,iHasi 3a6ojxeBaeMoCTm B KbpruI3CKofi

Pecny6JnKeyBCJIHMHnaCbC 53 cniyqaeB Ha 100 TmICV HaceiieHHs Ao 132 CIyqaeB Ha 100

TbICSN. E,KerojgHo BO3HHKaeT 6o0iee 6000 HOBbIX CA"*aeB Ty6epKyjIe3a, H 7000cTaHoB5TCSA XpoHiimecKuMm rIoKa3aTejm XPOHHMecKHx cTryaeB 10 Ha 10 OTIc.crqnTaeTcA KpHTH1ecKHM no cTaH,apTaM B03. B 1996 rO,AY B qemxpex paAoHax ,BXByXo6nacTei cTpaHbi 6bma HaqaTa peaJ43a1A nporpaMMbi DOTS. B CBeTe o6Ha,eAw-Ba1oUJX pe3yJIbTaTOB 14CrIOJIb3OBaHI HOBbIX nOUXO,10OB B jieqeHH HOBbIX ciiyqaeB

Ty6epKyjie3a (ypoBeHb ycneIIIHoro Hcxo,a nieqeHnuA rpynnbi naLHeHToB B 1996 ro,gyCOCTaBHJ 88%, a BbNBSJIeMoCTh 6bIna Ha 14% BbIIne, t.eM B gpyrEx pagioHax cTpaHbI), B

1998 roAy DOTS 6bIna BHe,IpeHa no Bcefi cTpaHe. 3To pacmrpeiHEe r1POHI30IIO B

pamKax nporpammbI pecpopMbi 3.1paBooxpaHeHi, peaH3yemo MHHHcTepcTBoM3,gpaBooxpaHeHH5 KbIprbI3CKOl Pecny6m4nam rpH no,gepxKe Kpe,HTa BceMnpHoro6aHKa. Boniee OHOfi TpeTH 6ioxKera rio KOMrIOHeHTy eepBHqHO, megHKo-CaHHTapHOf

noMOIIm 6bIio BbI,AejieHO Ha o6yqeHHe, g1arHHOCThKy H ieqeHi{e Ty6epKynIe3a.BHe,ApeHH-e crpaTeruH DOTS ,AelcrBniTeJIbHO pHBeO K HMemeieHHOMY yiyPImeHIIIO

3nHgeeMHoIorniqecKoAi CHTyaIUH B KbIprbI3CKofi Pecry6niKe. OTqaCM B pe3yJIbTraT

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Ty6epKmyne3 B Kbiprbl3cKoH Pecny6nuKe (Ha I 00 TbIC. rpaw.AaHCKoroHaceneHufl)

1990 1995 2000 2001

CMepTHocmb OT Ty6epKyneaa 7,2 13,4 12,6 13,5PacnpocTpaHeHHocrb Ty6epKynesa 228,5 246,1 363,8 313% HOSblX *bbsneHHbiX cnyHaes

6aqiunnosbuAenuTeneA (bK+) 31 25 22 24

BbrABneHNe cny4aeB TS 2306 3266 5953 6274noKa3aTenb ablAsneHHN TS 53 72,4 121,8 127,3- cpeAu MyYCKHH 59,3 90,1 145,3 146,9

- cpeAn NCeHU4HH 44,9 55,1 97,9 107,2- cpeAN AeTei 20,2 28,3 57,5 77

MCmo.nUK: MHCTNT)r Ty6epKyjle3a.

BMH/Cnfg 1 TYbEPKYJlE3 B LEHTPAI1bHOA A3mm 59

ipogojDKajni pacm g,Zo 1999 ro,za. B 2000 rogy, BnepBbie c 1993 roAa, KOjIWqecTBoBbI5BIeMbiX cnyqaeB yMeHbIIIOCb. Ho noKa eue CJWHIUIKOM paHO Cy,HTm 0 TOM,y,aaOCb 1I14 nOBepHyrb 3flH,eMHO BCnRTb.

B KOHi-e 2001 ro,ga cHcio naiiieHTOB C aKTHBHOM cIOpMOn Ty6epKyjie3acocTaBJiso 15420 - 6onee xeM Ha 50-npoIieHTHoe yBeimiieeHi-e rio CpaBHeHHIO c 1990ro,oM. B nepHog c 1990 no 2001 rOgbI BbLIBjieHHe yBejn-HqaCb fIOMTH B 3 pa3a, aypoBeHb cMepTHocTH BbIpOC no,im B,ABOe. XOTH BbIbeiCHeC Ty6epKyne3a, COCTaBjsIIo-igee 127/100 ThIC. HaceIieHH5, SBJMIeTCq BTOPbIM nIO BeniHqHHe B EBponeficKoM perHoHeB03, BKiiOqalOIuwM Cpe,H1o1o A3io, io oLueHKaM rjio6aRbHogi rporpaMMbI Hag3opa 3a6Opb6oEI c Ty6epKyAe3oM B03, B 2000 ro,gy 6bLiO 3aperHCTPHPOBaHO JIIrIIlb 82% BcexHOBbIX c.iyqaeB Ty6epKy"e3a OQAHaKo c 1999 rogZa fpOH3OaIWO 3aMe,veHHe pocTa

