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B L]eHTpaAbHof A3HH, KaK H B OCTajTbHbIX c-paHax EL,A, MacMTa6bI nIIHeMHH 3HaxnTeJIbHO HeJgooiAeHIsBaoTcq, O,gHaKO Bce rIOHHiMaioT, rITO pacnpocTpaHeHie B1I4 yBemJrH4BsaeTCI BcjIe,g 3a a3rmeMHMmH noTpe6IeHHsI HHbeKqHOHHbIX HaPKOThKOB (HHIH) 14 3a6OjieBaHi4A, nepegaiomuixcA IIOJIOBbIM niyTeM (HrInT) B 3TMX cTpaHaX. Ilo gaHHbIM OpraHIH3aHH EBpO-BW [Euro- HIV], B qeHTpaRbHoa3HaTcKHx cTpaHax OTMeqaeTCq pe3Koe yBeafHqeHme HCjieHHOCTH H 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)Hr4waAIbHbIM gaHHbIM, 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 H4 iHHbeKLAMOHHOfi HapKoMaHHH cTan yBe)IWH4BaTbC5 c 1995 roga, HO oco6eHHo pe3KO BbIpOC riocnie Haiaia BoeHHbIX AeAecTBH4Ii B A¢raHHcTaHe B 2001 rogy. Korga rpaHHUbI C Ta,gKKCTaHOM H Y36eKIHcTaHoM 6bTIH OTKpbITbI, LxeHbI Ha HapKOTHKH cTai naraTa. I 2 PASO'II g,OKHAg BCEMHPHoro SAHKA 1996 2001 noKa3aTenb noKa3aTenb CTpaHa Cny4aH Ha MnH. Cny'am Ha MnH. Bcero Ka3axcraH 48 2,9 1175 72,6 2522 Kblprbl3cKax Pecny6nmKa 2 0,4 149 31,5 202 TaAmNHKHCTaH 0 0 34 5,4 45 Y36eKHCTaH 0 0 549 22,2 779 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,LE nmi4L, ynoTpe6junlOaiIX HapKOTH2KH BHyrpHBeHHO (60-90%), npoi;eHT cjiyqaeB 3apa)KeHHi HOCpegCTBOM reTepoceKcyanbHorO KoHTaKIa B nocnie,Hee BpeMq yBeju-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 pIHCK BHI/CrlHJa HaH6o.nee BbICOK. tacTr4Hoe COBiageHHe rpynn IHH H PKC B 3TOM cy6- perloHe pacCMaTPHBaeTcq KaK gonoJIHETejIbHbIfA PHCK nepegZa-IE 3nr1,eMHH OT BbICOKO-y3I3BHMbIx rpynrn K YH3BIHMbIM rpyiriaM, TaKHM KaK MOJIo,eA(b. Boniee Toro, CayqagHbIl ceKc pa,H 3apa6oTKa, KOTOpbIM 3aHHMaiOTCR cTygeHTKH, H 6onee pacripocTpaHeHHaSi, 'eM ripHHiTo cqHiTaTb, romoceKcyanbHas npaKrTKa MoryT 6bITb ,gOIOJIHEHTejibHbIMH 4)aKTopaMH pHCKa 6bicTporo pacripocTpaHeH we 3neM cpe,H MojiogexK B XejiOM. MonoRbIe nio,i, 6pocHBiMe yqe6y, KOTOpbIe oco6eHHo pHICKYIOT cTaTm HapKOMaHaMH EvH PKC, B03MO3KHO, 3aCiYXWBaioT 6onee LeneHarpaBneHHOrO BHiMaHHsI, 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, B TOM 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 A * i. - S. . I I rOA nepBoA '4cno monAef, Pacnpocrpa- npeo6naaAao- perNcCpaL4HH NyLOB4HX C HeHHOCrb U4HAI nyTb cny4an BSM BH4/CnlHAom (mapocnbie) nepeAarN Ka3axcTaH 1989 3448 0,14 nWH Kbiprbi3cTaH 1987 410 0,01 nfH TaAXcNKHCTaH 1991 92 <0,0 InIH TypKMeHUcTaH 1997 I <0,01 O1nbHWHHaq MH14eKL4HR Y36eKNcTaH 1992 2209 <0,0 I nfH l4eHTpanbHan Amsm 1987-92 5904 <0,01 nlH 14cmoqHuKc rocyAapcTseHHaR cTaTucThKa (Ha MapT 2003 r. B Ka3axcTaHe; Ha Mabi 2003 r. B Kbiprbl3CKOri Pecny6nlHKe; Ha 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 KasaxcYaH 31 48 437 299 185 347 1175 735 3257 KMprbi3craH 17 2 2 6 10 16 149 160 362 TaA,KNKUcTaH - 0 I I 0 7 34 30 75 TypKMeHmcraH 2 - - - - - 2 - 2 Y36eKMcraH 38 - 7 3 28 154 780 2000 3010 LIeHTpanbHaA A3ms 88 50 447 309 223 524 2140 2925 6706 cmo'4HuK EBponefcKrm L,ewrp MOHHTOPMHra cnl a, ma MmHCepCTBa 3ApaBooxpaHeHMR LAeHTpanbHOZ A3uu. 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CTpaTerHH rpegyCMaTpiBaioT MexcBeJgOMCTBeHHbuif ro,ixoJI H o6OCHOBaHHbIe, goKa3aTejibHbIe BMeIiaTejibCTBa 2NM 60pb6bI C 3ngHeMHefi (Boju, 1998; B3eppoy3, 2001 [Ball 1998, Burrows 2001]): co3JJaHHe A03OPHOrO 3IHHHag3opa, CHHKeHHe Bpega3, IIpoHIaKTHiKa H neqeHie HIrIl, a TaioKe o6yqeHHe MOJ1OgbIX riogefI B LxeI0M. Bo Bcex cTpaHax npiHHiTO 3aKOHo,gaTejibCTBo rO CrlI y, peaiH3YpoTcq MHoroJemTHHe Me>KoTpacneBbie riporpaMMbI no npe,OTBpaige- 1. http://wwwusaidgov/regions/europe_eurasia/car/briefers/hivaids_prevention.htnil. MapT 2003 r. 2. UNAIDS (2001). OTBeTHbIe MepbI rio 60pb6e c BW{/CrIH,oM, HflfIf 1H HapKOMaHmeg B cTpaHax LfeHTpaAbHofl A3m-i HpH cogeficTBHH UNAIDS. AnMaTbI: UNAIDS - LeHTpanbHaM A3mA. 3. CiivweHie Bpe,a - TaK Ha3biaioTcq riporpaMMbI ayrpH-i, ripe.;ycMaTpHBaiomi-He o6yCeHHe no npHHui]iHfy "paBHbfi paBHOMy", KOHCyJIbTHpOBaHH4e H TeCTHpoBaHHe, o6MeH HrIi H o6ecrie,qeHme Bipe3epBaTIsaMn BbICoIKo-y33BHMbIx rpyrn. 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CoruacHo HegaBHO npOBeAeHHbIM OLeHKaM, gbs npoc)waKTHKIH H nieqeHHi BWI/CIILa B LeHTpaJTbHofi A3 B 2004-2007 rr. noTpe6yeTcA oKojo 1 MHAjiHnapza zonnapoB CiA (oueHKa npoBegeHa opraHH3aiHHMH Futures Group H Instituto Nacional de Slad Publica, 2003). ruIo6aAbHbi f(IoHg 6opb6bIco COrIJMoM, Ty6epKynie3oM H MaJmpHeft (GFATM - FD)CTM) MO)KeT cTaTm CyletCTBeHHbIM HCTOqHHKOM q)HHaHCHipoBaHHiSA ,ljIm cy6- permoHa. Ka3axCTaH, KbIprbI3crKaA Pecny6umca H Ta,HKHCTaH yKe nouyqIvu rpaHTi rIDCTM Ha 6Opb6y c BHWI/CrlH4OM B 2003-2004 rr., a B 6rnjcarl4ueM 6yAynmeM MeAy- Hapo,Hoe areFrrcTBo pa3BHTHAI IDA MooKeT BbileiiHTh gonoriHHTeJTbHbIe rpaHTmi KbIprbI3CTaHy, Taxmia4craHy H Y36eKucTaHy. Y36eKHicTaH TaioKe nogan 3asBKy B rcICTM. 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B Ka3axcraHe 3iieKTPOHHaS cHcTeMa Ha,z3opa 3a BegeHiieM i H,gHBHgyanbHbiX ciryqaeB Ty6epKynxe3a (3CHIC - ESCM), pa3pa6oTaHHaAI npEI CO,geEiCTBHH aMepHKaHCKOFO LjeHTpa 60pb6bI H npocPHnaK=KH 3a6ojieBaHHA (CDC), cTaiia gegCTBOBaTb no Bcen crpaHe B 2000 rogy, O.2HaKO HeM3BeCTHO, geICTByeT iiH OHa ,go CMX flop; B KbIprbI3CTaHe Hag3OP BeZAeTC5I Ha OCHOBe permcipaiq Kaxigoro c.iy-aSA no cTaHAapTaM BceMHpHOfl opraHM3auun 3,gpaBOOXPaHeHHA (BO3); B gpyrEx CTpaHax HaA3Op rIpOBO,WTCa B OCHOBHOM no CTapoi COBeTcKoEl CH4CTrMe peri4cTpaLiHH, a TaM, r,ge ,eEiCTBy1oT riHoTHbIe nporpaMMbi DOTS (KpaTKocpOMHbIgi Kypc IiexieHH Ty6epKyJne3a nog HSAMbIM Ha6mnOJgeHHeM), ary pa6oTy Begayr COTpy,gHHKHi B03 Hi mexyHapo,Hbix HI1O, TaKxx KaK "BpamH 6e3 rpaHuLu" H npoeKTa "Xoyn" (HOPE). COOTBeTcTBeHHO nOKa3aTeJIH BbIBJieHHA B cTpaHax cy6-perMoHa CYUIeCTBeHHO pa3H3srrcq (Ta6niHixa 4). rIpo6neMa Ty6epKyyne3a 3aMeTHa B CBS3I4 C 3nHgeMHieA BW1/CHIa. Bo MHOrHX pemiHoHax Mipa Ty6epKyjie3 HBJIeTCA OCHOBHOf4 onropTYHHcTHxecKoi lHH4eKUweA, npHBBoJgRueffi K CMepTH 6oJbHbix BW/CrJ4J4OM. TaKHM o6pa3OM, 6opb6a c Ty6epKyjie3oM B3aMmOCBA3aHa c npOcP4AaKTHKoA BEN, oco6eHHO B MeCTaX TeCHOrO CKOIIeiCHHSI iiogefi, HaiHpMmep B TIOpbMaX, rge H3OM4pOBaHHoe npoCTpaHCTBO yBeJIH-RlBaeT PHCK 3apa>KeHHA y6epKyJIe3oM, a TImeHmCHH5 HpHBO,ART K ynoTpe6nIeHIEo HHLbeKlaHOHHbIX HaPKOTH4KOB H pHCKOBaHHOMy roMoCeKCya.IbHOMy nrOBeAeHHIO. 13BecrHo, TO Ty6epKyjie3 B TlOpbMaX SqBjHeTCq 3nHAeMHoAorHmecKHM oqaroM, niHTaJowM o6migo 3raiHeMHI1O B gpyrnix qacTrx peri4oHa ElJA rIoKa MajiO cgeiiaHO i,As 60pb6bl C B1P-1 cpe,rlH 3aKJIoqeHHbIX, Ho rocKojibKy H Ty6epKyjie3 H BEHL iMCeOT TeH,eHUHIo COCyiCeTBOBaTb B 3TOI4 ryCTOHaceJieHHOfl4 cpeje, BeCbMa Bepo3THO, MTO cpegH 3aKmiOqeHHbix 6yjgeT Ha6Jmo,gaThcs ABOIiHas 3iHgeMHA. Hpl4HHiMaAI BO BHiMmaHHe OTHocHTeCjbHo 6o0mbofl ymep6 oT Ty6epKylye3a, o KOTOpOM 6bvio CKa3aHO BbiIe, TaloKe CYIe4CTBYeT BepoLmocmT, -rro 3TE 3niHgeMHi4 6yAYrT qaCTIMHO repeceKaTmcA 8 PASO'i1 AOKTiAA BCEMIPHOrO SAHKA (npeAnonaraeMbli4 npoL4eHT BbiBsneHHbIX cny4aes c nOnOWNKTenbHbIM Ma3KOM MOKpOTbI) 1996 1997 1998 1999 2000 KasaxcrTai 73,6 55,1 78,8 73,4 80,0 Kbipri3cTaH 72,4 77,0 41,4 60,1 38,0 TaAmNKKcTaH 6,5 15,9 18,3 NA 10,0 TypKMeHNcTaH 41,4 54,1 55,0 54,0 56,0 Y36eKHCTaH 58,3 40,1 40,8 38,0 33,0 L4AP 47,0 CHr 36,0 LleHTpanbHan Empona 51,0 3anaAHan Empona 36,0 Bcero no Empone 39,0 MCTOmHHK: BceMHpHas 6opb6a c Ty6epKyJle3oM, oT4eTbl B03 3a 1998-2002 rr. cpe.H EIHpOKOrO HaceiieHHI, ec.M He npHH5ITb 34*eKTHBHbIX iipocpHIaKrecKIHx Mep. B qacrHocTH, oco6oe BHHMaHHe HeO6XO,AEHMO HaIIpaBHTh Ha TO, tITO6bI 3apa>KeHHbie Ty6epKy.Ie3oM H qaCTHI'HO nponeqeHHbie 3aaicoIeHHbie BnOCjiegCTBBHH nepe,aBaaHcb ciryxc6am o6rgeCTBeHHOrO 3,ApaooxpaHeH M COIAHaabHbIM cny)K6aM ,M 3aBepIfleH5Im nieleims OT Ty6epKyJIe3a. KpoMe Toro, BeCbMa BepOSTHO, xTo go6pOBORbHoe KOHCYJIbTHpOBaHie H TeCurpOBaHle (JK7) Anvu BCex 60o.bHbIX Ty6epKyIe3oM 6y,ieT 3aeKrHBHO9 MepoI npo4EHnawCmmIu BU cpegEiH3Toro KOHTHHreHTa. CTpaTermn, nOJIMTHKa m npasoBan OCHoBa BO BCCX cTpaHax nPHHqT peKOMeH,gYeMbIfi B03 no,gxogZ DOTS (KpaTKocpoqHbIg Kypc nemeHHi Ty6epKy.ie3a riog ripqMbIM Ha6uogeHHeM). OAHaKO, BbI3bIBaeT o6ecrioKoeH- HOCTh pWA o6cToSTeVIbCTB, Kacaioauixcs neAeH4H Ty6epKyjie3a B perHoHe: (1) orpa- HHqeHHbIi oxBaT H MacmTa6 BHe,peHH DOTS, o qeM rOBOpiT HI3K4fi IoKa3aTeJIb yCner[IHOCTH neqeHmis H BbICOKH14 rpOLXeHT MJIY-Ty6epKyle3a; (2) MacTHqHoe HIH4 HOJIHoe OTCyTCTBHe OxBaTa TiOpeM, CiHTaiOMi4XC5 I CTOxHHKOM 3IH,AeMfHH Ty6ep- Kyjie3a B perHoHe; i (3) B HeKOTOpbIX cTpaHax 4YTH3HaTpbI rOTOBblI HaiaT neqeHHe Ty6epKyne3a npenapaTaMH BToporo p5iga go roIryeHHS yoBeTBOP4TenbHbix pe3ynbTaTOB BHegpeHH4 DOTS. OxBaT HaceiieHHHi nporpammog DOTS 3HaqiTejIbHO pawiwTaeTcq B CTpaHax perHOHa: OT KbIprbI3cTaHa H Ka3axcTaHa, r,ze noxrr 100% HaceIieHH oxBaqeHo nporpaMMofi DOTS, go TypKMeHHCTaHa, rge OXBaT COCTrBaweT 34%, H Y36eKHcTaHa, rie pacniiipeH4e DOTS ui4eT ,OBOnbHO MenIeHHO, H, HaKOHeiA, B Ta,nmKHcTaHe nporpamma DOTS 6bvIa iipHOcTaHOB3IeHa H3-3a rpax4LV4pOBaHHbIe 6epeMeHHbie)KeHIHHbI MOryT ro0iyqaTB jieeHe4e aHTiHpeTP0B4PYCHbIMH rlpenapaTaMH. EcTiH 3rnigeMmH 6ygeT pacrm coriacHo rIporHo3aM, noTpe6HocTb B TaKoM iieqeHHH H Heo6xo,gHMaA 1lJIH 3Toro 1HHppaCTpymWypa 6yjiyr nornogaTb peCypCbl B yERep6 ,gpyrHiM Bax)HbIM npH4opTeTaM. (CpegH HHX - paciymaA 3xigeMHI Cepg7exHO-COCy,HCTbIX H Heorviacrm4ecKiix 3a6ojieBaHHfi B cy6-perH4oHe, KOTopbIe TaloKe Tpe6ypoT 3Ha'iHTenbHbIx pecypCOB Ha TpeTrl-HOM ypOBHe MeAHLUHCKOA i HOMOII1H). B uejiOM BCe CHCTeMbI 39paBOOXpaHeHHH B cy6-perHOHe HCHbrrbIBaioT HeXBaTKY cpegcTB. TaKoA HegOCTaTOK qHHaHCHpOBaHHA B 6ygym~eM o6epHeTC31 TparegrHefl orpOMHbIX MacTnTa6oB, ecJi npoc)maKTImecKHe MeporipHiATHR, KaK CKa3aHO HIDKe0 He 6ygyT HpOBOgHTbC31 H paCIUHp3lTbCH. ,aaKe IIpH HaAH'mu AOCTaTO0HOrO d HaHCHpO- BaHHA, y MeCTHbIX opraHH3aUH$1 (rocygapcrBeHHbix cAy.)K6 H HrIO) Mo0KeT He oKa- 3aTbcz ,goCTaTOqHO cHnw T06bI paCIIpM4Tb CBOIO gaeATeJIbHOCTb H OXBaTl4Tb 6onb- IIIEHCTBO rpynri pHCKa. Bo BceM pernoHe He,gaBHO co33,aHHbIM cjlyX6aM CrIfHa noKa He ipEiaIOT 6obiiioro 3HaqeHHA, BCjie,CTB4e xero BCTaeT BOiipOC o6 OTCyTCTBHH BJIHAHH4H, KOTOpoe Y3l3BHMbIe rpynnlbi gzonJibI HMeTb rIpH oTCTailBaHHI4H CBOIX IIoTpe6- HoCTeA, H o6 OTCyrCTBi4i 1IHCTMTYI0HaJTbHbIX B03Mo0KHocreii H5 HIHTerpauJHH cryAc6. 