narieMmi Ty6epKynIe3a Ha 5% B ro,r no cpaBHeHHIO C 17% B nlepHo, c 1995 no 1998rotb1. rIoKa3aTenIb cMepTHocTH OT Ty6epKyjie3a HeCKOJIbKO CHH3HACSI: c 16 Ha 100 ThIC. B1997 rogny zAo 12.6 B 2000 roAy, o,AHaKO B 2002 ro,gy BHOBb no.AH3lCAI zAO YPOBH5 1999ro,a - 13.6 Ha 100 mc3gq.

BbISBJeHHe cjiyxaeB 3a6ojieBaHEiA Ty6epKyjie3OM 3HatmTeabHo pa3nIiiqaeTcq B3aBlHCH4MOCTH OT perl4oHa CTpaHbI. CaMbrli BbICOKHfl noKa3aTeJIb, jocTHraioagiri noqmTI150 Ha 100 TbIC. HaceCieHHH, 6bIn oTMeqeH Ha iore cTpaHbI B AwaAa,¶-A6aAcKoA o6niac-m;

giTA cpaBHeHHB, cpegHHIir noKa3aTejIb no cTpaHe CoCTaBJMeT 127/100 TbIC., B TO BpeMSKaK HainMeHbMII4I - nopf[zKa 70 Ha 100 TbICAm. B HeKoTopEbx pagiioiax oTMeqeHInOKa3aTeJIb BbIHBjieHHA, npeBibimaiognp4f 200. O,Hofi H43 1IPHqHH yBeiHqeHHA YPOBH313a6oneBaeMocTn Ty6epKyae3oM cpe,g rpaaHCKoro HacejieHHA B 2001 ro,gy lBHAaCbaMHIICTH 1603 3aKmToqeHHbIX c aKTHBHOA qIOpMOg Ty6epKyjie3a.

Cmyagn c Ty6epKy"e3oM B TIOpbMaX TpeBowKHaA (Ta6dHLa 17). B 2001 rogyBbiSBieHHe HOBbIX cjxyaeB Ty6epicyne3a 6bVIo B 60 pa3 Bbiuie, qem cpegi- rpaxqaHcKoroIHaceneHA, a cmepTHocTm 6bvIa BbIIIe IOYTH B 200 pa3. B KOHUie 2001 ro,ga KojIEHqecTBO6OAbHbIX Ty6epKy.ne3OM B TIopbMax cocTaBEwo 2188, 13 KOTOpbIX 686 ymep.no. XOT51KOgnwieCTBO 3aKhX)YeHHbIX COCTaBASAeT BCerO OKono 0.5% OT o6u;ero HaceJIeHH, B 2000H 2001 rojAax oT Ty6epKy.ie3a B TIOpbMaX ymepnio roqTo CTOJTbKO Ke HJI ,gaaKe 6obIbmeeYincnio Iogei, qem cpegi4 rpax~aHcKoro HacenieHiH B 2001 rogayyMHpai O,HH H3 Tpex3aKIo-ieHHbIX c aKTHBHOP q)OpMOg Ty6epKyjie3a. B nepHo,g c 1995 no 2001 rogZXBbMi3BjeHHe cjiyYaeB B TIOpbMaX BbIpOCjiO 6onee ieM B g7eBqTb pa3, a cMepTHocTb OTTy6epKyjie3a yBeiiHqJIaCb 6ojiee YeM B gecHAT pa3.

3n9iHgeM4o.norHitecKasI ciTryaiLHi no Ty6epKyae3y B T1OpbMaX cnoco6cTByeT pocTyCMepTHOCTm OT Ty6epKyjie3a. MHOme B rHpaBriTe.IbcTBe KblprbI3CKOf Pecny6AiHKtrcoriIacHbi C TeM, YTO KoAjlHecTBO 3aKECIoYeHHbIX CA1IIIKOM BeJIHKO; OJIOOKCHHiCycyry6.iueTCs3 TeM, YTO B TIOpbMaX cTpaTerEiA DOTS He npHMeHerTCq, H 6On1bHbIe Ty6ep-KyjiC3OM B TIOPbMaX OCTaIOTCq rIpaK-ImHeCKH 6e3 hiCieHH5I BBHY HegOCTaTKa q4HaH-

1990 1995 2000 20013aKn.O4eHHbme c aKTHXoHi cOpMOi TS - - 2580 21883aKIo'eeHHbie C *HOb sbumnmeHHbiM TS - 174 1422 19923aKnio4eHHbie, ymepwme OT TS - 56 542 686CMepTHOCTb OT TS - 262,2 1887,4 2635,9npoHmmory6epKyne3Hble 6OnbHHI4bl TiOPeM I I 3 3I 4CmO'IHUK UHc5OpMOtAUU: MiHUcTepCTBo BHYTpeHHI4X Aen.