12 PA6OLMrI AOKnA, BCEMMPHOrO SAHKA KpoMe Toro, npi peiaaum- a4)eKTHBHog egHHo0i crpaTerHn 60pb6bI c BM/ CrIUOMM M 14rIII He c.ieqyeT 3a6bIBaTh 0 TaKHX H4HCTHTIyH0i-HaibHbIx nperpa,gax, KaK Tpa,EHLIHOHHbie KOXK6 BUM/CrI4la B cyiiecTByioiwe cTpyKrypbi, paccMaTpmIaeTmi KaK OAHa H3 caMbIX HeoTjiOXKHbIX 3a,a- im Tag1cTncTaHa, TypImeHHcraHa H Y36eKHcTaHa. COCTOHHHe CHiCTrM 3gpaBOoXpaHeHHq B ILeHTpaibHo0 A3H yXygzHOCb B riaHe Ha,g3opa 3a 3a6oAeBaHIAMn, a TaioKe oxBaTa neqeHHem IHHeKLWOHHbIX 3a6ojieBaHHA. 3To yxyruneHie B HeMa0of cTeneHH oripegleJmeT ycrieMHOCTm iipoiHjiaKnwecCKHX MeponpHIIi, fOCKOJIbKy iieqeH4e KFrIrfIf, oco6eHHO 313BeHHbIx 3a6oneBaHHA, TaKix KaK 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 BaXKHOli cocTaBwuonXeA B ,gene npo4H.uaKTmiaI (Boc H gp., 2002). PIHCK pacnpocrpaHeHiui BM al-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 MeJHi1HCKoe o6CyIcHsBaHHe, nE6o B cH.ry cBoero per4cTpaiAmoHHoro craTyca H COUHaRbHOH H3O IUHH, mI6o no H1pHIHHe "HerocTenpHHMHocTH" MeAHLiHHCKHx yqpegeHi. KpoMe Toro, KOPPYrIHI B CHCTeMe 3g1paBoOxpaHeHIHs MO>KeT BbIHyA2Ta Y.3BHMbIe rpynrbl HeCTi paCxo,Db B BHAe B3HITOK HAlH "KOHBepTOB" ripexqe, qeM yCJryrH 6ygyT ipCeoCTaBjieHbI. KJIHHHKH ApyIeJuIo6Horo OTHOUiCHH K MOjioAemK riOKa He CTraH IIIIpOKO 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 H BUM Tpe6yloT TIgxaTCjIbHOrO nociieAyioiigero BegeHHR naLUHeHToB, H eCJIH TaKHe riaLuIeHThI He MOryT HAlH He XOTHT IIOJib3oBaTbCI MegU,4HCKHMH yCCyraMm, pa3OBbeTCI eKapCTBeHHa YCTOTIOCTh (H K ripOTHBOTy6epKyne3HbIM, H K aHmpeTpOBHpyCHbIM npenapaTaM), TeM CaMbIM oc.noxaiaH 60pb6y C 9ThMI4 1HHpeKLtWOHHbIMH 3a6o0eBa- HIIHMI4 BO BCM MmHpe. ATIH pemerHI-u 3TOg npo6neMbl Heo6xogHMbI TaKe CXeMbI q)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 3gpaBOOXpaHeHHS rAo6anbHoro 3HaqeH4HA. BCeMHpHOMy 6aHKy Heo6xogHMo ygeiiHTh cepbe3Hoe BHHMaHHe 3TOH rioTpe6HocTH irpH pa6oTe Hag ciHcTemaMMH qHHaHCIpoBaHHA B ceKrope 3.paBooxpaHeHHa. rlpHBaTH3aLjI B KOHTeKCTe 6opb6bI C 3apa3HbIMH 3a6ojieBaHH3MI HMeeT orpaHH'eHHyIO rlojie3HOCTb, a HeoCTaTOHoe qHHaHCH- pOBaHHe capMaUeBTHiecKog oTpaCMi B gaHHOM ciyMae co3AaeT cepbe3Hoe npenL5TCTBHe 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-a1qaT co3IAaHHe .A030pHorO 3ar ng3opas no BW1/CrI4Ay H YCOBsepieHcTOBaTh ciCTeMy Hag3opa 3a H4rIrlI, Ty6epKyjie3oM, MJW-Ty6epKyjie3oM H peaAm3aiweg flporpaMMbi DOTS. JJla,iee, Heo6xoAHMo 3HaTh 6onbmne o pacnIpocTpaHeHHocm pICKOBaHHOrO nIoBegneHi cpe,gi IHHH iH PKC, o riepejiHBaHn1 HenpOBepeHHOfi KPOBH H o paCnpOCTpaHeHHocTrH BHEI cpe,H BbICOKO-ySI3BHMbIX rpyIrI, TaEKX KaK PKC, ;KeHU~HHbI, CTaBUiHe o6'BKToM ToproBJIH, MHirpaHTbi, BO,ATrejH rpy3OBHKOB ("gaAbHo6o9mHm") H gp. TbKOri HoCpCeACTBOM yiymeqmeHM CHCTrM Hag3opa MOxHO ruaHHpOBaTh 34¢4eIrHBHbIe BMemaTe.ibCTBa H OijeHHBaTb UX pe3y.nbTaTmI, a TaioKe 6oaee TOxHO 3HaTh O pa3BTHH 3niiLmeMH BHI4/CrIH;la Hi 6opoTmcA C Hefl. 2) IIpmIzTe H pea7n3aJ~m cTpaTerHH 6opib6m c BH'q/CfHHoM, HHHH ii Ty6epKyAe3oM. 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, a TalOKe 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 pacnpoCTpaHeH4e BT4H; BCe IInpaBieThbCTBa ,gOjDHbI H3bIcKaTb H BbiejiHTh ,gOCTaTOqHOe 4cHHaHCHpOBaHHe gmS peajIH3agLU riporpaMMbi DOTS. rlpaBHTembCTBO 'IypKMeHHcraHa ,gonXCHo KaK MO)KHO cKopee npi-HmTb CTpaTermno no BWI/CIHITHy, noiroToBneHHyIo ripii cogeIfcTBHH UNAIDS. 3) YCHaeHHle pa6oTmI C BMCOKCO-yJ3BHMMIMH H EY3BHMlIMH rpynnaMH. 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OHIHHM H3 ripersTCTBHfl JIi MHOrOCeKToOpaVbHOrO COpyHH-eCrBa ABJIeCST CTHrMa, KOTOpaAS BHO ripHCyrCTByeT B Cy6-perHoHe. CpegH KmIoi0eBbIX oTpaciefi - 3.paBooxpaHeHie, o6pa3oBaHHe, apMH4, rieHHTeHapHbIe yqpexeH H pbIHOK TpyAa. Bce OHH 6bIH ycrieIHO 3aA,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 npHHHTA aHaJIo0HxIHbIX UIOAXO;0B B [JeHTpaAIbHOf Ami-. 3) HapauHBaHze InoreHixHaa. B qacTHOCTH, B cy6-peMOHe ecTb Heo6xo,HMOCTh B TeXHHqeCKoM o6y4eHHH. K rpHMepy, nOgrOTOBKa ia6opaHToB, qTo6bI OH1 MOrTIH iymIIIie oripege.1Tb MJ-Ty6epKyAe3; o6yqeHHe BpaMefh riepBEqHOrO 3BeHa TOMY, KaK pacII03HaBaTh, lIeqH4Tb 14 ,aBaTb cooTBeTCTByiouee HarIpa3JIeHHe Ty6epKy.ie3HbIM 60o.bHbIM; o6yqeHHe Meg,HLMHHCKI1X pa6oTHHKOB goCTo0HoMy o6paMeHHIo C JI1OAbM4, XUHBYII;HMI C BWIt/CrIH4OM, B COOTBeTCTBIIE C ripaBami 4eJIOBeKa; o6y"eHme npenoOgaBaTeIiegi H y"HTCreiie TOMy, KaK paccKa3aTa o6 onaCHOcTH BIP-I; H o6yqeHH4e Me,gcecTep IIpoBe,geHHI0 ,iKT cpe,H BbICOKO-yS33BHMbIX rpynn. 06y"eHHe HOBbIM MeToqaM npOBepKH (CKpHHHHra) Ha BMW Heo6xo,HMo IIpOBeCTH B 6y,tyigeM, Kor1a 3TH TexHooiorHH 6ygyr pa3pa6oTaHbI H BHegpeHbI. 4) TexHIrneccoe coAeAcTBHe HI KpeAHToBaHHe. B pamKax npIOBOAHMOI B ccpepe 3gpaBooxpaHeHI pa6oTbi 14 4IHHaHcHpyeMblX BaHKOM rpOeKTOB B cc)epe 3gpaBooxpaHeHi H gpyrHx o6nacTix, BaHK 6y,reT npogoAnKaTm cogefrcTBOBaTh perOHaHibHbIM npaBHTTehbCTBaM B npHHSHTHE H y0oBReTBopwTenIbHog peaH3aiLHH CTpaTermgi 60pb6bI c B3H/CrIfHOM, urinr H Ty6epKyne3oM. B Ka3axcTaHe cJIegyeT ipOBeCTH npexiaraeMbIil alHJM3 riporpamm 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 rOgrOTOBKH npoeKTa no BW{q/CrlHAy, CPl4HaHCHIpOBaH4e KOTOpOrO npegnOnaraeTCA 3a cqeT rpaHra MeVyHapogHoro areHTcTBa pa3BHnTHS (MAP). B Ta,g>KHCTaHe npe,qBapeiTeJmHasI pa6oTa no roAroTOBKe npoeKTa WH KOMnOHeHTa no BHN/CrHlAy, TaioKe 3a cT4eT rpaHTa MAP, yAKe Haqaiiacb H gomnxua 6biTb npogoJDKeHa BO B3aHMoefliCTBmH c peajr1a3aqHeA rpaHTa r1'CTM. B TypKMeHHCTaHe BaHK gojDKeH npogornxcaT ciiegHTb 3a ,HHaMHKOA noTpe6jieHHI HaPKOTHKOB, BHE/CrIIa, HIrIrH HI HTy6epKyne3a, a TaIoKe pa3BHBaTh pe3yAbTaTbI pa6oTbI, HpOBOAlHMOf npaBH4TeJIbCTBOM, TeMaTHqecKori rpynnoi OOH H opraHH3asiMH-napTHepaMH no npoclaxma Ke Hi 60pb6e c 3THM14 3a6ojieBaHHAMH. B Y36eKHcTaHe BaHK gojDKeH npogoJxcaTb co,eficTBoBaTh npaBiTe.eIbCTBy B riogrOTOBKe H4 peaniaLAM MeponpHufi no BHI/CrI44y, qHHaHCHpyeMbIx 3a cqeT rpaHTa MAP, Hi npoaojixaTm nopA,epXUBaTb meponpHawm no 60pb6e c Ty6epKyAe3oM B CTpaHe.7 PeKoMeH8a%uu no 8anbHeOwuM uccaneOo6aHuwM 1) 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 gm 60pb6bI C 3nHgeeMHel Ha rocygapCrBeHHOM 4 perHOHaIbHOM yHpoye. YCHJIH54 OCHOBaHbI Ha MHpOBOAq OKa3aTejibHOA npaKTHKe, H B HHX HI4HHHMalOT y'acTEHe MecTHLIe napTHepbi. HIccjiegoBaHie TaioKe HMeCT i-eIb cnoco6CTBOBaTb 6. BceMHipHbIfi BaHK (npoeKTo oKymeHTa B CTrarixr paccMoTpeHHI5). KOHIIenTya1IbHbIe 3aMeTKHI ESW no cTpaxoBaHnio, BWI/CIflIMy i4 ry6epKyne3y [The World Bank (draft under review). ESW Concept Note on Insurance, HIV/AIDS and TB Sector Work. Washington DC: The World Bank ECSHD]. 7. BcemipHbiAfi BaHK (npoeKT goKyMeHTa B cTagzi-i noA1OTOBK4). KoHiAeriaiH npoeKTa [The World Bank (draft under preparation). Project Concept Document. Washington DC: The World Bank. ECSHD]. 16 PArOLMomA gOKnAg BCEMWPHOrO SAHKA rIomnEIrEecKoMy ganory BaHKa H onepaTHBHbIM HCCiiegOBaHHM no 6opb6e C BWI/CrIHJOM B UeHTpaAbHHOM A3HH, nIogepXHBa2 rnpH 3TOM permOHaJlbHoe napTHepCTBo MeXy lIpaBHiTejIbcTBaMHi, rpawAaHCKIM o6a4ecmoim, areHTcTBaMHi OOH H MHoroCTopOHHHMII II gByXCTOpOHHHMH areHTCTBaMH B geie npouHnaKTicKH BH{/CHHI,Aa, IUrIrI Ty6epKyne3a. B pamKaX 3TOIA pa6oTbI 6bInH nIpOBe,eHbl cjieyioie KOHKPeTHbI HCCJIe,1OBaHHs: (i) OgeHwa IIOTeHIJHa;mHOrO 3mnHAeeMnoAorHqecKorO H 3KOHOMHqeCKOiO BroIBlHNHHE .IHeMH BHI/CHH.a B IleHTpahiHoA AmImI. Hccine,oBaHne COgCpxHT olueHKy B03MOxCHOrO 3Hii4eMHojiorHqecKoro H 3KOHOMHX.ecKorO Bo3,eiCTBH 3mHgeMm BWI/CrI4,Da B UeHTpabHOfi A3HH. BOJbIITIHCTBO 3aHHTepecOBaHHbI CrOpOH coriiacMHAcb, rro yIacTme BaHKa npHgacT 60obMYIO LAeHHOCTb HaKorLIIeHHbIM 3HaHHHM IIHI nOMOUJH TaKoro MOAeJIIHpOBaHHH 3HigeMHH. B 3TOM MogeniH pa3pa6oTaH psg B03MOXMHbIX CLeHapHeB, 'TO IIOMO)KeT IpIH o6cy,geH4n c 3aCHTepeCOaHHbIM4 CTOpOHaMH rioTeHIAHa1ibHoro B03gefCTB 3ni,24eMHH. 3To rocJyTr gOCTiDKeHHio riomnm'ecKoro H COIUanJbHOrO KOHCeHCyCa ,IS npHHEr5 cKopeAmHXiX H. 3JeKTIFBHbIx mep 60pb6bI c 3apoqaioweAcq 3riHeMIeHeA B cy6-perHoHe. (ii) BuLBwiIeHHe ynyxgeHH]fi B cTpaTerEH, noIHTmKe H 3aKoHo,aTe.cTBe, HapaBHeHHX Ha 6opb6y c anHzeMmek. 3rTo CCJInegOBaHEHe ripogojDraeT aHanI3, co,gepwaau ICs B CTpaHOBbIX pa3,eiiax H, HaCKOJIbKO B03MOXCHO, onpe,geJi5eT Heo6XogHMbIfi o6feM c)HHaHCHpoBaHH. B HeM ,aHbI peKoMeH,aUiHH o BEIpa6oTKe ,aJIbHe$IIIefi rIO.IHTmK, ripH 3TOM oco6oe BHHMaHH4e yeiieHO TiopeMHOMY HacezeHHio. (iii) OlpezAeaIeHme KIViOqeBbIX 3aHTepeCOBaHHx CTOpOH. B HCCJIeAOBaHHH oipejeJieHbi KEtOiBbIe 3aHHTpecOBaHHbie CTOPOHbI H HX pOIb 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 RAz 60pb6bI c 3iHgemiI4eft. HccjiegOBaH-e AOHOJIHeHO yrny6JIeHHbIm alHaJI3OM nporpamm no BHL{/CrHlAy i Ty6epKyjie3y B Ka3axcTaHe. (v) IIo,roToBsa iuiaHa yracTHa H B3aHMo,eficTBHE no BH'/CIH y B tIeHTpa.mbHoA A3HH. B rInaHe oripegenieHa cipaTerHa B3aHMozgeftcTBHsI xIvm BaHKa H ApyrHx 3aiHTepecOBaHHbI CTOpOH B OTHOmeHHH BM/CI-Ia B cy6-perHoHe. CTpaTerA B3aHMogeficTBH5 cnoco6crBoBana 6bI cO3waHmHo nojiHTHnecKoro H4 coU4JIbHorO KoHceHcyca, rapaHn4pypouero cKopefimee pHHSITHe ripaBHTJeibcTBaMH H ApyrE-MH riiaBHbIMH 3aIHTepecOBaHHbIMI CTOPOHaMH 3(4eCeTHBHbIX crpaTerf npo4uvlaKTMKH H 6Opb6bI c BH/CIIHAoM. 2) HIccjIeOBaHHe no Ty6epicyAe3y. BaHK peiiiHi npOBeCTH icCcAiOBaHHe npo6AeMbi Ty6epKyjie3a B UeHTpaAIbHOf A3HH BBHAy BaxHOCTH 3ToIi 3nH,geMHH camofi no ce6e H ee CBS3H c 3nieMHef BHN/CrHHJa. 3,reCb TaioKe oco6oe BHHMaHHC 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 O6MecrBo ony6nHKoBan¶ nonHoMacmTa6Hoe HCcjieTOBaHHe o6 ycimHqx no 6opb6e c HapKOTHKaMHI 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 KoHTpa6aHgbI H ynoTpe6jieHHH HapKOTHKOB B perIOHe, KOTOpbIe cnoco6cTByloT pOCTy HapKoMaHH4H i BHLH/CrHJJa H ycyry6.nsnoT 3nHgeMHiO Ty6epKyjie3a BO BceM MHipe. B qacTHocTH, Heo6xogHmo rIpOBecTH oLAeHotHBIe H4ccjiegBaHH5a no0X0,o,oB H MepOIIpWITrHA no CHFDKeHHIO Bpega. 4) Hyxgzpu cHcTcMr 3MpaBooxpaHeHH. BaHKy WIH jpyrnm 3aIHHTCpeCOBaHHbIM CTOPOHaM cJIejyeT HIpOBeCTH rIoJiHyio oiueHKy CHCTeMbI Ha,zg3opa 3a BW1/CfI4OM, HrHrl H4 Ty6epKyJIe3oM B IfeHTpaAbHOi A3HH. XOTS USAID/U4AP, mepe3 CDC H rpoeKT Hope, oKa3bIBaeT 3HaxiHTeJibHyio 4HHaHCOByIO H TexHH-ecKyio roggepxmcTaHe, ypKmeHHrcaHe H Y36eiKcTarHe cryqaH BW-{ 6bum e,HHHxmbIM4. OQHaKo K KoHiLy 2002 ro,ia B nHri pecry6nmKax 6bUIO 3aperHCTpHpOBaHO HOqTH 6000 BHM-HHL)HUpOBaHHbMI DiaBHbIM HOBO0OM Am cepbe3HOEi o3a6oqeHHocTH cRyKaT MapmpyrbI HapKoToproBaH, npoxoliiwe Tepe3 4eHTpajbHyio A3mo. OH4 cnoco6cTByEoT pocTiy iH beKLH0HHoro rnoTpe6nieHHA HaPKOTEIKOB B cy6-perHoHe; coriiacHo 3KcnepTHbIM oieHKaM, B peruoHe MoX(eT HaC'qHTbIBaTbC3I CBbIIIIe OInYMHJUI-OHa HioTpe6HTejiei HapKoT4KoB, H BCrIbIIIIKH CBSI3aHHOA 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 CHJIy PHCKOBaHHOrO noBegeHH4A noTpe6HTeieg HH1beKLXIHOHHbIX HapKOTHKOB (HIUH), a TaioKe H3-3a pocra xmcna UrIrIrI, PKC, MHipaLiEi H gpyrix q)aKTopOB pHcKa. B Hacroqmee BpeMA 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 BbIcoKoro p14CKa. rJnABA 2 BIVl 4I/CfnlVlgA U Ty6epKyjle3 B BOCTO0HOII EBpone U LeHTpanbHOIl A3UU BocrO-IHofi EBporie H l[eHTpaIbHoA A3HH iCncio ciry-aeB 3apaceHH BEI4 pacTer B6bIcTpee, HeM B KaKoM-JIH6o .pyroM perI-oHe mIHpa. CaMaq ocTpaSI KpHBaq pocTa BWI B MHpe B 1999 ro,gy 6bIna oTMe4eHa B POCCHACKOP (I)egepaiAHH, r,e nIpoIueHT BENH- H4H gHpOBaHHorO HaCeJIiHH YABOICSA B repHog c KOHua 1997 Ho KoHeiL 1999 roga. 3a ceMb nieT rHcno ciyqaeB BbIpOcO o 6onee ieM B 30 pa3. B 1994 ro,gy 'Hc.o gno,efi, xKHBymH4x c BHT4/CflHJIoM, cocraLsquio rIpMHepHo 30 ThIClM B pernoHe c o6auiM Hace- iieHHeM B 450 MHJUIOHOB. K KOHIy 1999 roga B BocToqHofi EBporie H LleHTpahbHOf4 A3HH fpegnoioxffHTenbHO HaCqHTbIBaJIOCb 420 TbICSN B33pOCAbrIX H geTereg xKsByIux c BHq4/CrIJ4oM. B 2001 rogy rpegonoxTeIbHo fpOH43OUJo 250 TbIc3pi HOBbIX cmyqaeB 3apa>KeHHM, B pe3yjibTaTeC ero xHCJIOno ef4, xKHyBUHx c BHH/C1tligoM, gocTIrino 1 MHJIJ4HoHa. Y 6onee em 13000 MenoBeK pa3BHCICH CrIIA H CBbIIIIe 5000 ywe yMep.no. XOTH1 B MacniTa6aX rocyrapcTB pacnpoCTpaHeHHOCTb cpeEH B3pOCjIbTX - MeHee OQHOrO npogeHTa OT o6Mero HaceieHHS - cHETaeTCi HH3KOfi no MexgyHapol- HbIM CTaHAapTaM, HaH6oJlIbMyIO TpeBOry BbI3bIBaeT CTpeMHTejTbHbIli POCT cJnyMaeB 3apaX(eHHR B noOCJICeHHe HeCKOnbKO iieT. B YKpal4He, PoccHiEcKofi (DegepaiHH, Bena- PYCH H MOXAOBe oTMemeHO camoe 6o0nbmoe qHCJIO niio,eE, AHBYWIHX c BH4/CrIMOM B perHoHe. 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XOrT cTIyqai BEH permcTpI4pyMOrCA BO BCeX o6JIaCT3HX, HaH6oJIee rOCTrpagaBIIHMH SiBjmiOTCq KaparaH,UHHcKaq H rIaBnogapcCKaq o6iiacrH: Ha HHX HIPHXOMTCI OKOjiO 70 iiPOgeHTOB cayYaeB 3aPaKeHHA BE. * -I, Ia0 .1 ILII 11 1400 1200 -____________________________ 1000 800 - //_ 600 400 200 / 0 1995 19IS 199 1998 1999 2000 2001 2002 BmL/CnfgM TYbEPKYJnE3 B LEHTPAn6bHO1 A3wm 35 1990 1995 2000 2001 2002 m4ucno yMepuwmx OT CnfuAa - 3 29 57 74 Cny4aN CnflAa - 2 8 20 85 Cny'am BM4 4 5 347 1175 735 Cny'am BM4 cpe.A nMH - 3 302 1050 Cny4am cHmupnIca 242 20235 23996 20577 3aperNcTpuposaHHble noTpe6nrenm HapKOTHKOB 10300 10900 37812 42680 45000 3aperNcrpnpomaHHble nHH 3000 4583 26087 31390 npeAnonaraeMoe 4mcno noTpe6MTenei HapKoTNKos - - 183125 180410 nlpeAnonaraemoe 4mcno ll4H - - 130800 128900 250000* nlpeAnonaraeHoe 4Ncno PKC - - - 13000 50000* npeAnonaraeMoe 4'cno MCM 20000* nlyHcrbi AOsepHR (AKT) - - 30 96 nlporpamHbl cHN)KeHKn speAa - - 3 3 nporpallbm Annm PKCIMCM - - - 2 CnfA l 4eHpbl 19 19 21 21 CoTPYAHNKH CnlL4 I4eHTpoB 213 407 458 485 PtcmowmHuK uHOpMa4uU: Pecny6nuKaHcKcii LAeHrp npo4L4naicruKM u 6opb6bl co cnfloom; *3Kcnpecc-aHanH3 UNAIDS 2002. 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CoriacHo OT TeTy o geMorpacmH H 390pOBbe Ka3axcTaHa, 17% IOHOmefi H 33% geBymeK B BO3pacTe 15-19 JIeT He 3HaIOT O TOM, Kax ripe,OTBpaTHTh npegaaMy BM-HH)eKiei4HH, a 27% MyoKtHH H 65% )KeHII;4H He HIOJTb3yioTTCSI Hpe3pBaTHBaM4 BO BpeM5 rlOJIOBBoro KOHTaKTa C HeIOCTOSHHbIMH4 napTHepaMH.L AaHHbIe UNICEF nogrBepqaioT, YTo 74% MOJIO,ZbIX nmojgef B BO3pacTe 15-29 fieT H 46% MOJIOJgbIX )KeHII;HH TOA) )Ke BO3paCTHOfl rpyIInhI OCBegOMjieHbI O rp3epBaTmax KaK O cpejgCBe npo4wiaKTiiKmi BIP-, H 54% Ka3axcTaHueB B BO3pacTe 15-49 .eT 1H3 6eAHefImix cjioeB o6iecmTBa 3HalOT O HeO6xOAHMOcTh HCIIO.Ib3oBaHHI npe3epBaTHBOB giS 3aITb I OT 3apaKeHHa 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 cJyrafiHBMH1 napTHepaMH; 58% My1C4HH H 19% KHeHHH B BO3pacTe 15-59 iieT OTBeTMJH,qTO HCHOJnb3yIOT ripe3epBaTHBbI. (UNICEF 2002). 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HaceJIieHHe He,ooiXeHHBaeT pHCK 3apawKeHH BW{, nIOCKOJnbKy RIO,4 He Bep5IT, ITO 3'Ta 6one3Hb KOCHeTCA HIX AHfqHo. B HacroAnee BpeMq B CpegcTBax MaCCOBOEi iHH)opMaWHH HeT nporpamm no BUH/CHIliAy, HO KoopJHHawLOHHbI KoMHTeT no BHM/CGf114y ninaHHpyeT HaxiaTm HHc)opMaUHoHHyo, o6pa3oBaTenbHyxo H KOMMyHH- KaiHOHHyIO (10K) KaMnaHHI,o JJ nOBbImeHHA OCBeqoMjieHHocTh o6ulecTBeHHocT. Pa3pa6oTKa flpOrpaMMbI 6bIna nopy'xeHa MxiHHcTepcTBy HHcpopMaLH, H oxa4gaeTa, WTO B CKOpOM BpMeeHH OHO HaqHeT KaMriaHHEO no BH1/CInMp;y. UeHTpbi 39OPOBr00 o6pa3a 3HHI rOpO,gOB AnMaTbI H AcTaHa oTBeqaxOT 3a IpOCBeTHTejibCKyiO pa6oTy no BOnpOCaM BUtI/cH4Ma, K ipiMmepy, 3a KOOp,HHaLHO IpOCBeTrTejibCKcHX Mepo- npHSIHil B o6nacTm oxpaHbI 3A0pOBbH B cpegcTBax MaccoBoAi IHH)OPMaiU H B c4pepe o6pa3oBaHI4A. CO3AaHxie rIyHKTOB gOBepHgi FILTH H i4py= maprmHan43HPOBaHHbix rpynn MoxKeT cnoco6cTBoBaT HOBbImIeHHIO YpOBHA OCBeOMneHHOCFH cpegI 3TEIX BbICOKO- y53BHiMbIx rpynn. 