60 PArO'Mom ViOKJ1Ag BCEMHPHOrO EAHKA

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CmpamezuA, nonumuKa u npasoaA ocCHoSerIpaBHTerJbcTBo TBep.Ao HamepeHo 6opoTmcs c Ty6epIcye3oM, xTO niOgTBepxaeTcqriocAeiAoBaTejibHbIM rpEHHTHeM ,gByX HanOHaJIbHbix rIporpaMM 60pb6bI c Ty6epKy-

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TaKHx opraHH3MOB, KaK BI'- H renaTl4T B H C.

1995 2000 2002

4mcno ymepumX Ox CnlMAa 84

Cny'Iam cnfAa 25

npeAnonom"TenbHoe M'CnO cny4aes BM' 6000

4mcno 3apermcTpNpoBaHHhix cny4aes BH4 51 2209*

BWI cpeAm nfH (3aperncrpnposaHHble cny4an)

Cny4aN em4)Imnca 73,5

npeAnonoxKwTenbHoe -meno noTpe6wTene H apKOTHKOB 25000

npeAnonoecmTenbHoe qncno nllH 100000

npeAnonomKnTenbHoe 'ieno PKC 20000

npeAnnosrnc"TenbHoe 4Ncno MCM 15000

Mlcmo04uK: MMHtcTepcrBo 3ApaBooxpaHeHKR. Cny4am B11-I Ha KOHe4 anpenS 2003 r.

90 PASO'." IqOKnAg BCEMLPHOrO SAHKA

CormacHo oc4HLwabHOA cTaTHcTKce, 1,2% rIHH (nIpoTecTHpOBaHo 6o0iee 18000xien.), 0,01% PKC (npOTecTMpOBaHo CBbIule 15000 qen.) H 0,4% 3aKniIoqeHHbix(ripOTeCTrpOBaHo 6onee 65000 yen.) B 2001 rogiy oKa3aJIHCb BWI-HnHPL1pOBaH-HbIMH. OgHaKo gaHHbIe ,O3OPHoro 3nmgHa,g3opa ino TamKeHTy yKa3LIBaEOT Ha TO, 'ITOpacripocTpaHeHHocTb cpeg,i r114H B TamKeHTe cocTaBJImeT 46 npOiLeHTOB.1 0 OTCejibHbIeciryqaH BMH-IH14eiuwH 3aperl!cTpHpOBaHbI TaioKCe cpegH MCM, ,AOHOpOB KpOBH,naLu4eHTOB C HI,rII, 6epeMeHHblx KeH1HH H HOBopoxIeHHbLX (3 ciiyqaz B 2000-2001rogi;ax). Ilo aHHbIM [teHTpa "CrlIA'", 13 360 qejeOBe, IIpOTecCT4pOBaHHbIX B TpexnyHicrax ,oBepHsH, 45 HMenH rionoxcHTeJIbHbIe pe3yjibTaT Ha BWI, xoTA pe3yjibTaTbIBToporo HCCJnegOBaHAH rIOKa3ajiH, 'qTO TOJIbKo 20 iipoueHTOB nH¢HIJL4pOBaHbl.3Kcnpecc-aHanH3 rII4H, IpoBeqeHHbai B TamKceHTe B 1998 r., rioKa3aA, trTo 6o0ee 90ripoLieHTOB 143 HHX - My?K'I4HbI, H4 6oIbmHcHCTBo cocTaBiSioT MojogbIe .mogH 18-30 neT(Busel H gp., 1998). HIowH 70 npoieHTOB rn1HH He HMeIoT pa6oTbm. IIo AaHHbIM Apyroro3Kcrpecc-aHaTIH3a, npoBegeHHOrO B 2001 roAy B CaMapKaHge, cpegH BW4{-HHcPHW-pOBaHHbIX no'ITH 90 npiOiLeHTOB cocTaBHiEoT myxcambi, 60 nPOi4eHTOB - MOAOAexcb AzO30 ner, I4 6ombmiHHcTBo 143 Hi4X 6e3pa6oTHbie (3apHnOBa H gp., 2001).

O pocre oriacHoro ceKcyanbHoro rOBegeHHIH CB igeTejibuyeT BbICOKaA pacfipoCTpa-HeHHOCTb 1IrI, yBe'nEaI 4 Eonx PE4CK pacnpOcTpaHeHIHA BHI. B 2001 ro,gy BY36eKHcraHe 6bm oTMeqeH 221 cnyqar4 c1HqHpca Ha 100 TmIc3m 6epeMeHHbIx, KcTopbIeo6bmqHO He c'HlTalorcI yH3Bn Mofl rpynnoa. OgHaKo 3TO B 10 pa3 6onbuIe oC4W)HaHbHHO4L44pbI pacripocTpaHeHHocTM cpe,A4 HacenieHH5 B LxeJIoM. Y Kax,oIi 143 mIecr PKC,

rIOCeTHBIIIH4X BeHepoAonrH4ecKylo KunMmIcy, 6bUI o6Hapy-ECeH CcI4HI4C. 3Kcripecc-aHIHa.3bI cpegH PKC 6bLTm fPOBegeHbl B TanlKeHTe B 1997 (ToMac) H 2001 (OcTq)o-renbc) ro,gax. CoriacHo oiAeHKe 1997 roAa, B cro.,4ge HaCxuThBanIOCb 5000 pa6omHI4KOBxommepiecxoro ceKca H 250 TbIcq KCm4eHTOB. PKC nbITaioTcH YKPbITrC5 OT BjiaCTeI4, OqeM rOBOpHT TOT q)aicr, xITO B TamKeHTe 3apenrIMPI BaHO Bcero 180 ceKc-pa6OTHHKoB,HeCMOTPA Ha TO, 'ITO B 1996 rogzy 3870 PKC 6bunE IIpOBepeHbI Ha IrHHH, a B 2002 rogycBbIffle 15000 npoumE ripoBePKY Ha BLR/CHF1 B L]eHTpe "CHII".

rlpe3epBaTH4BbI CBo6ogHo rpOAMTCH B KocKaX, 14 HeKOTOpbIe PKC MOryT KYIH4TbH4X no iAeHe oKo.no 50 ileHTOB 3a IITyKy. OgHaKO 60ofbIEa4HcTBo PKC, Bo3paCT KOTOPbIXKojie6jieTc.q B npe,geiax OT 13 Ao 30 nieT, He nojub3yeTcC rpe3epBaTmamm, a 30 npogeH-TOB I43 HHX ynoTpe6jmioT HH¶beKLWOHHbIe HapKoTHKH. BOJIbrLHHCTTBO K3IHeHTOBOTKa3bIBaeTC.I nO.Tlb3OBaTbC3l npe3epBaTH4BaMm, oco6eHHo y36eKH4, KOTOpbIe mCHOjib3yiOTipe3epBaTH4BbI ga)Ke MeHee OXOTHO, 'eM HHocTpaHLbI. 0AHaKo pyri4m 1IIIIJIOCb 6bIIOTPaTHTh Ha npe3epBaTHB npi4MepHO 10% CyMMbI, nonryqeHHoIg OT K)I4eHTa. 06cne-AOBaHH4e 3,AOpOBb5 HaceJ1eHIH B Y36eKI4cTaHe (03HY) nOKa3aAO, nO JIH4HIb 2 ripOgeHTa3aMYxKHHX 2KeHI1AHH nlOjib3YeTCHi npe3epBaT4BaMH, HO 3TOT npo4eHT Bo3pacraer ,go 27cpeA14 HC3aMyxEHHX WKeH11EHH; 11141Tb 1 ripOl4eHT )KeHaTbiX Mywq'HH Hon3yeTCminpe3epBaTHBaMi4, TorAa KaK HCIIOJIb3OBaHHe Hnpe3epBaTBa HeKeHaTbIMH MyXCq14HaMH4cOcTaBJIeT 39 rIpOLeHTOB (ME4HHIcTepcTBo 3gpaBOOXpaHeHH, 2003).

Onpoc 3600 MOjiOgbX niogeE4 (B Bo3pacTe OT 15 Ao 24 jieT) no BceMy Y36eKHcTaHynOKa3bIBaeT, qTO 44 npoi4eHTa MOJIOAbIX MY)KqI4H CeKCYanJbHO aKT4BHbI, HO lI4Ilb 23ripoieHTa flOAb3yEOTCR xaKmM-jHm60 BHgIOM KOHTripaeCriuI (Y36eKCKa& Acco0I4a4uPCHPOAYK4BHOrO 3AOPOBbSA/IPPR, 2001).3To i4ccjiegOBaHi4e TaloKe nOKa3bIBaeT, 'TOOHH Y3HaioT MaJIO H4. COBCeM HH'erO 0 nyrslX 3aPaKeHHS 14 MeTOAaX npocIJIa wKHBHH-HH41eKuiA4 143 IKOJIbHbIX npOrpaMM, iCnJblO KOTOpIJX qBmeTCri npegocTaBjieHHeTaKO1I HiHcqOpMaLi4I. Ho AaHHbIM 3TOrO HcCJIeAOBaHI4H, 50 riPOiJeHTOB MOAOobIX .n0IAefI