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Korga 3TH LeHTpbI BriePBbIe OTKPbLIIHCb, 6bInio oqeHb TPY.AHO BbI3BaTb K HHM OBep4e co CTopOHbI TIH H ,gpyr=X MaprHHan3HpOBaHHbix rpynn. JIIOH C BbSBjieHHOci nojioxnTejibHoH peaKuWef Ha BEUH cqHTajiHCb npeCTynHHKaMH, H B LeIoM OHHI He o6paH;aIoTcs3 3a nOMOni1bIO B CHU,i] eHTpbImH HlO. IyHHKTcI ,OBepHA OoBe;aioT o6 aHOHHMHOCTH nipni o6MeHe IIIPripieB, HO HU1H, B03MOXKHO, noKa He BepSIT B 3TO. nIYHKTbI ,OBepHA, KaK npaBHAo, pacnonaraIoTcq B 3aaHH5X IOAHKHEIHHHK, HO LUeHTpbI no 60pb6e co CHUom oM TiaHIHHpyIOT HCHOJIb3OBTb ,apyrxie niMieiTAeHHH, HanpHMep, anTeKH, ji5 co32gaHH5 nporpaMM o6MeHa Hri. KpoMe Toro, Heo6xoNIMo npOBecT HoeHKy rlHKTOB )OBepHH H CpacmHpHTh MaCifTa6Hx gerTesnbHOCTH, xrro6bi oxBaTHTm 6ombiiie noJIb3oBaTejiefi. DPoHA Copoca/UO npoBei Hccjie,goBaxiHe c iueJIbIo onpe,eAnhTb oXBaT H 3cjeKTIBHOCTh 3THX nporpamm ff BbICOKO-y3I3BHMbIX rpynn B Ka3axcraHe. B 2001 ro,gy 6bulo po3glaHO OKOJIO 1 MHJIIOHa IIipHUlCeB H npe3epBa- THBOB, OAHaKo nIHIb 10 IpOiLCHTOB OT npegnonaraemoro qHCjja HUH (250 Tic5q) H PKC (50 Ticxq) IHMeIOT AOCryn K 3THIM nporpaMMaM. CeTb HapKOjiOrH'meCK=X gM4cnaHcepOB 3aHHMaeTcS .qIeqeHHeM H pea6mmagHegi HapKo3aBHCHMbIx, O,txHaKO 3TH rporpaMMbI He cnoco6Hbi npegocraBHTi ,OCTaTOqHbH o6'beM yciyr pacTyMeMy MHCAy IHUH; OHH TaioKCe B HeOCTaTOwHOf CTeneHH HHTerpPHOBaHbI B CHCTeMbI HaA3opaM Hn B nporpammbI ,Z1KT. BW4/cnfgJ M TYSEPKYJ1E3 B LAEHTPAJ1bHOI A3mm 41 BonpoCbu npodUnfaKmuKu, OIuaMocmuKu u ne'feHuA HalHOHaJIbHbIA iueHTp no 6opb6e co Cr,IMOM IHIb HegaBHO ycTaHOBIVI KOHTaKT C Ko;KHo-BeHepojiorH-iecKHMH IHCnaHcepaMH, KOTOpbIe npOBOgsT IHarHOCThKy H jieqeHHe IrII. OAHaKo cymgecTByeT MHOxKeCTBO npo6neM npH oKa3aHHH 3ThMH yqpexqeH mm yciyr rpynnaM BbICOKOrO pHCKa, TaKHM KaK PKC, H Y53BHMbIM rpyiiriaM, HaripHMep, MojJoge,. KpoMe Toro, oHm noKaHe corniacyior CBOH .ehcTBHA c I4eHTpaMi no 6opb6e co CrHIIoM HqpyrHMH opraHH3aLJHsIM43aHHMaIOigHMICSC npocpHnaKTHKofi BfPf/CIIIAa. B 1999 rogy 6o0nee 19000 naLpeHTOB c paHHe$i cTagmei cEI4HJ1Hca 6buIm roCrHHranH3HpOBaHbI, oTO COCTaBHAO CBbIme 400 TmicAi KOciKo--Hefi i4 npIHBeJIO K HeHyxHbIM 3aTpaTaM Ha MegHLAHHCKHH YXOJ Ha MHOrO MHUHOHOB .onnapoB. B cooTBeTcTBHH C MeexIyHapo,HbIMH npoToKOjiaMH, naiHeHThI c nepsBHM- HOfk H BTOpHqHOi cTa,HeEi cH4EJIEHca HyxqaIoTCA JIHmb B CTaLUHOHapHOM jieqeHI4. B 1999 ro,gy MeHee 30 ipouieHTOB 60JbHbIX CH14HJHCOM o6paTMlOCb 3a nOMOnIbIO B KOAKHO-BeHeponorawcmKHe ,JcrnaHcepbI; MHOrHe naLAHeHThI n1oiywaioT aHOHHMHoe ieMeHie 6e3 roCmnTanI3 aH, XOT71 OHO EIM ,Aoporo o6xogiffcq. Korgaa TaKoe nieqeHie npOBOM,HTC. BHe CHCTeMbi o6iAecTBeHHOrO 3gTpaBOOXpaHeHHA, OHO HaHOCHT cepbe3HbIA ypOH CKOOPAITIHHpOBaHHoMy no,xo,1y B iiexeHHH 14EIlIfr. rlOx,axO o6r4ecTBeHHoro 3,ApaBooxpaHeHH5I Tpe6yeT OTCjieXKBaHHA KOHTaKrHbJX JIHUL H HX iexeHH5; OH TaioKe MO)KeT CJInYGTb MOCTHKOM K go6pOBOJIbHOMy TeCTnpOBaHHIO Ha BHITI IIaLWeHTOB c 14flrIrI. B qacTHocmn 6onbHbIe CHcHJHCOM noABep)KeHbI oqeHb BbICOKOMY PHCKY 3apa)KeHNA BI, HpH4HHMZa BO BHHMaHH4e OTCyTCTBHe npaKTrKH 6e3onacHoro ceKca, a TaioKe 6HoAorwIecKyio y313BHMOCTh, co3gjaBaeMyIo q3BeHHbIMH nOpaxeHEHHIMHr npEi ciH4HHce. Oxa4gaeT.r, Trro ciryw6bI penpo.yKTHBHoro 3gopOBbA H UeHTpbI CeMeiHOi Me,lUlAHHbI TaioKe 6yjRyT HrpaTm pOnb B npo4EmaKTHKe B1I/CrILma, HO On3rrb-TaKH, HHTerpaISI IH COriiaCOBaHHOCTh C HaUHOHajTbHOr4 nporpammog OTCyTCTByeT. MpH noggepxuKe USAID meyHapoHaA opraHH3auiA "Cryxc6bI ,M HaceIieHHA" (PSI) Haqa,ia nporpammy "Couiia.nbHbfi MapKeTHHr .u npo4 UaKTHiKH BII-IHHceKiwH H BeHepHtieCKHX 3a6oneBaHi49". B paMKax 3TOI IIpOrpaMMbI B Ka3aXCTaH nocTaBJIMeTC' OKojio 5 MHJI4HOHB npe3epBaT4BoB. MacTi hix 6ygeT 6ecruiaTHo po3AaHa iiHiAaM, BXOAHUIIHM B rpynnibi pi4CKa; OCTanbHbIe 6yAyr peanEH3OBaHbI 'epe3 anTeK4. CTOHMOCTh npoeKra cocTaBJieT iiMpHepHO 1,5 MHJIoHa ,ojnapOB CUlA Ha ABa roga. HTO KacaeTC5 BOIIpOCOB .ieqeHHSA, oxu aeTcA, MTO 6oJIbHiw, Ty6epKyjIe3HbIe H OHKOIorlmHeCKHe nciaHcepbi 6yAyr o6ecnreqHBaT jiemeHe onrnopTyHHcTH'ecKH4X 6one3HeAi npi4 CrIJAe Hi namiHaTHBHbrI yXO, 3a HeH3jiexiMo 6OJIbHbIMH4. AHTHpeTpoBHpycHbIe npenapaTbi CT0IT OAeHb ,goporo, a iieqeH4e npOH3BODHTCA Ha nTaTHoii OCHoBe. TonbKo geTH go 15 .neTr H HH4,HHPOBaHHbIe 6epeMeHHbIe XKeHI4HHbI MOryr noryoiaT aHTHpeTPOBHPYCHOe hle-'eHHe 3a C{eT roCy,gapCTBeHHOA CHCTeMbI 3,lpaBooxpaHeHH5. AejemenbHocmb HnO u napmHepos rIpaBiHTeTIbCTBO HamepeHO HOBbICHi-b yqacmEe rpaxgaHcKoro o6iIeCTBa, BKrnoia1 HrO H qaCTHbIA CeKTOp, B peajiH3aLim riporpammbi no BWI/CrIMy. OgHaKo HpaBHTelb- CTBO IOKa He MO)KeT HaHHM4aTh HHO gim IPOBegeHHA pa6oTmi C YI3BH4MbIMH rpynnamH H rpynnami4 pHCKa, KOTOpaA ocymecTnBmeTcs CHI,J-ueHTpoM npH nogvepwKe areHTcTB OOH I4 MeyHapO.HbIX HrO, TaKi4X KaK DonHg Copoca/1400. TeM He MeHee, MI4HI4cTepcTBo 3ApaBooxpaHeHH He,gaBHO ycTaHOBHInO KOHTaKT c gByMA MecTHbIMi4 HrIO ("PaBHbI4 paBHOMy" 4 "BocToK-3anag') guI o6cgeHrn coTpygHIHeCTBa meXgy CMIJA-L-eHTpaMi4 I4 HUO. MecTHbie HUIO XOTeJIii 6bI IMCeTb B03MOXKHOCTh yJIy4U4Tb B3aHMoAeI4cTBiHe iH coTpygHiH4ecTBo MewAy 3THMI4 opraHI43aiHiMmH, HO Ha KOOpgHHa- UIH4HHbIe yCHHH He xBaTaeT cpegCTB. Bce areHTCTBa OOH OKa3bIBaiOT nogep;cKy 42 PAGOLWI ,AOKnAA BCEMIPHoro BAHKA rpaBHITeJIbCTBy Ka3axCTaHa - TexHHrqecyO H 4)HHaHCOByIO - B peajnl3arnH mep no ripoc)maicmxe BM/CII4,TJAa. B qacmocTm, UNAIDS oKa3bIBaeT IIMOMOb rlpaBHrTeAb- CTBY B Boiipocax nOAHTHKH. BaHK H rpaBHTeejbCTBO B Hacrosrnee BpeMSA rpOBOg1T H3y,qeHHe pa6oTbi cnyxc6 no BWI/CrIMy H HrIrIn B paMKaX HporpaMMbI CecKTOpHbIX HccIiegOBaHHE, C0BMeCTHo c)HHaHCHpyeMOA BaHKOM H HpaBHTiejbCTBOM. Ho MHeHHIO ,gpyr4x riapTHepOB H RHO, BaHK Mor 6bi npHHAITh yqacTe B CoCTaB)IeHHHI 3lHmeMHO- jiorHqecKHx H- 3KOHOMWiieCKHX fpOrHO3OB 3Ig1eMHH 1 OlKa3aTh IIrOMOMb B pa3pa6oTKe CHECTeMbI Be,HeH cnyqaeB HrIyrm, a TaKoCe KmHHHqeCKHX npOTOKOnOB no npoc)HnaK- TMKe H .ieqeHmio BWI/CrIHia. Cpe, HanpaBjieHHiE, Tpe6yio[WHx gOnOYIHITeJIbHOh cpEHHaHCoBof4 nogeepAmc, 6buIa TaioKe Ha3BaHa 3aKynKa MegHKaMeHTOB. 4OUH0HCUpoeaHue B 2001 ro,gy rIpaBHTejibcTBoM 6buLo Bbi,enIeHo oKono 370 MHJUIHOHOBg ojiapoB Ha HybI 3gpaBooxpaHeH (oKo.no 25 gojvapoB Ha gymy HaceIieHHI B ro), a pacxogbi HaceneHHA cocraBrv 28 MHAHOHOB qojiAapOB (oKo.no 2 JojUapOB Ha qejioBeKa B rog). 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OgHaKo BbigeiieHHbIe cpe,gcTBa q1aKWiqecKH Bb,IruaMeHbI He 6bIHm H, 6o0IbnHcrTBo perIHOHaJbHbIX LueHTpOB 6Opb6bI co CHLaoM BepyT CBOH nprpoHInaKTHEecKRe iporpaMMbI 3a CqeT rpaHTOB, 1OCTynaioII4x OT HrIO H ,AByCTOpOHHHX opraHH3aHA. rHo OiUeHKaM rIpaBHTenbCTBa, qHHaHCHpOBaHHie riporpamm 60pb6b c BH/CrlH,IOM B 6JmDcaEime TpH rozga cocTaBT OKOJIO 1 1 MWHIHOHOB gonIapoB H3 pa3HbIX HCrOqHHKOB, HO B 2002-2007 rogaax noTpe6yeTcs gOHOJIHHTrejIbHoe qEHaHCHpoBaHHe. o03ToMy npaBHTej¶bcrBO, qepe3 KoopgHHauioH- HbEk KoMHTeT, HaripaBHIO B 1DCTM 3aqBIKy Ha rpaHT B pa3mepe 23 MHJEIHOHOB AojIapOB Ha 6opb6y c BHH/C1HJoM H4 ,AOIIOrJIHiTejibHO Ha 4,5 MHAJIHOHa ,goJiapOB Ha 60pb6y C BHH/Ty6epKynIe3oM Ha npe,AcroAne nam jier. rno6anhHbIA q)OH, coriiacHIcS Bbi,gIejiHTh 6,5 MJIH. gOJiaPOB Ha nepBbIe gBa rogaa. HIIO H g1pyrHe MevyHapo,AHbIe opraHH3aI4HH TaioKe npe,IoCTaBJuIiOT 3HamH- TejIbHLIe 06'beMbI c)HaHCHpOBaHHAI Ha nporpammbi npocpiaKTHIKH BHI/CcnThJa. AreHTcTBa OOH 4qIHaHCHpyiOT nporpaMMbI no npo4iuiaK-rHKe BH{/CrHAa H nponaraH,ge 3,gOpOBoro o6pa3a )KH3HH4 CTOHMOCTbiO OKOJO 830 TbIC. AoJiapOB CIIA. B 1998-2001 rozax qLoHA Copoca/14O BnioxGc 600 ThIC. gojvapoB CMlA B ripOrpaMMbI CH1DKeHHHA Bpega, H 3TO noMoraeT no,gepXcBaTm pa6ory 6onee 90 rIyHKTOB gOBepE4A B 2002 rogy. 3TH npeBeHTHBHbie riporpaMMbI pacHIHpAioTC5I nO BCdei CIpaHe. USAID peajHi3yT B Ka3axcTaHe ripoimnaKrmHecKy-o nporpammy CTOHMOCThiO 6,7 MHJUIHOHOB ,oJuapOB CIA, B pamKax KoTopofi CDC noMoraeT pa3pa6aThIBaTh meponpHwrim ,03OpHOrO 3rIH,HaA3opa. Cioga BXO0HT 3HaHiTejibHbli obem o6yqemHbM giM COBepmIIeHCTBOBaHHSI c6opa ,raHHbIX, ynpaBieHi4i H nOBegeHqecKHx HiCCjie,OBaHHH. MewzyHapoAHa5i opraHn3aunm PSI (Population Services International) npOBogEHT coL1HajibHbIi MapKeTHHr npe3epBaTusoB H HOK UNICEF ocyIUecTB.IeT nporpaMMy CTOHMOCThiO 4,5 MHJIJHoHa gonnapoB CMlA Ha nepH,og 2000-2004 rr., HanpasneHHyE Ha noRpepaHm pa6OTbI C geThMHi H MofIo,Cexbio, Ky.a BXO,HT nIpeBeHTHBHaS H npOCBenTTfeJIbCKaS pa6oTa no BHH/CrIHImy. Ty6epKyne3: 3nmAemonor"meCKam cHTya4Lim Yr4ep6, HaHOCIHMblr ly6epicyne3OM B Ka3axcTaHe, 01H H3 CaMbIX TSDKejIbIX B LjeHTpaJibHoA A3HH; Ha KOHelu 2001 roga 6bmo 3aperHcTpHpoBaHo 48701 cnyqafi aKTHBHOH cpopMbi Ty6epKyne3a. Kaxigbig roz 20-2 5 ThIC HqejiOBeK 3apawa1cTCH Ty6epKyne3oM, H OT 4 go 6 TbICAi YMHpaIOT OT 3TOfi 6o0e3HH. Mexsy 1990 H 2001 BH4/cnlmgI1VIV TYSEPKYJ1E3 B LAEHTPAn1bHOOI A3im 43 1990 1995 1996 1997 1998 1999 2000 2001 CMepTHOCTb 1061 26,4 34,6 37,7 38,4 30,7 26,4 24,5 PacnpocrpaHeHHoCrb 270,4 235,9 301,2 328,4 BmRBJeHme cny'iaeB 65,8 67,1 82,5 91,3 118,4 141 153,2 155,7 CpeAH AeTeÆ 23,2 20 50,9 48,4 % 6a4KnnnoblAenmTeneiA (BK+) 31 31 39 39 4Cmo.lHUwC MMHmCTepCTBO WPaBooxpaHeHmm. rogaaMH oc)nianbHbIe HioKa3aTenjl HOBbIX cjiyaeB 3a6oneBaHH Ty6epKyjie3oM H4 CMepTHOCTH B Ka3axCTaHe BbIpOCJIH B 2,4 pa3a (Ta6&nHia 10). PacnipocTpaHeHHocTb Ty6epKyjie3a B pa3jiWEHbIX o6nacTrax Ka3axcTaHa pa3aIMnHa - OT 12 1/100 Tbic. HaceieHu ,go 308/100 Tmicsq. (ra6jmLma 12). rIociie ycneieIHoro BHegpeHHH HaIIHoHajIbHOi cTpaTermu DOTS (BHegp5eTcI c 1998 roga) floKa3aTejib yCHrieHOCTH neMeHH BbIpOC ,Ao 83% B 1999 H 2000 rojaax, a CMepTHOcTb OT Ty6epKyTe3a CHH3HAaCb Ha 36% K 2001 r. nocnie lnHKa B 1998 ro,Ay. HamiiHaA C 1998 ro,ta TeMnI pocra HOBbIX c7ryaeB Ty6epKy.ne3a 3HaMHTejIbHO 3aMegvIEJcA, XOTH rIOKa3aTejIb 2001 rogaa ocTaBancq caMbIM BbICOKH4M B cy6-permoHe. rlo OiACHKaM USAID/CDC, peaH3jm a cTpaTerHH DOTS B Ka3axcTaHe cnacna ipMepHHO 13000 X3HeA 3a HepHi,o c 1998 no 2001 ron. 143-3a neperiOJIHeHHocTH, ruioxoAi BeHTHhImHH H IInoxoro InITaHHH B TIOpbMaX qHcuIo 3a6oJIeBMHIX i CMepTHOCTb OT Ty6epKynle3a cpe,z 3acnuoqeHHbix 6bTIH 3HaqTCejnbHo 6onee BbICOKRME-, ieM cpeg- rpaxc,iaHcKorO HaceiieHHS (B 30 H 9 pa3 cooTBeTcTBeHHo) (Ta6rn-ra 1 1). OgHaKo 3TH Ll4)pbI rOBOPHT 0 3HaqHTejibHOM y"yiIIeHH CHTyaLHH no CpaBHCHH1O C 1997 rogoM. 