10. CCM (2003). 3aRBKa Ha rpaiHr FDCTM. TaLKeHT: Pecry6nHicaHcKas xipe3Bbi'afiHaAKOMHCCWI ro 6opi6e c aniHueMxef BWi/CrI,A a n Ty6epKyjie3a

B"q/cnlVg M TYSEPKYFlE3 B LAEHTPAnbHor1 A3mw 91

ctuHTaeT-,To PICK 3apawKeHH BENx oTcyrcTByeT, a Apyrie40 npolAeHTOB He HMeioT

gaxe rHio THTI 0 TaKoM picKe. B oTiere UNICEF (2002) rOBOpHTCH, qTO o6 HCHOlb-

3OBaHHH npe3epBaTrBa KaK o cnoco6e ripeAoTBpamteHr BI4H-HH4eKWHH 3HaIOT 43

npoLeHTa MoAoJbix iiioAef B BO3pacTe OT 14 go 17 neiT. OAHaKo cpegm xeHIIHH 30-49

iieT 3Taz on CcHmKaeTcq Jo 35 npoiAeHToB, a cpeMn Mojiogbix KeHUHH OT 15 Ao 29

COOTBeTcTBysioii iAH4q)pa eige HHDKe: 26%. Ho AaHHbIM 03HY, 90 ipoieHTOB onponieH-

HbIX >KeHuiHH Hi 95 IpOLeHTOB oipOifeHIHHbIX MY)KqHH CJIbImaiHm O CHI Me, HOJIHIHb

oKojio 60 npoLeeHT0r )KeHII4H 14 80 IpoiLeHTOB MyAK1HH nojiaraioT, xTO eCTb cnoco6

y6epe-bcA OT CnIIa.

Cmpameauw, nonumuKa u npasosaR ocHosaCBi4AeTejIbCTBOM TBepgorO HaMepeHHH ipe.oTBpaThT JajibHeflmee pacipocrpaHeHHe

BIlM/CFIlaBa IBJIoTcSI: yBepveHe 3aKoHa o CrI14Ae H HaLU4oHaabHofi rlporpaMMbi

60pb6bI c BHx/CrIH4OM; rpmHHITHe ipaBiHTejbCTBOM cooTBeTcTByionueEr CTpaTerHHll",

noIroToBneHHa. npIH coAeHcTBHH UNAIDS; gecTByioAa3i TeMaTirqecKas rpynna OOH;

co3AaHHe 6onee 200 rlyHKTOB qOBepi no Bcefi cTpaHe; H 32aBKH Ha rpaHI FDCTM H

MAP (IDA) H NM rIOMo01H B ,anbHefimerI 6opb6e C Ha3peBalon4eii 3alHAeMHe.

IpaBiTeejbCTBO TamcKe fI1HBepeKCHO 60pb6e c iH-HbeKIUIOHHbIM ynoTpe6iieH4eM

HapKOTHKOB Hn HO1AHCaJO BCe mexyHapoAHbIe KOHBeHUH14, HanpaBneHHbie Ha 60pb6y

C He3aKoHHbIM o6opoToM HapKOTH4KOB. Co3JAaHa CneiwvIbHaA roCyyapcTBeHHaSq

KOMHCCHI BO rniaBe c npeMbep-MIHHHCTpOM ,aRuu 60pb6bI c KoHTpa6aHgOg HapKOTE4KOB;

KoMHcCHA UiMeeT cne&4EaTbHbIe oT,ejmbl B MHH3,ApaBe i4 MBJIl. B cocTaB MeeKBe,oM-CTBeHHOA KOMHCCHH BXO)ffT npegcTaBi4Tei MiHHHCTePCTB BHyrpeHHH4X e.AI, o6opOHbI,

o6pa3oBaHI, 3gpaBooxpaHeHH5, Tpyga H C04oXaIbHOfl 3aaum'I. B mone 2002 roga

lpaBlBTeCJbCTBO Y36eKHcTaHa npoBejio perHoHaibHyIO KOH4IepeHiHio no npo6nieMaM

KoHTpa6aHAbI HaPKOTHKOB H HapKoMaHHH.