41HCJIO 3aperHCTpHpOBaHHbIX HOBbIX cryqaeB H CMepTHOCTh B T1OpbMaX COKpanTHMHCb Ha 61% H 85% cooTBeTCTBeHHO. MHHHcTepcTBo lOCTHL4HH, B BeeCHmH KoroporO HaXo,lHTCA TlOpbMbI, paciueHHBaeT TaKoe nOJIO)HTfeJIbHoe H3MeHeHHe KaK pe3ynbTaT BHegpeHH5 cTpaTernn DOTS B TiOpeMHOA crCTeMe. XoTH Ka3axcTaH ycneMHo BHegpHJi H B HaCTOHrAee BpeM peani3yer cTpaTerHio DOTS, MyjibTHpe3HICTCHTHa cpOpMa Ty6epKy.Te3a (MITB) no-npexKHeMy BbI3bIBaeT 6o.bImyIo o6ecnoKoeHHocTm C nO13HUH$ o6gecTBeHHoro 3glXpaBooxpaHeHHH. XOTH gaHHbIX HaUwoHaIbHoro MacnTa6a o iieKapcTBeHHOA yCTOAlI1HBOCTH HeT, coriacCHo oiAeHKaM, YCTOqHBbIe cpOpMbI Ty6epKyine3a cocTabJSioT pHMHepHO 10 ipoLUeHTOB Bcex cnyqaeB Ty6epKyRe3a c rojoI0,KTejIbHbIM aHaIH3oM Ma3Ka MOKpOThI [6aIHMnoBbwrejiirreniH]. B03 H MexyHapOgHbIi C0103 60pb6bI c Ty6epKyjie3oM H JneroqHbIMH 3a6oAeBaHHHMI (IUATLD) CxHTa1OT CTpaHbI H perHOHbI, rge MJYTB Ty6epKyne3 B TiOpbmax, Ka3axcTaH (a6conloTHoe 4Mcno u nOKa3aTenb Ha 1 00 TbIC.) 1997 1998 1999 2000 2001 lNcno yMepwHx OT ry6epKyne3a 1302 1218 345 175 174 CmepTHocmb OT Ty6epKyne3a 880 820 300 140 130 PacnpocrpaHeHhocrb 11903 12970 13697 10061 8060 HoBble cny4aN ry6epKyne3a 5555 5061 5591 3434 3038 lnoKa3aTenb BblABneHuR 5591 4268 2995 2515 2210 MCTO4HlUK: CDC (2002) CeTrb opramli3aLm4A no 6opb6e C MHH)eKVMOHHbIMmm 6one3HAMM B L.eHTpanbHOA A3UU. 44 PAro'-IwrI gOKnAg BCEMHPHOrO SAHKA ,~ W . ripeBbIuIaeT 5 npoiieHTOB, rOpR.HMmH TOqKaMH. PacnpOCTpaHeHHOCTb 1aHHbIe HaiWoHajibHoi CnpaBOHOfi jia6opaTo- Ty6epKyne3OM no o6nacTnM pHH 3a 2000 ro,a noKa3bIBaIoT, xTO ypOBeHb (Ha 100 TbIC. HaceneHI4) MJ B B o6iiacr5ix KoJIe6JneTcI OT 9 go 22 ripoUeHTOB, rpIH AOCTraTOHbIX 3nmeMmo- O6nacTm 2000 JIorH'ecKHx gaHHbIX (Ta6Ima 13). 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AnmaTbi 36,5 16,2 39,9 19,2 38,9 18,2 Cemepo-Ka3axcraHcKaR 58,1 9,8 63,6 21,8 61,4 42,3 lOKHo-Ka3axCMaHCKaR 37,1 7,5 37,8 9,2 37,7 8,9 Bocro4mo-Ka3axcraHcKam 44,2 6,3 90,0 27,8 71,3 19,1 KaparaHAHuicKal 56,9 10,I 70,8 22,3 64,5 16,8 KycTaHaAcKai 21,8 5,5 63,4 13,5 50,8 11,0 r. AcTaHa 72,9 13,9 87,7 48,0 39,4 5,5 AKMOnmHCK8R 39,2 6,7 55,8 10,5 46,7 8,4 )KaM6bincKan 12,6 - 82,6 2,0 37,0 1,0 AThipaycKas. 26,1 - 57,4 6,4 33,9 1,9 3anaAHo-KaaXcTaHCKaM 86,2 10,3 87,0 14,2 87,2 13,7 namnoAapcKaJ 78,8 12,1 93,7 34,4 91,3 30,8 AwnIo6HHCKaM MaHrmcraycKan 72,2 25,9 86,8 26,2 80,0 26,1 K3binopAnHcxan 33,0 16,8 21,1 34,3 73,6 22,9 Ka3axcrau 46,2 9,7 62,7 18,3 lCmOo4HUK: Ha4UOHanbHbIg Hay4HO-mCCneAOBaTenbCKiU U4HCTMTYT Ty6epKyne3a (2002). BMH/Cnfg M TYSEPKYJ1E3 B LAEHTPAJ1bHOI A3mm 45 B Mae 1998 roAa ripe3HgeHT Ka3axcTaHa Ha3ap6aeB gwan yKa3, Tpe6yIoMlH4 BHe,peHHs DOTS no BceP Pecny6rniKe H BbeIieHA cpezcTB rocyapCTBeHHOrO 6iopKe'ra Ha 3aKyrucy npoTHBoTy6epKyjie3HbIx rperapaToB. IoTpe6HOcTb B npenapaTax nepBoro pzAa onpegeuieTCA KanxKbIe nonroga nyreM MOHiTOPHHra 3anaCOB B KaKwgOM ixeMe6HoM yqpe)EaeHIH -iepe3 KOMmBrboTepH3OBaHHM cCHcTeMy, geAcrByiouWo no Bcefi cTpaHe. CornacHo npe3HgeHTCKOMy yKa3y, HpaBHTejIbCTBO Ka3axCTaHa rHiHHmmO DOTS B KaieCTBe OdH4imajIbHOf cTpaTermn cTpaHbI Ho 6opb6e c Ty6epKyne3oM. MHHHcTep- CTBO 3gpaBOOXPaHeHH5 oTBeqaeT 3a Bce MeporipHITHAl, CB3aHHbi c Ty6epKyAe3oM, a HayqHo-Hcc.iejoBaTejIbcKxif HHCTHTyr Ty6epKyne3a peani3yeYT H KOOpgHHHpyeT c-paTeri4io DOTS. Bce iporpammbi DOTS, BMinoqag H Te, KOTOpbIe IpOBO,gHT HrIO, yrnepxcAaioTcs HHCTMTyTOM go HX BHe,peHm5. nompe6Hocmu f macl3ope u aononHumenbHbIe uccneaoafHuR 3ieKTpOHHOe Ha6JKogeHHe 3a cuyqaAMH Ty6eplcyTie3a no3BojSeT JioDLaM, IpHHHMaio- ]4MM norioHnTHecK"e pemeHHA, rnoJiy'aTm AOCTOBepHbIe aHHbIe, 6bicrpo aHanJH3HpoBaTL TeHCeHUHH 1 IIpHHHMaTh lHHqOpMHpOBaHHbme peueHms. 3jieKmpOHHa5I CHCTTMa HaA3o- pa 3a BegeHHeM HHHBH,yaJbHbIX cJyqaeB (3CHHIC-ESCM), pa3pa6oTaHHas IpH cO- gefcTBHiH CDC, 6bm1a BBegeHa B AeficTBMe no Bcefi cTpaHe, a 6a3a gaHHbix 6bula co3gaHa B srHBape 2000 ro,a (6onee 65000 c.7y-4aeB Ty6epKyne3a). CHcreMa noinocTsIo coBMec- THMa Kax C C eCTeMOA Hag3opa B03, TaK 14 c cH4cTeMoA Hag3opa COBeTcKoro Tmna. OgHa- KO HeAcHo, ioAepBaeT 3m MHHHcTepcTBo 3ApaBOOXpaHeHH51 3TY CH[CTeMy go CM4X nop, HAM e OHO BepHyJIOCb K iipe)H)e COBeTCKOfi CHCTeMe Hag3opa. 3Ty CH[CTrMy Heo6xogi4Mo 6ygeeT pacmi4pHb, 'rro6bI OHa TaioKe Biuoqania TeCr Ha .ieKapCTBeHHylO yCTOfrIMBOCTh A,i onpe,AejieHH5 BO3MOmKHOCTm rIpHM4eHeHHSH riOXOgOB DOTS-nrnoc EK .neqeHMo ycToxmBb1x qopM Ty6epiynie3a. Heo6xogHMbI orno.niHieremHbie iCcjiejoBa- HE11, 4TO6bI oipeguenmT,B SbJioTc5I 31I BbICOKELe roKa3aTeJIH MJIY- Ty6epicyne3a H BEM- H4eKLUm npripwHog 7-9 npoiLeHTOB He6JiaronpHErTHbix MCXOgOB neqeHm no crCTeme DOTS, a TaKxce npiwEnHHofi 5-nposleHTHoA CMepTHOCTH OT Ty6epKynTe3a. B pamKax nOninnimrecKoro lmanor-a IH oTpacneBoii pa6oTmi, COBMecTHo qMHaHcMpye- MOfl HpaBHITeJICTBoM H4 BaHKOM, B HaCTOqmITee BpeMq npOBO,MTCH yrTly6JieHHoe H3y"e- HHe HauWoHaibHofi nporpaMMbI 6Opb6bI c Ty6epKysie3oM. 3'To Mi3yqeHMC BK:1inoqaeT aHaJIH3 3nrugeMHojiorHrqecKHx gaHHbIX, o6cJiegOBaHHe MegmEWHCKErX y"peqeHH1, a TaioKe inpoBegeHHe (OKyC-rpynnOBbIX ,MCKyCCII C laUWeiHTaM- Ha MeHmepa6oTHmKaaMH. Bonpocba npolunjaKmuKu, 8UGzHOCmUKU u ne.'eHUA Bcneg 3a BBeAeHemM B 1998 ro,y crpaTerim DOTS, K 2000 rogy ee oxBaT 6bIcTpo pacnpoCTpaHmc3i Ha BCIO cTpaHy, xTO 3Ha-nHTeJIbHO IOBJIHSIO Ha 3iaimeMHOnOrH- qecKyMO CTyragUHO B Ka3axCTaHe. YpOBeHb CMepTHOCTM cpa3y CHH3HJICS, a pOCT qHcJIa HOBbIX c.y'aeB 3aMeXpm1 cA. OgHaKo noKa3aTenb ycneinHoro niexieHm eige He AOCTH4r 85%, 'TO ABnHeTCH1 uejibio BO3. 3HaxiHTeIbHoe CHHXKeHHe cMepTHOCTM H q4cjia HOBbIX cJIyQaeB B pe3yJIbTaTe BHegpeHHH DOTS B TnOpeMHOA C14CTeMe rogqePK14BaeT BaKHOCTh HenpepbIBHoro CHa6>KeHEi4 npoTHBoTy6epKyne3HbIMHi npenapaTami H ne iienHi oCBo6oxIgaeMbIx 3aKnioqeHHbIx B Ka3axcTaHe. 03a6oxeHHOCTm BbI3bIBaeT BOnpOC 3q4eKTHBHOCTH McnOIb3oBaHEHl MMeIOmMXCA pecypcoB H AOHOpCKOrO cJJHHaHCMpoBaHHR. XOTA HagHOHaJIbHa5I nporpamma 6Opb6bl C Ty6epKyne3oM Ka3axcTaHa 3aHBAHeT o IP4BepeHKIHHOCTMnf CTpaTeC4II DOTS, BKJnoqasi raCCHBHoe BBmiiBeHMe n-yrem 6aKTeepHocKonwmecKoro aHlaH3a MOKpOTM, B CTpaHe no- npe>KHemy tpe3MepHo H4 6e3 Heo6xogHMocTR ripMiH1eiTCcA MaCCOBaA peHTreHocKoriHA (Ta6nHiL4a 14). B 2001 rogy npEMmepHO ,Be TpeTH BcerO B3poc.iOrO HacenJeHHA rIpOmnH CKplHHHHr, H4 6buio cgeiiai-o CBbIIUe 5 M14MHJLOHOB peHTreHOBCKMX CHHMKOB (MMc1), T.e. 517 CHHIMKOB Ha KawKAbIf BbIqBjieHHbIHr c7yMaEr Ty6epKyie3a. B 2001 rogy 6bIno 3aKyri- 46 PASOL4 gOK:I1Ag BCEMIPHoro EAHKA 1990 1995 2000 2001 Ty64ncnaHcepbi 350 345 341 334 CaHaTopHm 39 34 30 32 T5-Ka6uHeTmi lnyHKTbI b o6blHHblX ne4e6Hbux y'penmAeHHnx 127 136 159 147 KONKH Ann 6onbHblX Ty6epKyne3oM 19815 15733 13490 13522 KOIKH a caHaTopmHNx 5925 4541 3843 4040 Bpa4n-4rTN3naTpbl 1522 1280 1305 1346 KOHKO-AHN (TblC.) 5787 4674 4329 4477 CpeAAHn npoAonflCTenbHocrb rocnwran3san"n 128 120 97 92 Xnpyprn'ecKme nmewaTenbcrBa 199 1255 1565 0Oniooporpa4n'aecKne annapaTmi 604 659 545 601 L4n¢poBbie 4)niooporpa4)n4ecKme annapTmi 30 PeHreHocKonNqecKoe NccnegosaHme (MM(P) 6965 6803 3892 5177 % HaceneHHR, npoweAwnx peHTreHocKonwio 42 41 26 35 BaK4AHHai4m N peBaK4HHaa4m 5l14)K (Tbc.) 662,8 698,7 404,8 411,3 Ma3KN MOKpOTbl Ha *bulcneHHe TS (Tblc.) 1046,6 1016,9 AHanH3 KynbTyp MOKpOTbi (Tbmc.) 334,9 261,1 AHanK3 MOKpOT Ha 4yBCEHTlenbHocrb K IieKapCTBeHHbIM npenapalmm 10001 11107 McmowHuIc MmHmcTepclmo 3ApasooxpaHeHKfl. JneHo 30 LcIpOBbIX qpnooporpawHmecKHx anrapaToB. rIpH alHla0orHbIX noKa3a- TCTLqX ycnIeiiHocI jieqCHH5A B Ka3axCTaHe H KbIprbI3CTaHe, cpeAHAII HpOrOAXGKTeIb- HOCTh HaXOxeHHA5I B 60JIbHmlue ogHoro nponeqeHHoro alUHeHTa B Ka3axcTaHe 3aMeTHO BbIIIe, qeM B KbIprbI3CTaHe: 92 iH 74 gHI COOTBeTCTBeHHO, 4TO rOBOpHT O 'Ipe3MepHoM iHcIOJIb3OBaHHH 6o0bHIwqHbIX yqpewAeHEI4 B Ka3axcTaHe. B Ka3axcTaHe noKa HeT HaUHOHaJbHO$A nporpaMMbI 60pb6bI c MJIYTB. IAMeIoTcs riojTBepA) eHHbie AaHHaibie o TOM, -rro 60-80 npOUiHTOB 6OmbHbIX MyAbTHpe3HCTeHTHbIM Ty6epKyne3oM Mo)KeT 6bITb H3iieqeHO rIpH npaBHIbHOM BqaeHHm cJiyqaeB, OCHOBaHHOM Ha HCHOJHb3OBaHHH npenapaToB BToporO H Tpembero p3iga (DOTS-runoc). Hagnewcauaq mHmerpauH CTpaTenm DOTS-rnoc B HaLwoHaIbHyIO nporpammy 60pb6bI c Ty6epKynie- 30M B Ka3axcTaHe ripegCTaBiSeeTIc OnpaBgaHHO0. O6ecnoKoeHHoe MacmTa6oM npo6ne- I MbIYTB H ee nOcjiegCTBHqmiM, HlpaBiTeJTbCTBo npeAnpHHniO cnIeAyioie MepbI: (1) co3,aaio qeTmipe EioTHbixy'yacTKa xvm peaJM3aLwm DOTS-rbuoc (USAID/IJAP, Mepe3 npoeKT HOPE H CDC, co3,ano gBa AOflOJHTJIbHbIX mwioTHbix y'acTKa); (2) cocTaBHno 3afSBKY B KomHTeTr "3eieHoro cBeTa" B03 Ha 3aKynIKy npenapaTOB BToporo psva no 6onee HH3KHM ilCHaM; H (3) HCrIob30BaJo 3aeM BcemHpHoro 6aHKa Aim npHo6pereHrm npoTh- BoTy6epKyjie3HbIx npenapaToB, TpaHCnOpTHbIX cpeACTB Avim o6nacTHbIx Ty6,grHcnaHce- pOB, jia6opaTOpHOro o6opygoBaH1Hs H pacxojHbix MaTepaHnoB H co3gaHH5 HawHO- HaJIbHOA crIpaBo-iHoA nia6opaTopHH no Ty6epKyjie3y C no.iHbIm Ha6opoM o6OpyAOBaHinI AJii HpOBegeHHR aHaHJ13a Ha yBCTBHTejibHOCTb K ripoTHBoTy6epKyjie3HbIM npenapaTaM. Hqemipe mionOTHbIx ytacTKa (CeBepo-Ka3axcTaHcKaA H IOX(HO-Ka3axcTaHcKa3i o6iiaCTH, ropoA AnMiaTbi H HaUHoHajibHbIf iLeHTp 6opb6bI c Ty6epKyAe3OM) B HacToAIree BpeMA npoBoaT ,AHarHOCTKny Hi Iie-ieHHe MIYTB; B 2000 rogy OHH OTcjIexGmB3Am B o6igegi CwioxHocm 300 naiwexirroB. B 2001 rogy, npEI coge2CTBHu USAID, 6bUnI co3,aHbI eige ABa uvIOTHbIX y'acmAa iiS neeHm MJJYTB (AKTno6miHcKasl H KaparaHAirHCKaA o6naCMT) B pe3yjibTaTe iero B 2001 rony KomJI'ecTBo B351TbIX Ha y'eT naWeHToB cocra- BVq/Cnlg1 M TYSEPKYJ1E3 B L4EHTPAflbHOI A3mm 47 BHTo 400 TiejIOBeK B 2002 rogy rIpaB nebcTmo Ka3axcraHa o6ecnewimo ripenIapaTamH BToporO p3wa euie iniecT o6niac-refi (BocrotIHo-Ka3axcTaHcKyo7, )KaM6bIicKyIo, 3aria,qHo- Ka3axcTaHCKylo, K3bmuiop,mcKyio, MaHrbicraycKyIo E' rIaB.no,apcKyfo) TeM CambIM gono.n- HHiTeJbHo oxBaEniB 1300 6oJbHbIx MJIYTB. B 2003 ro,gy IIpaBTeirbcTBo rulaHHpyer pacumpb .neeqeHHe MTYTB ,Aim oxBaTa Bcex perEOHOB cTpaHbI. IlpaBHTeJIbcTBo 3aKynaeT npeIIapaTbi BToporo pla gVH rIIHJIOTHbIX npOeKTOB C 2000 ro,za. OAHaKo ,gni 6bicTporo pacripocTpaHeHHA riporpamm JieteH4IA MJIYTB He XBaTaeT ,AOJDKHOfi KJHHHiecKofi riO,rOTOBKH, .na6opaTopHoro noTeHLUHana gui aHaJUl3a x1yBCTBHTeJIbHOCTH K nperiapaTam H XopoIuHX pe3yJIbTaTOB peaJIH3atWHH cTaH,TapTHbIx HIPOTOKOJIOB DOTS. nIO3TOMY B03MoKHoe pa3BHTHe yCTOfNlHBOCTH K ipenapaTaM BToporo psga BbI3bIBaeT TpeBOry. OAH14M H3 HaH6oAee BaKHbIX BOIIpOCOB 3iBjU1eTCA oTcyTCTBHe B Ka3aXCTaHe HayqHO o6ocHoBaHHbix jiete6HbIx IpOTOKOJIOB, a TaioKe oTcyTCTBHe Ha MeCTaX TexHHxieCKH4X BO3MOHOCTefi Awim 60pb6bI c MJYTB. AeRmenbHoCmb HnO u napmmepo6 HaLHOHaAbHaA nporpamma 60pb6bI c ry6epKyne3oM 6buIa HaqaTa B KOHue 1999 roga urpH nojgepxcKe BceMHpHOrO 6aHKa. Ee ieIbIo 3iBieTcH ynyImeHie KaxecTBa JIe-eHHA Hi yiperuieMie nojiHEf pecjopMEHpOBaHHR H ocyiecTBwieHHA MeponpTHai no 6opb6e c Ty6epKyAe3oM no Bcefi pecny6n4Ke. BO3 npe,rocTaBana TexHH-IecKoe co,eflCTBme STOMY 4¢HHaHCHpyeMOMy BaHKOM ipoeicy. rIpH 4)HHaHCOBOM H TeXHH- -iecKoM cojgeficmmn USAID H ero napTHepoB no peaJII3agHH (CDC B CIIA H rIpoeKT HOPE), K 2000 rogy cTpaTerMH DOTS 6bia ycnexIHo pacnpoc'TpaHeHa Ha BceA TeppHiTOpHH CrpaHbl. rIpaBiTejIbCTBo Ka3axcTaHa BbieJIH.o cpeAcTBa Ha peryJIspHbIlf MOHHTOpHHr peaJ13aunu cTpaTerHH DOTS. C 1997 roxaa rlpoeKT HOPE npOBO,XT o6yteHHie no DOTS KaK ,WIu qI143HaTpOB, TaK Hi wmi Bpaiefi nepBHqHorO 3BeHa. L_eHTp CDC HpIHHIMmaeT aKTHBHoe yxacTile B o6HoBnIeHHIH na6opaTopHfi H COBepmneHCTBO- BaHHII HaBbIKOB COTpy,AHHKOB TB-jia6opaTopiHA. CDC TaKe ripOBesi o6yqeHHe MeTo,TaM aHaAH3a ,gaHHbIX SIieKTpOHHOfi CHCTeMbI Hag3opa 3a CT1yqaqHMH Ty6epKyne3a (ESCM) xvu o6AiacmbIx Ty6gHcriaHcepOB no Bcefi CTpaHe. HIpH3HaBaH cepbe3HOCTh ,aHHO1i npo6JneMbi LeHTpaJIbHoi Am3HH, c 1997 ro,a USAID/CAR Haqajio OKa3bIBaTb coAeicTmHe peanii3auHH DOTS B 'emipex rHIOTHbIX yqacTmax Ka3axcTaHa. B 1998 ro,Ay no npOCb6e rIpaBHTelibcTBa USAID pacimupmio cBoe ! TexHH'leCKoe co1AeficTBe Ha 21 HnHOTHblI Ty6AHcnaHcep. rIapTHepaMH USAID no peanji43aLHHi cTpaTermi DOTS ABIIOTC31 rlpoeKT HOPE H4 CDC, KoTopbIe pa6oTaioT no Bcei eTpaHe. rIpoeKT HOPE nomoraeT CBOHM riapTHepaM B pa3pa6OTKe nIpaBOBOII IH roJnTHiqeCKoA 6a3bI, a TaioKe B noBbImiieHHH ipOcpeCCCHOHajibHbIX HaBbIKOB Iy3rH3HaT- pOB H Bpaxiefi nepBWnHOrl MeqiHKo-CaHHTapHOf4 IIOMOIIH. B HacTomiee BpeMAI HpoeKT HOPE BHegp3ieT CTaHqapTHbIe KOHTpOJIbHbIe JImCTbI IA perynipHoro MOHHTOPHHra H 04eHKH peanm3aug DOTS B TeCHOM COTpyuHmeCCTBe C rIpaBHTejibCTBOM. HeTaBHO ripoeKr HOPE H CDC HaqanIH HOBYIO nporpammy 60pb6bI H npo(pcHaicrHKn Ty6epKy- nie3a B KaparaH,HHCKO}I TlOpbMe. rIpogonKcal cqirnaTm cipaTerio DOTS rJIaBHbIM IIpHOpETeTOM B genie 60pb6bI c TB B Ka3axcraHe, USAID/CAR npH3HaeT, tTo M.IYTB npegICTaBnmeT co6o0 cepbe3Hy1o yrpo3y 39tXeKT-BHOCTH peaJU13aLiH CTppaTerHH DOTS B CTpaHe. ,ZII oKa3aHHB nOMO- n;H rpaBHTeCjbcTBy Ka3aXCTaHa B ero ycHwEIx rio 6opb6e c MJIYTB, PerHoHanbHoe npe,zCTaBHTejIbCTBO USAID B LJeHTpanbHofI A3Hi npe,ocTaBnieT TexHHxiecKoM COgeACTBHe B co3zaH4H Bceo6lbeMjlloigeft MoAeCJi BegeHHA MJYTB. 3Ta MORejib 6yAeT onpo6oBaHa B ,AByX nIHiOTHbIX yiacTKax Ha 6a3e Ty6gHcnaHcepoB r. AnMaTbI H4 Kapa- raH,HHCKOfi o6iiacTH. riiaBHOfI iXe.IbIO Toror npoeKTa ABJnHeTCH pa3pa6oTKa HaH6oJTee 3KOHOMHIqeCKH S4eKTHBHbIX H Ha"YHO o6ocHoBaHHbIx CTaH,gapTHbIX rIpOTOKOJIOB 48 PASOHMA goKnAg BCEMWPHOrO SAHKA jie,qeHHA MJIYTh, MorHTopHIHr pa6oTmi IJOTHbIX y'aCTKOB, o6yqeHHe BegeHHIO MJIYTh H pacnpocrpaHeHHe HaKonlieHHoro orbiTa no Bcefi cTpaHe. B ceKTope 3gpaBooxpaHeH Ka3axcTaHa pa6oTaeT HeCKo0nbKo HI-O. OAHaKo egHHcTBeHHOfi MecTHoi HrIO, 3aHHMamoMegcg 6opb6of c Ty6epKyIe3oM, ABimeTcq AJIMaTHHCKaA o6AacmHas accogmau 60JbHbIx Ty6epKyJIe3oM (KypMaHra3bi, Ber-AAI). IUHaHcupoOaHue B 2001 rogy rIpaBHTejIbCTBO H AOHOpbI Bbigenimi4 32 MHMHJIOHa g,LojIapoB CIHIA Ha inarHOCTHKy H ieqeHiEe Ty6epKyJIe3a, a B 2002 rogy rlpaBlrTevcmTBo BbgeniiHJIo 8 MHJI4HOHOB gojJapoB CMIA Ha 3aKynKy nIpOTmBoTy6epKyjie3HbIX nipeIIapaToB nepBoro H BToporo pwga. 3To o3HaqaeT, -ITO Ka3axCTaH pacxogyer nI4HMepHO 640 AoJuIapOB Ha Kaxqoro 6oJIbHoro Ty6epKyAe3oM B roA, MTO B TpI) pa3a BbIIIe CyMMbI, HcnOJIb3yeMofi ripH pacqeTe CTOHiMOCTH nporpamm 6opb6bI c Ty6epKyIe3oM Ha OCHOBe CTpaTerEm DOTS; H 160 gomapOB Ha ogHoro 6OJbHorO B roj Ha MeAHKaMeHTmi. 43 200 gomapoB Ha ogHoro 6oJIbHoro B ro, - eToHmocTm nporpammbi DOTS - 50 gnojuapoB HeT Ha 3aKyriy npenapaToB nepBoro pAga. YBejinieHHe (PHHaHCHpOBaHHE npoTiHBoTy6epKy- JIe3HOAi nporpammbi 143 rocyiapcTBeHHoro 6ioBKeTra cTaiio 6ecnioKoHu CqeTry1O naniaTy, KOTOpaqI 6bIna 6bI 3aHHTepecoBaHa B TOM, q'To6bi nepecMorpeTm nporpaMmy BKMIO4aH aHaAH3 paCXOgOB H aKOHOMHqeCKof a44eKTHBHOCTH. OAHaKo g,i pacmisipeHri nporpammbi DOTS B TlOpbMaX H4 BBegeHH4A nporpaMMbI DOTS-rlmoc cpegHl rpaxaHcKoro HaceIieHHI rioTpe6yeTrcq ewe 6o0mbme cpegcTB. HCXOAH EI3 pacnpocrpaHeHHocTH Ty6epKyjie3a 153/100000 HaceJIeHHH B 2000 rogy, cpexHHri no cTpaHe noKa3aTejIb MJIYTB B 10 IIpOLXeHToB cpe,H 6aLbnnoBbiAeJmTeniefl (noJIoxcrrTe3bHbIi Ma3oK) gaeT OCHOBaHHII noJIaraTm, rTO B Ka3axcTaHe HaCqHThIBaeTCs npHMepHo 2300 6O.IbHbIX C MyjIbTIpTe3HCTeHTHOfl c)OpMOfl Ty6epKyJIe3a. feqeme MJIYTB B Ka3axcTaHe CTOHT npHMepHO 5000 gonmapoB CIMIA Ha o,gHoro 6o0bHoro, qTO no'rpe6yeT ipMHmepHO 11,5 MIUH HOHOB gojnapOB CILIA B rog, eCJIH IieTHTb Bcex 60o.bHbIX C MJIYT. B 1999 rog7y BaHK npegocraBHui Ka3axcTaHy 3aeM B pa3mepe 9,5 MHJInHOHoB OAQ- iiapoB CIIA ,m ceKTopa 3gpaBooxpaHeHHs. B pamKax wToro npoeiKTa na6opaTopHH MHOrHX rOpO,OB CTpaHbI 6bum o6opyAOBaHbI AJi npOBegeHH5 aHJaiI3a KYJIbTypbI MHKo6aKTepHH Ty6epKyTie3a HI AOCTOBepHOrO aH.a1i3a Ha jieKapCTBeHHyEo IWBCTBH4- TeJIbHOCTL. 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Bo3pacr 60rnee 50 npoiLeHTOB HaceIieHH5 coc'raaTier OT 15 go 49 .ieT, H 6o0ee nO)IOBHHbI =BeT B 6eHocrM (MeHee $1 B ,geHb). BI44/CnfA: 3nmAemmonorMeCKaA cmTyaL4mm B KbiprbI3CKOf Pecny6nime pacripoCrpaHeHHocTm BIHT- Bce eiie HeBeJITKa. OHaKo B HacTosigee BpeMA B CTpaHe Ha6nEoAaeTc5I 6bicrpbIf pOCT qucnja BHOBb 3aperHcTpHpo- BaHHbIx BII-H4H)HpoBaHHbIx JnIM, oco6eHHo B nocieAHHe ,Ba rog7a (,HarpaMMa 4). K Malo 2003 ro,a 6bvio oc)HL4HaJTbHO 3aperErpIpOBaHHbix 410 cJAyqaeB BUM, 1H3 KOTOPbIX 309 6buIH BBmBjieHbI B 2001 H 2002 roAax. CTO COpOK geBqTb (149) HeJIOBeK 6bLuH EwHqH4)IIpOBaHbI B 2001 rOD,Y xITO B TpH pa3a npeBbIIIIaeT o6fee KoJIfHqecTBo ciry'aeB, Bb1BJieHHbIX 3a nepHog c 1997 no 2000 rr.. OAHaKO no oi4eHiKe UNAIDS, peaibHoe xmc.io cJy'qaeB BULl B 2001 rogy cocTaBnsno 500 (UNAIDS 2002). Pacrpo- cTpaHeHHocTh BH-HiiHceKUIM HaH6oAee BbIcoKa cpegH MyXqHH (74 npoLqeHTa) oco6eHHo B Bo3pacre Ao 29 neT (64 npoiAeHTa). OKono 56 npoueHTOB CnyqaeB o6Hapy- )KeHO cpe,H 3aKmoxeHHbIx. CaMaH BbICOKaq pacnipocTpaeHHHocTm Ha6moAaeTCq B OiiiCKO o6IiacTH, Ha KOTOpy1O iipHxoguTcs 6onee 50 npoUeHTOB Bcex cJryqaeB, HO nocTpagani4 TaioKe r. BHiIKeK H HyficKaa o6jiacTm. FOpoA 0111 HaxO,MTCS Ha nepeceqe- HI1 MapIIIpyTOB HaPKOTOprOBMI H3 AcraHHcTaHa B POCcHIO. B 2001 rO,Y B CTpaHe 6bmo TemIpe naiemra, 6o.lbHbix CrIH oM, IipH 3TOM cemepo K TOMY BpCMeHH yMepjHi. Hpo6JieMa BH4/CHI4lAa TeCHbIM o6pa3oM cBH3aHa c yBenjiqeHHeM KoHTpa6aH,gbI HaPKOTHKOB H conyrcrByiolHM pOCTOM xiciia rIHH. rIpHMepHO B 83 npogeHTax cnyqaeB BUM HH4)eKmH OCHOBHbIM qpaKTopoM pHCKa mmAerca noTpe6iieHEHe i4HHbeKIAHOHHbIX HapKOTHIKOB. rIopa3rTeJIbHO,, 'TO no oiLeHKaM pa3JIHqHbIX crieLWaJIHCToB, ripmepHo Tpoe H3 Hemipex HIUH y2Ke 3apaXKeHbI BUI. B 2000 rojy gaHHbIe A03OPHOrO 3MHWHag3opa nOKa3aJI4, xTO PaCnPOCTPaHeHHOCTh BUMx cpegm rHH cocraBnaer 12-19 rpoieHTOB B BHUiKeKe m 32-50 npoileHTOB B Ome, Ha OCHoBaHHH wero MilHHicTepcTBo 3,paBooxpaHeH3 nogcqmTajio 'ITO 'HcJIo BM- HHc)HUHPOBaHHbIX HUH B BHmKeKe cocTaBLIeT oKojio 6500, a B Ome npHMMepHO 2050. roBeAeHxiecKHe 4ccjiegoBaHi4A, fIpOBeAeHHbIe B 2000 roAy, ioKa3aJIH, xrO 96% HapKoMaHOB riojim3yiOTcq o6u4HMH CHCTiMTMmH An7 HH'beKLHA, 99% ,eiiaOT iHHbmKuH1o 1nnpH4eM H3 o6MeA emKocrH, 35% HCHOJIb3YOT OAHH H TOT Ke mnpHm 6o0iee 20 pa3; 42% HC1IOJIb3yIOT o6u4HA mnpH4i; 64% He MorYT 1IO3BOJIHTb ce6e noKymiy innpuHLOB; H HImb 14% HCHOTIb3YirT CTePHJIbHbIe mnpHubI. 