CTpaTerinecKoe inaHlpOBsaHHe no BHH/CrHIMy HaqalioCb no HHHLqHmTHBe

TeMaTHWIecKof rpynnrl UNAIDS, r,Ae B HacTomilee BpeMSi npegcegLaTe-JbcTByeT BceMHp-

HbI$i 6aHY, H ocyigecTBmseTCm npEI nOnHOEi rogAepmKe co CTOPOHbI npaBHTejibCTBa.

KpoMe TOrO, MHHHcTepCTBO 3,paBooxpaHeHH5 nOJIHOCTbiO COTpy,AHHqaeT c areHTCTBa-

MH OOH Hi AoHopaMH B peanMa4vm meponpHwrr no BW/CrI4y. MHHHcTepcTBo

BHyTpeHHH1X ,eJI TaioKe corpygHnqaeT c DOHgOM Copoca B npOBe.1xeHHH meponpHsrr4

no 6opb6e c BW-I/CnmZOM B TlOpbMax. npHiHrras HeeAaBHO CTpaTerHS 60pb6bI c

BHH/CrIM4OM HanpaBneHa Ha:

, CTHMyJInpOBaHHe MexBmeoMcTBeHHorO noAxora K peaCJIH3aHH CTpaTerHH no

BWI/CrI4Ay c yqaCTHeM cooTBeTCTBywouHX MHHHCTepCTB, TaKICX KaK

MH-HHcTepcTBo 3,ApaBooxpaHeHHA, MBJIl, MHHHcTepcTBo o6pa3oBaHmA HI

MHHHcTepcTBo cIJHHaHCoB, a TaiOKe areHTcTB OOH H HrIO.

* YcHmeHHe TejneBOrO BMeiuaTeJIbCTBa Ai5 rpynn BbIcoKoro pHCKa, KoTopoe i4rpaeT

KpTrrw4ecKEI BaXKlO pOmb B coKparmeHHH MacmTa6oB 3nHgeMHi B Y36eKHcTaHe.

1* YKpenieHHe cTpyKTypbi ynpaBJIeHHA Hi noTeHgi4aAa peanA3aLH4H HaIAHOHa7bHOf

rlporpaMMbi no BWI/CHrIMy H 14U11H c ueIbO o6ecneieHHR ee ycTOfPlHBOrO H

noCJIeroBaTeJIbHoro BHe1peH4a.

11. Mex<BegoMcTBeHHas pa6o'asi rpynna no BW/CrIMIy (2002 r.). CTpaTerwSecKas

nporpaMMa npOTHBog1eficTBHA pacipocrpaHeHHIo 3anHeMHH BHH/CrIHAa B Pecny6mHKe

Y36eKHcraH. TauIKeHT: IIpaBITeJrbCTBO Y36eIcrTaiia.

92 PAso'wA gOKvA, BCEMIPHOrO SAHKA

Ilpoeicr CTpaTerHH paccMaTpHBaeT c.neAyIoowe cjaKTopbI KaK cnoco6cTBylouIwepacripocTpaHeHwro BH4-iHHeKUaM B Y36eicraHe: (1) He,oCTaTomHO CHAbHOepyKOBoACTBO yCH]InMMI no 60pb6e c 3iHAeMHeie; (2) cnia6oe MexKe,AoMcrBeHHoeM3aHMo,eficTBHe; (3) BbICOKaA IIOABep-KeHH0CTb 3apa)KeHHIO B rpynriax HaceiieHHiq, B

KOTOpbIX cocpe,AoTo0eHa HH(PeKum; (4) HenonHoe co6mio,geHHe nipaB H cBo6o,qejioBeKa, CBs3aHHbIx c npo6fleMaMH BHI/CHI4Aa; a TamoKe (5) He,AocTaTo:HoeBHHmaHMie K nIpo4pHJiaKTH1ecKHM MepoiipH5TM, yxo.y H nieqeHMo H noggepwKemiog7eI, xKHyBYUmx c BMI/CrIJ1M. Ha Ajene KoopAHHaqFm5 ycwIi4 MHHH4cTepcTBHeylAoBIeTBopHTeJIbHa, ripasBTreAbCTBo He cnxemino yrBep,im CTpaTerHio rioBWI/CrIlMy H 3a3BKH Ha pH4HaHCHpOBaHHe B rFDCM B cHjJy peIHrHo3HbIX HKYJIbTypHbIX coo6paxeHHf.

He3aKOHHoe npHo6peTeHHe H xpaHeHHe HapKOTHKOB npecnie,yercA KaK yronJoBHoeripecTyriueHHfe, a 3aMeCTHTeIbHaH TepanrA B Y36eKncraHe noKa He y3aKoHeHa. PKCnpeciieCyIOTC51 3aKOHOM, a MCM TaioKe nojgBepraioTcq YronoBHOMY rIpecIie,oBaHHio.3aKoH 0 CrIlZe crioco6cTByeT eue 6oflbmeefi cTHEMraTH3aiH BHtI-HH(pHLHP0BaHHbix,C03|gaBafS J0oronH1HTejIbHbIi nOBo, ,JIS HaH6o)iee yI3BHMbIX rpynn yiKOHSIThC51 OTTeCTHpOBaHHI.

nompe6Hocmu * Haebope u aononHumenbHbie uccneao.aHUwB Y36eKHcTaHe cyiecTByeT 14 L]eHTpOB "CrIG" H 90 ia6opaTopHA nio jHariiocmxKeBWI. LleHTp "CrI114" ny6nHKyeT e7)eKBapTaIbHbie orieTmi IIo BIxI/CIIH4y. C 1998 roAaUNAIDS flpOBeCjO HecKOJnbK sKcnpecc-aHaJiH3oB cHyaLH B TauIKeHTe. B HacTo3ngeeBpeMA ODCCP [Biopo OOH rio KOHTpOJIIO HapKoTKo0B H ripeAoTBpaii;eHRio ripecTyn-HOCTH] IIpOBog/rT HCciiegoBaHme HapKoMaHHH B Y36eIcTaHe. Lferlrp 6opb6bl Hnpoc)mIaKTrHI 3a6oJIeBaHHA (CDC) npoBo,WT HccnelgoBaHHe pacnpocrpaHeHHocTHBUIN B TaILuKeHTe, H pe3yJIbTaThi AOJDKHbi 6bITb H3BeCTHbI B 2003 rogy. AMepHKaHcKoeAreHTcifBo MexRyHapo,Horo pa3BsTHT (USAID) BO B3aHmoAieACTBHH C CDC ripe-.AocraBi5AeT o6opy.AoBaHHe ,ins na6opaTopiiA CrIHa, a Taioe o6y-ieHHe MeTogaMKOHTpO.IbHo-Bbi6opOqHoro (go3OpHOrO) 3iiHgeMHojiorHqecKoro Hag3opa.

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Bl4/CnfAW TYFEPKYJ1E3 B L3EHTPAnbHoi MHm 93

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AcpHKe. °owiaA Ha KoHcpepHuHH IAEN B )yp6aHe.

Boam A., 1998. flojiHTnKa H BMeiuaTeJIbcTBo )JV ocTaHOBKH 3ariHeMHH B1{-1,

CB5I3aHHOf4 C iHHbeKLAHOHHbIM noTpe6jieHHeM HapKOTHKOB. B "I4HbeKIwUOHHbIe

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BpeAa B o6nuviHe H4 B T1OpbMaX POCCHi2CKOiI TeAepaiXHH.

B1O3e3Tb H Ap., 1998. PacnpocTpaHeHHocTb HHbeKIu4OHHOPi HapKoMaHHH H BIT-

iHH4eKUHH B TaIUKeHTe. TamKeHT: UNAIDS

KaplHH4oHeT, 2000. 3gopoBbe HaceiieH H 3ApaooxpaHeHHe B UiHTPaJIbHOa3HaTCKHX

pecny6.nircax. iHHopMaIUoHHblfi ileHTp B03 rio 3ApasoOxpaHeHO B HAP.

ABcTpaJIHAcKoe CoApyKecTBo, 2002. Bo3BpaT KanHTaJIoBwioKeHHA B npOrpaMMbi

o6MeHa 4mJ H uinpEiLgeB B ABCTpanHH. CHAHei: ,erenapTaMeHT 3fpaBooxpaHeHM 1

B3pocJieHHS CogpywecTBa.

Ka,ruHr=oH ,ZJJK, X3HKOK, 1994. OiLeHKa BJInHSHRH CIIma Ha pOCT 3KOHOMHKHI MaiaBH.

>KypHaji.

lapHeTr r. HI Ap. (Heony6nHKoBaHHaA1 pyKorIHcb). MogeflHpoBaH1ie BW1/CfrI4Ba B

Poccim.

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aq)pHKaHCKohr cTpaHe: 4CnOJIb3OBaHHe MoQeiiH o6umero paBHOBeCHS1 KaMepoHa.

)KypHali "DKoHoMm,Ka CTpaH AcpHpi4"

KoKKo C., 2002. Ty6epKiyne3 IH BI4'1/CnIT B TIOpbMaX Pecny6iniE KbIprbI3CTaH:

pemeHie pacTyau4x npo6.ieM rocyAapcTBeHHoro 3gpaBooxpaHeHH51.

a1,CKyCCE40HHbIli goKyMeHT. BamHiHrroH, BceMHipHbIf 6aHK

Jio6mH H., KiefITc A., BapcernAH 4., 2002. 3anpeT Ha HaPKOTHKH B AqraHHcTaHe H

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nporpaMMa.MaKcPapAaH M., Creppm C., 2001. MaKpo3KoHomHwecKoe BANJHHe BW/CHI4TIa B

BOTCBaHe. Pa6oMi4 i0oKyMeHT MBD.