180 160 140 120 100 80 60 40 20 0- 1995 1996 1997 1998 1999 2000 2001 2002 Bs4/cnfg 1 TYSEPKYJlE3 B LEHTPAJIbHOVI A3wL 51 rpyriria MM14H B KbIprbI3CKOAi Pecrly6fnlKe O,gHa I43 CaMbIX MHOrOqHCJIeHHbIX B lteHTpaJnbHofi A31Hi (npMMepHo 55000 ,ejioBeKi, H3 KOTOpbIX 65% MoAo)Ke 35 .ieT), H, CJIe,AOBaTeJIbHO, pacripocTpaHeHHOCTm HapKOMaHHH 3lLecb caMaAI BbICOKa3 B perHoHe (1700-2000 Ha 100000 HaceJIeHH5I)9. Cpe,HHf Bo3pacT noTpe6HTe.iefl HapKOTHKOB cocTaBI5eT 14-15 jieT. TaKoe rioJIo)KeHHie co3gaeT PbIHOK ,gi HapKO,eTibLOB, H He TOJIbKO Ha iore, HO Teriepb H Ha ceBepe cTpaHbI, oco6eHHO B 60Abmi4x ropojaax. B 2002 ro,gy .HMb OKOjiO 5000 HapKOMaHOB 6b0 ooHLa1bHO 3aper4crpHPOBaHO B KameCTBe nIaUHeHTOB HapKOnIOr1NCCKi4X iAeHTpOB, HI riO4TH 70 rIpOgeHTOB 143 HiHX yrioTppe6Ji[H orIHyM. rIoKa3aTejIb BHOBb 3aperHCTPEPOBaHHbix noTpe6HTeAief HapKOTHKOB yBejiHJIc3i c 6o0ee 30/100 Tic. HaceiieHH5I B 1992 ro,gy g,o 6o0ee 100/100 ThIC. B 1999 roAy, M C 73/100 TmIC. B Ome jgo 280/100 ThIC. B BHIIIKeKe B 1999 rogiy. ,Zl,03a repoiHa CTOWT B Oiue 50 UeHTOB, rro ,AeiiieBJIe, -ieM 6yTbIuKa BO,gH Him gaxKc nIHBa, 14 2 ,oniapa B BHueKe. B perHoHe, rge cpeAHemeC3f-HaA 3apa6oTHaA nnaTa no-ripeaKHeMy cocTaBJIeT MeHee 50 gojnapOB CIIA, npOTH3BOACTBO H c6brr HapKOThKOB 3SBJIIOTCS 3aMaHxIBbIM HCTO'IHH4KOM goxo,a B o6egHeBmiief pecrry6nHIKe 6bIBmero CoBeTcKoro Co0o3a. 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B TO BpeMA KaK B 2001 rogy IiHum 4 ripoueHTa ciyqaeB 3apawKeHH5 BHi4 nOSBHIHnCb B pe3yJIbTaTe repeAaxI rerepoceKCYarbHbim iyreM, B 2002 rozy Hx oJu BbIbpociia go 23 1995 2000 2001 54cno ymepwNx o0 cnAUa 7 CnymaN cnfAa 4 npeAnonaraeNoe 4NCnO cny4aeB BM4 500 3apermcrpupomaHHble cnyMam B44 53 149 BUM4 cpeAu fINH (3apermcTpNpoBaH"be cny'4am) 28 143 CnyeaN cHNsNnNca 73,5 3aperNcTpNpomaHHbue nOTpe6HTeIH HaPKOTHKOB 2136 4479 5057 3aperucrpupoBaHHbme flIIH 1108 3261 3474 rlpeAnonaraeMoe 4mcno noTpe6uTeneii HapKOTNKOB 100000 npeAnonaraeMoe 4ucno ntlH 55000 nppeAnonaraeNoe 4Ncno PKC 3000 npeAnonaraeMoe 4NCnO MCM 5000 /lcmo#HuK: MmmwcTepCmo 3ApaBooxpameHmmR 9. OieHKa UNODCCP (AreHTcBo OOH no 6Opb6e C HapKoTmKaMH H ripe,oTBpameHmio npecTynHOcTH), 2001. 52 PABO04MV1 gOKnAA BCEMI1PHOrO SAHKA npoL]eHTOB. DnHgeeMlH BI4H npeguiecTBoBaia 3anHeMH5 HrIrIrI. CorIiacHo oTqeTaM IOHHCE(D, B 2002 rogqy B KbIprbI3CKoA Pecrly6nEKe 6buI 3aci4)KCHpOBaH O,HH H3 CaMbIX BbICOKEHX noKa3aTeilefi 3a6oneBaeMocmH HrIrlrl B perHoHe (notrm 300 Ha 100000 HaceiieHHS HOBbIX c.ny-laeB CHIcqJJ4Ca H roHopeH). Hlo o4pHqHaJibHofi craTHcHKe, 3a6o0IeBaeMocTh cH4HinAHcoM yMeHbmmIaInCb c 167/100 TmIc. HacenieHHH B 1997 rogy go 73,5 B 2000 ro,gy, xoTq noKa3aTenE4 Bce xce BapbHpOBaHIICb oT 225 B r. KapaKon jio 41 B gwcajiaii-A6aMzcKof o6nacm. KpoMe TOMo, npegionoxeIbHo oKoJio 3000 ,ieeOBeK BoBRe'qeHO B KoMMepIecKHAi ceKc. Cpeji PKC, noCeTH4BMIHX KoKHo-BeHeponorwqecK1e gHcraHcepbI B 2001 ro,ay, 37 l1poiLeHTOB 6bum 6O.nbHbI CI4q)HACOM. Cmpamezux, nonumuKa u npaso.aA ocHosa rHo BceC oqeBlHHoCrH, KbIprbI3cKa5 Pecny6jnnia Bcepbe3 BOCnpHHHMaeT onaCHOCTh HapKOTHKOB I B4/CIHLaa H BbLeJmeTCs1 cpegiL cTpaH perHoHa CBOHM HOBaTOpCKHM nOJ7XO,AOM B 6opb6e c anH4eMHefi. )KeiiaHie KbIprbI3CKoi Pecny6nimau pearrpoBaTm Ha noTeHUHaIbHYIO 3rugeMHmo BEN Ha paHHefi cTa,gH-Korg7a 6bLTI BbIABjseHbI nepBbie czy"aH BHpyCa - MO)KHO CtqlTaTh HaHJryqIIe1fi Me yHapOgHO4i ripaK-rKofi. HeCMoTpS Ha cepbe3HyIO HeXBaTKy cHHaHCHpOBaHHA, rpaBHTejibCTBo npHHHMaeT aKrHBHbIe MepbI 6opb6bI C iTceHHaJlbHOi4 3riHgeMHef nipH co,geAcT1i MecTHBIx HrIO Meey- HapO,HbiX niapTHepOB. KoopgmHaLIoHHbIf KoMHTeT no BHGI/CrIMy Bo3rnaB.TIeT nepBbIfi BHLue-npeMbep MHHCTp KbiprbI3CKOA Pecny6JIHKn no qpe3BbiNaiHbIM CHETyaIU4AM. HIpo6neMbi CrIMa H npoIHIaKTicKa HIHrIHl BKjiIOT-eHbI B rIpOrpaMMy pec¢opMbI ceKTopa 3lgpaBooxpaHeHH "MaHac" IH rocyAapcrBeHHyrO nporpammy "3gOpOBaq HaLxu". B 1996 roAy Kora B crpaHe 6buIo 3aperHiEpOBaHOB cero 4 cnyqai BWI HHcjeKIpHH, IapjiaMeHT o,zo6pin 3aKoH o IlpocEwIaKT1Ke BEN/CrIMa B KbIprbI3CKOA Pecny6jnHKe. rIpHHpie gaHHoro 3aKoHa HecoMHeHHo ycHno meporipxHsWli no npoqjnaKTnKe BWI B cTpaHe, o6ecneqmio BoBjieqeH4e Bcex rocy,apcTBeHHbIx opraH343aiVH1i, 14 BbigeTieHHe cpegJCTB nog cneHanIbHbIe nporpaMMbi. rIepBaR HaIHo- HanbHaAHrlporpaMMa no npo4a)JaKmIKe BEHI/CrIla 6buIa o,go6peHa B 1997 roAy, a B 2000 ro,gy 6bIn npiEsrrH3 "CTpaTerwmecKmI nnaH HaLHoHaAbHoro pearMpoBaHMa Ha 3grHgeMH1o BI/C1II a B KuprbI3CKofl Pecry6nHKe". 06iueA 3a,gaqei nporpammbi npo4)JIaKTMM ABIe'rcs coKpaigeHHe ti1Hcna BH-E{HHcIHLPOBaHHbIX, a TaioKe coKpan;eHHe YPOBHS 3a6ojieBaeMocTH 141Irl4I B KbIprbI3cKof Pecny6nEIKe. 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XOTH peiIHrHO3HbIe iHAepbi o6H13aiH4Cb noz- gepKHBaTm rpaBa penppOAYirBHoro 3AOPOBbS H HpocpiAaKTHKy BWI/CHa, OHH BbICTYIIaOT HIPOTHB o6CyxqeHHR BOripOCOB 6e3aoIaCHoro ceKca H pa3gaH ripe3epBaTH- BOB B IIIKOJIaX. 4)OHg HapogoHace7ieHI4 OOH opraHH3OBaji Kpyrnbir CTOji c yqacTHem peJIHrIO3HbIx iiHgepOB H oxKHgaJI noniy'HT i4X oAo6peHHe 3aKoHa "O penpogyWMB- HblX ripaBax". BepxoBHbIH KOMHCcapHaT OOH rIo ,Aeiam 6eceHiLeB (UNHCR) 3aHHMaeTcH nIpo6ieMaMmH penpo,TyKIIBHoro 3.OpOBbq H BHH/CllHaa cpe,H MOjOlobIX 6e)KeHueB, KOTOpbIe B OCHOBHOM rIpH6bIBaloT I43 Tag>EICiiTaHa (HO ABJTAIOTCS 3THw4eCKLHMH KHprH3aMH), OJHaKo cpe,H HHX eCTm TaioKe qeqeHIbI H aqjraHLbI. UNHCR noNIep- ,HBsaeT Hp0.oIoHMbIe HrIO KaMnaHHH no HHcJopMIpoBaHHo MOJIO,AbiX 6eMeHIeB, pa3Aa,ay npe3epBaTHBoB H4 co3L7aHHe KnEHHHK gm 6eweHLIeB. MexyHapo,gHaA OpraHM3aqR no npo6AeMaM MHmpaqHiH (MOM) npoBO,HT KaMHaHHIIO o6IIXecTBeHHof4 HH(OpMHpOBaHHOCTH gV5 Tpy.OBbIX MHrpaHTOB. 06bMHO TpygOBbIe MHrpaHThI He HMemOT ,AocTyna K Me,LHgHcKoOf noMomJH H4 6o0iee YH3BIMbI gIm BHH/CrI4Aa. MHormIe )KeHMHHbI OKa3bIBaIOTCq B CHTyalUH4, Kor,Aa HX BbiHyxaaroT oKa3bIBaTh ceKcyalIbHbie ycnyrH, miH6o npHi6eraloT K rIpocTHTyIHH4 B KaqecTBe BpeMeHHoro cnoco6a 3apa6oTaTm, noKa He HaAgyr nOCTOsHHOA pa6oTbi. JIM oci4iniaRnbHOrO ycTpoiCTBa Ha pa6oTy B KbiprbI3CKOA Pecny6mnKe Heo6xo,HM aHa7IH3 KpOBH, H nO3ToMy 3THEH-eia4e KHprH3bI, BO3BpaigaioWHecH 143 Ta,KnHcraHa, Y36eKHcTaHa H gpyriHx cTpaH, o65I3aHbI nporm TeCT Ha BIlqI, LTo6bI CTaTh rpa)KAaHaMm KbIprbI3CKOfi Pecny6nrHn. IOCAJ, oKa3bIBaeT noggepAucy MeponpH5{HAM no npoc¢waKCrrKe BW/CrIILa B KbIprbI3CKOfi Pecny6nmKe B KOHTeKCTe peajul3agiH CBoefl CTpaTerMi B 4eHTpaJTbHOf A3HH, KoTopaS npeAycMaTpHBaeT Bb1geeieHHe 2 M I40nEIOHOB ,onmapoB CILA Ha npO- rpaMMbI CHIDKeHH4A Bpega B TeqeHHe 6m.DKafIiniIx ,gByX neT. IOCAIM TaioKe Co,gefCTByeT MepOnpHITHHM, OCyf;CcTBJieMbIM aMCpHiKaHcKmM LeHTpOM 60pb6bI Hi npo(4HAaKTHKH 3a6oj1eBaHHA (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 H noggepIcKy peCTpyKTypEH3aLHH cHcTeMbI HCHOJIHeHHH HaKa3aHHE. lmBeiLxapcKoe AreHTCTBO no COTpy,7HwmecTBy npeg7oCTaBHoIO 160 Tbic. IIIBeiuapcKHX qpaHKOB Ha nporpaMMy HHqopMMHpoBaHHH o6 ynoTpe6JieHHH HapKOTHKOB B OIIcKoE o6nacTH, KOTOpaH paCC'rITaHa Ha cTyAeHTOB H npegycMaTpHBaeT o6y"eHIIe yHTeReA. ArCHTCTBO OTKPbIJIO HHc)opMaLHOHHbIr iUeHTp "Payra", KOTOpbIA noggepAMBaeT 3Ty nporpaMMy B 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 o6ecneluTm goinocpotnHyio ycmOwnmocm MeponpHHIA no npo4ivaKxrHKe H neiqeHimo BIH/CflI4Aa B KbIprbI3CKOA Pecny6inme; npeAocTaBJH HH4JopMaiwio H4 o6y'eHRe no BW{/CIHIHAy TeM, KTo 6poci mIKoly; pemax npo6neMy cHmMbi; npeKpamaq yrOAoBHoe npeciie,oBaHie 3a ynroTpe6neHne HapKoTmKoB; yMeHbmaIi nepeHaceJIeHHe TopeM; H rloNIepKHBaA pacampei-le 3aMeCraTejnbHofl Teparni C IcnoJTb3oBaHI4eM MeTagoHa AJs ILMH. OPuHaHcuposaHue B 2000 roAy B KbiprbI3CKOA Pecny6nHKe Ha 3gpaBooxpaHeHHH 6buIO BbIAejieHO 1,8% BBHI (12% rocygapcTBeHHbIx paCxoAoB), qTO cocTaBJuxeT MeHee 7 AOhaPOB Ha Ayrny HaceiieHHA. rIpaBHTeCJbcTBo coo6nxwro, TrrO B 2001 rogy BbqenMO OKOJIO 1 MHJInHOHa AO.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 3aruiaHIPOBaHHoro cEHHaHC11poBaHHA, nO3TOMY ciie,yeT o6paTErrb BHHMmaHHe Ha ocBoeHHC Cpe,gCTB B pamKax BTOpof nporpaMMbI. (P1HaHCHPOBaHHe COBMeCTHOI riPOrPaMMbI FIPOOH H UNAIDS cocTaBluo 250 TbIC. gojIapoB CIIIA rIporpaMMbI cHECeHHA Bpega nOAz;ePXU1BaioTCS areHTCTBaMH OOH, cDOH,OM Copoca/IHciuTyroM OTKpbrToro O6MecrBa 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 ,gpyrHx HrCTOqHHKOB (Bpa3mepe iipHMepHo 5 MHUOHOB oJIJapoB CIIA) Ha 2003-2007 ro,bI. Ty6epKyne3: 3nHAemmonOrm'ieCKaR CmTrya4Hm rIo pacnpocTpaHeHHOCTm Ty6epKyjie3a KbiprbI3CTaH 3aHMmaeT B'ropoe mecTo cpe, LteHTpaJIbHoa3HaTCKHX pecny6nnHK B Haqajie 1990-X rO,iOB 30-.neTH3vA TeH,reHUHq1 K CHi-DKeHHO 3a6oneBaeMocTH Ty6epKyAe3oM B KbIprII3CKof Pecn6n.Kiiie H3MIeH11iaCb B rIpOT11BOHOJIOXKHylO 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 7000 cTaHoB5TCSA XpoHiimecKuMm rIoKa3aTejm XPOHHMecKHx cTryaeB 10 Ha 10 OTIc. crqnTaeTcA KpHTH1ecKHM no cTaH,apTaM B03. B 1996 rO,AY B qemxpex paAoHax ,BXByX o6nacTei 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,gy COCTaBHJ 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 MHHHcTepcTBoM 3,gpaBooxpaHeHH5 KbIprbI3CKOl Pecny6m4nam rpH no,gepxKe Kpe,HTa BceMnpHoro 6aHKa. 