Orcroremic P., 2001. OuLeHKa cpegH )KeHUII4H-PKC H HX iHumeHTOB B TaunKeHTe,

Y36eKmcTaH.OcTrcorenbc R, Mm.KCenbceH X. (1998). O1ieHKa CnTYaijim c BIN cpeA MCM B

TamKeHTe, Y36eKI4cTaH.

PerHOHalbHaH KOH4?epeHiHA ro npo6iiemam HapKOMaH41 B lUeHTpanbHOi A3HH.

OueHKa CHTYajm4 H OTBeTHbie MepbI. UNODCCP, B03, USAID, OECE,

Mi4HHcTepcTBo EIHOCTPaHHbIX Aji ABCTpHH4 H npaBHTenjbCTBO Y36eKcrTaHa.

105

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PIOAb K H gp., 2002. 3KOHOMHqeCKHe ioc7iegcTBsA BT-1 B POCCI. 1HTepHeT-cTpaHHuaBceMHpHoro 6aHKa o PoccHu.IlUBehmapcKas 3KCnepTHaq KOMHCCiHH PeKOMeH,YeT ,geKpHMHHaRH3auioynoTpe6.neHHR HaPKOTHKOB (1996). KaHa,gCKHSi BioJIeCTeHb no rIoimKeBHT-I/CrII4a H 3aKOHODaTeCIbCTBY.BCeMHpHHbri 6aHI, 1997. BOPb6a Co CrIMoM.---. (nipoeKTo rKyMeHTa paCCMaTpHBaeTCq). KoHiAenrm cTpaXOBaHi, oTpacieBaupa6oTa no BWII/CrII y E¢ Ty6epiyxe3y;-- -, (IpoeKKT gOKyMeHTa rOTOBHTCq). KoHAeniuHIToMac M., 1997. OIgeHKa cHryaT KoMMepqecKHix ceKcyaabHbix ycjiyr B TaIIIKeHTe.OTBeTHbIe mepbi nIo BII4/CrIMIy, HFHIr H HapKOMaHHH IpH cogeM i cTBm UNAIDS BcTpaHax lAeHTpa)TbHOA A3iH. AAMaTbI.

2002a. 3riHACMemOAiOrmqeCKKHC 4aKThI B Ka3axcTaHe.2002b. (Daimi B KbIprbI3CTaHe2002c. OTqeT o rflo6anbHofA anaJeMHu BWTY/CrJ44a 3a 2002 r. )KeHeBa..2002d. CoIWajmbHbif MOHHTOp: BH4/CGIHA H MOjU,oeJKb. cniopeHLiw.IOCAM/LIAP 2002. CTpaTerHS npo(pwaKTEc BHW/CIGI4Aa B 4eHTpaALHOio A3HH Ha2002-2004 rr. Aimami.

Y36eKcKas AccoLHaLaw penIpOgYIMBHOrO 3.OpOBbq/IPPR (2001). Pa6oTa YAP3 cMo.noIaemIO Ha mecrax no npocpwaKTIIKe B{/CGH1ia B Y36eEI4cTaHe. TamIKeHT.MexceAoMcTBeHHa3i pa6oYas rpynna Y36emHcTaHa no BW4I/CrIHy (2002).CTpaTerHtecKasI nporpamma 60pb6bI c pacnpocTpaHeHuem 3BnHeMHBH14t/CrIfHa B Pecny6AHKe Y36eKEHcTaH. TamIIKeHT: rIlpaBTEJbCTBo Y36eKcraHa.BaH xeT JIo H gp., 200 1. AexpHmiEHaJH3aL ynoTpe6leHMn HaPKOTHKOB B rlopTyranHH:BbIpa6oTKa nomnRm. HEwepAaHgbI.BHHoKyp, rognmbo, ,AaA H HarenbKepKe (2001). 3nEriHgemHr Ty6epKyne3a HI BHY/CfImaB PoccicKoI (DPe,gepaumH. BaUHHrrOH: BCeMHpHbIf 6aHKB03, 2001. PerHOHajibHaA cTpaTerma B03 no ceKcyanbHoMy H pepogyBHoMy3.0pOBbMO. KoneHrareH.3aplmoBa H ,p., 200 1. PacnpocTpaHeHHocT HHbeKUHOHHOfi HiapKoMaHHH H BH-HH43eKiMH B CaMapKaH,e. CaMapKaHA: MHH3gpaB, LleHTp C11a

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