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 yjytIImeHnI BbIS1BJIeHHA nOKa3aTeTI1 3a6oJeBaeMoCTH H CMepTHOCTH Or Ty6epKyjie3a Ty6epKmyne3 B Kbiprbl3cKoH Pecny6nuKe (Ha I 00 TbIC. rpaw.AaHCKoro HaceneHufl) 1990 1995 2000 2001 CMepTHocmb OT Ty6epKyneaa 7,2 13,4 12,6 13,5 PacnpocTpaHeHHocrb Ty6epKynesa 228,5 246,1 363,8 313 % HOSblX *bbsneHHbiX cnyHaes 6aqiunnosbuAenuTeneA (bK+) 31 25 22 24 BbrABneHNe cny4aeB TS 2306 3266 5953 6274 noKa3aTenb 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/Cnfg1 TYbEPKYJlE3 B LEHTPAI1bHOA A3mm 59 ipogojDKajni pacm g,Zo 1999 ro,za. B 2000 rogy, BnepBbie c 1993 roAa, KOjIWqecTBo BbI5BIeMbiX 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 Ty6epKyjie3a cocTaBJiso 15420 - 6onee xeM Ha 50-npoIieHTHoe yBeimiieeHi-e rio CpaBHeHHIO c 1990 ro,oM. B nepHog c 1990 no 2001 rOgbI BbLIBjieHHe yBejn-HqaCb fIOMTH B 3 pa3a, a ypoBeHb cMepTHocTH BbIpOC no,im B,ABOe. XOTH BbIbeiCHeC Ty6epKyne3a, COCTaBjsIIo- igee 127/100 ThIC. HaceIieHH5, SBJMIeTCq BTOPbIM nIO BeniHqHHe B EBponeficKoM perHoHe B03, BKiiOqalOIuwM Cpe,H1o1o A3io, io oLueHKaM rjio6aRbHogi rporpaMMbI Hag3opa 3a 6Opb6oEI c Ty6epKyAe3oM B03, B 2000 ro,gy 6bLiO 3aperHCTPHPOBaHO JIIrIIlb 82% Bcex HOBbIX 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 1998 rotb1. rIoKa3aTenIb cMepTHocTH OT Ty6epKyjie3a HeCKOJIbKO CHH3HACSI: c 16 Ha 100 ThIC. B 1997 rogny zAo 12.6 B 2000 roAy, o,AHaKO B 2002 ro,gy BHOBb no.AH3lCAI zAO YPOBH5 1999 ro,a - 13.6 Ha 100 mc3gq. BbISBJeHHe cjiyxaeB 3a6ojieBaHEiA Ty6epKyjie3OM 3HatmTeabHo pa3nIiiqaeTcq B 3aBlHCH4MOCTH OT perl4oHa CTpaHbI. CaMbrli BbICOKHfl noKa3aTeJIb, jocTHraioagiri noqmTI 150 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 BpeMS KaK HainMeHbMII4I - nopf[zKa 70 Ha 100 TbICAm. B HeKoTopEbx pagiioiax oTMeqeH InOKa3aTeJIb BbIHBjieHHA, npeBibimaiognp4f 200. O,Hofi H43 1IPHqHH yBeiHqeHHA YPOBH31 3a6oneBaeMocTn Ty6epKyae3oM cpe,g rpaaHCKoro HacejieHHA B 2001 ro,gy lBHAaCb aMHIICTH 1603 3aKmToqeHHbIX c aKTHBHOA qIOpMOg Ty6epKyjie3a. Cmyagn c Ty6epKy"e3oM B TIOpbMaX TpeBowKHaA (Ta6dHLa 17). B 2001 rogy BbiSBieHHe HOBbIX cjxyaeB Ty6epicyne3a 6bVIo B 60 pa3 Bbiuie, qem cpegi- rpaxqaHcKoro IHaceneHA, a cmepTHocTm 6bvIa BbIIIe IOYTH B 200 pa3. B KOHUie 2001 ro,ga KojIEHqecTBO 6OAbHbIX Ty6epKy.ne3OM B TIopbMax cocTaBEwo 2188, 13 KOTOpbIX 686 ymep.no. XOT51 KOgnwieCTBO 3aKhX)YeHHbIX COCTaBASAeT BCerO OKono 0.5% OT o6u;ero HaceJIeHH, B 2000 H 2001 rojAax oT Ty6epKy.ie3a B TIOpbMaX ymepnio roqTo CTOJTbKO Ke HJI ,gaaKe 6obIbmee Yincnio Iogei, qem cpegi4 rpax~aHcKoro HacenieHiH B 2001 rogayyMHpai O,HH H3 Tpex 3aKIo-ieHHbIX c aKTHBHOP q)OpMOg Ty6epKyjie3a. B nepHo,g c 1995 no 2001 rogZX BbMi3BjeHHe cjiyYaeB B TIOpbMaX BbIpOCjiO 6onee ieM B g7eBqTb pa3, a cMepTHocTb OT Ty6epKyjie3a yBeiiHqJIaCb 6ojiee YeM B gecHAT pa3. 3n9iHgeM4o.norHitecKasI ciTryaiLHi no Ty6epKyae3y B T1OpbMaX cnoco6cTByeT pocTy CMepTHOCTm OT Ty6epKyjie3a. MHOme B rHpaBriTe.IbcTBe KblprbI3CKOf Pecny6AiHKtr coriIacHbi C TeM, YTO KoAjlHecTBO 3aKECIoYeHHbIX CA1IIIKOM BeJIHKO; OJIOOKCHHiC ycyry6.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 2001 3aKn.O4eHHbme c aKTHXoHi cOpMOi TS - - 2580 2188 3aKIo'eeHHbie C *HOb sbumnmeHHbiM TS - 174 1422 1992 3aKnio4eHHbie, ymepwme OT TS - 56 542 686 CMepTHOCTb OT TS - 262,2 1887,4 2635,9 npoHmmory6epKyne3Hble 6OnbHHI4bl TiOPeM I I 3 3 I 4CmO'IHUK UHc5OpMOtAUU: MiHUcTepCTBo BHYTpeHHI4X Aen. 60 PArO'Mom ViOKJ1Ag BCEMHPHOrO EAHKA CHPOBaHH, OTcyTcTByeT 3I4)eKTIUBHbIA MexaHI3M HaripawieHHfl Ty6epKyAe3HbIx nawLeHTOB 13 TlOpbMbI B Ty6epKyne3HIIe gHcnaHcepbI. CmpamezuA, nonumuKa u npasoaA ocCHoSe rIpaBHTerJbcTBo TBep.Ao HamepeHo 6opoTmcs c Ty6epIcye3oM, xTO niOgTBepxaeTcq riocAeiAoBaTejibHbIM rpEHHTHeM ,gByX HanOHaJIbHbix rIporpaMM 60pb6bI c Ty6epKy- JIe3OM (HrUT). E)KerogHo npOBOARTCI HaUHOHanbHbIe Me)KBegoMcUBeHHbIe coBei4aHH no Ty6epKyJIe3y, a c He,gaBHHx nop no Ty6epKy.7e3y H BHHT/CfIIELy, no,i npe,cejgaTe.ib- CTBOM npe3HgeHTa KbiprbI3cKoA Pecny6mum, npeMbep-MHmIcTpa l BiuLe-ipeMbep- MHHHcTpa. B 1998 ro,zy nprHHrr 3aKoH o npo43maKrHKe Ty6epKyjie3a B KuprbI3CKOh Pecry6JuiKe. rIpaBHTenbcTBo paccmaTpBaeT B03MO)KHOCTL npHHITHS HeKOTOpbiX nOIIOJIHEHTenbHbIX Mep, KOTOpbIe MOrni 6b oKa3aTh lOJIO)KHTeJIbHOe Bo3g1eAcTBHe Ha 60pb6y c Ty6epKyule3oM, B TOM mHcjie: geKpHMHHaII3aLmS HoTpe6JIeHHA HapKOTHKOB ,1II CHDKeHHA nepeniOJIHeHHA TIopeM; coKpaEReHne BpeMeHH npe6biBaHHl B cne,- CTBeHHbIX H3ojSTOpaX (CI430); H HepacrpocTpaHeHHe aMHHCTHH Ha3aKMloqeHHbjX, 60obHbIX Ty6epKyjie3oM OMAHaKo npaBHTiebCTBO nnaHnpyeT BHegpeHit npOrpaMMbI DOTS-rfLoc g,i gHmHOcTKH H qie-eHHH MyyJIbTHpe3HCTeHTHbIX qopM Ty6epKyJIe3a, Trro IBSeTc3i npHEnmioi o6ecnoKoeHHOcm HrIO H ,AOHOPOB. Ko.iuqeCTBO 3amino1eHHbix (20 TbIC3m) BeiHKO OTHOCE1TenbHO qHcjieHHoC-nm HaceJIeHH3I, OgHaKO 3TOT nIOKa3aTeJIb ZBJMeTCS CpeAHHM Am HCTpaH CHF. [*enbIo MmHicTepcrBa ioCTHLuHH ABwmeTcq coKpaureHme KoJHMecTBa 3aKmoIeHHbIX Ha 1200- 1300 qeJIOBeKBrog 3To 6ygeT AOCTHrHyI'O iyTeM BBegeHHq aibTepHaTHBHbrx 43opM HaKa3aHIHA, nepexo0a K 6onee KpaTKOCpOqHbIM ipHrOBopaM H yCTpaHeHlH4 43aKTopOB, BeAYU;Hx K rOBTOpHbIM ripaBOHapymeHHM, 14H qaKTopoB, Jie=aIUMx B OCHOBe npecTy- rJieHHIk H ripeCTyIIHorO o6pa3aXWK3HH. CHcTeMaTiopeM KbIprbI3CKo]i Pecny6niiKH HaxOAHTc.q B aAMHHHCTpaTHBHOM nOA1qlHHeHHH MBA, O,HaKO IpaBHTejTbCTBO KbIprbI3cKofi Peciny6jHKH ripegnpIHH4MaeT marm no nepegaqe qTHx yqpewIAeHHA M14HHcTepcTByiocTrILDm.MHHHCTepcTBo IOCTHUH4 Ha'aJIo npOBeeHHe IMHpOKOrO cneKTpa nO,rOTOBHTeIbHbIX MeporipHSTrHH, HaiUeieHHbrX Ha BBegeH4e q3yH,aMeHTajb- HbIX IH3MeHeHH B CH4CTeMe HCrOnHeHHA HaKa3aHmA (KoKKo, 2002). 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Io,go6Ha5x cwTyaiLs MO)Ke'r co3JgaBaTh pacca,HHK amiHgeMHH, HIpHBOhInm,i K pOCTy pea.ibHoro ymep6a OT Ty6epKyjie3a, XOT51, OrmTb-TaKH, HMeeTcs o04Hb Majlo CBejeHHA o ,aJIbHenmeg cygb6e OCBo6owgaiomnxcs 113 TiopeM Ty6epKIyne3Hbix 6onbHbix. CTcyrcTByeT npeeMcrBeHHOCTb B pa6oTe T1OpeMHbiX H rpamaHCKmiX Ty6epKyTIe3HbIx yqpexeHII. tTO KacaeTcs gaHHbix no o6nacrM, ynIep6 OT Ty6epKlyne3a npeACTaBJIeH nyqme (Ta6HunLa 26). B gByx o6jiacTsIx 3a6OJIeBaeMocTh yBeCnHJTIaCb c 2000 no 2001, HO nOKa3aTeCAH CMepTHOCTH OCTaJIHCb OTHOCFTeJIbHO HeH3MCHHbIM1I Ha HpOT3DKeHHH 3THX gByX iieT. B 2001 rogy o6ulee qHcjio ciyqaeB Ty6epKyjie3a B TypKMeHHcTaHe 6buIo HeCKOJIbKO Bbime, qeM B 2000 ro,gy (14285 i 14171 ciryqafi cooTBeTcTBeHHo). Cmpameaua, nonumuKa u npasooaA OCHOSO B leVIoM rIpaBHTeJIbCTBO y,eJiseT He,AOCTaTOqHO BHHMaHH5 6opb6e c Ty6epKyJIe3oM B TypKMeHHcTaHe. rIpaBHTejnbcrBo rip3HaeT, xTO npo6AeMa Ty6epKyne3a aBJnCTCH BaXKHOI 1E npIBerTCTByeT HHOCrpaHHyEO L4PHaHCOByiO ii TeXHH4ecKyO noMOIIb. OgHaKO o6 HCTHHHbIX MacmTa6ax npo6ieMbI Majio rOBOPHTCq5 OTKpbITO, EI rocyapCTBeHHoe q43HHaHCIpOBaHHe 60pb6bI c Ty6epKyne3oM AIMeTCs HeAocTaTOqHbIM. K KOHL]y 2003 ro,a M1IHiicTepcTBo 3rpaBooxpaHeHE v riaHHIpyeT ,AOCTnIb 100-npoLieHTHoro oXBaTa HOBbIX ciyqaeB cTpaTerHeg DOTS, BKJUO4Ma TEOpbMbI. XOrA nrnuioTHbie npoeKTbi DOTS ywKe ocyigecTBJxnoTcs, HaiAIOHaOIbHaH nporpamma 60pb6bI c Ty6epKyjie3oM Bce eme HaXO,HTCS Ha CTraHH nogroToBKH. ,OCTyr K MegiHL4HCKHM yciyraM g,A 6o0nJIbHcTBa naW4eHTOB 3aTpy,gHeH, a HegaaBHee peineHie nepeBecm4 rocygapCTBeHHyPO Ty6epKyjie3- HyIo 60oIbHnIgy Ha HeCKOJTbKO KOMoeTpOB 3a npegejibi CTOJILHLxbI (Amra6a,ga), cKopee Bcero, enTe 6oAbme 3aTpy,gHHT ,AOCryn K Ty6epKyJIe3HbIM c.ny6aM wIsI roporAcKHx )KTenefi. nompe6Hocmu e Haa3ope u lononHumenbHlbe uccne4DOGaHUA PerynfpHoro Ha6mogeHHH 3a peaJnM3aijiier nrImOTHbIX npoeKTOB DOTS He Begec3i. 0 c.uyas1x Ty6epKy.me3a B TIOpbMaX He coo6igaeTcsi, m nO3TOMy 3TH cMiyaEi gaxKe He BKnEoxeHbI B O)HaJIbHYlO CTaTHCTHKy. 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OcymecTBnieHEHe cTpaTeruii DOTS HaxiaaOCb B 2000 ro,Ay B ABYX pa1ioHax JAamory3cKoft o6nacTH ipiH cogecTBEi MSF H B ropo.Aax AiuIra6ag H TypKMeH6aIuin rIp1 TeXHHMeCKOM COZeACTBHM B03; o6y'eHHe IIPOBOgtV LIeHTp 6opb6bi Hi npo4)naircmKH 3a6OAeBaHHfl (CDC), a TexHH'ecKas no,gepia 6bIua rpe,goCTaBieHa lpoeicroM HOPE/USAID. K anpenIo 2002 roAia MSF oxBaTnva npOrpaMMOfl DOTS Bce pa1iOHbI Jgamory3cKofi o6hIacTm. O,txHaKo nmmHbe npOrpaMMbI DOTS 6bVM He o'eBb ycneiIHbI: rIOKa3aTeJIb ycrieiu- HOCTH iieCeH B 73 npoueHTa 6buI 3aE4HKcHpoBaH gIi HOBbIX Ty6epKyjie3HbIx 6onmHbix C HOJIOXffTeAbHbIM Ma3KOM MOKpOTbI, 3aperCTPHPOBaHHbX B ,Aamory3e B 2000 roAy. 3To BM4/Cnf1 I TYSEPKYJ1E3 B LAEHTPAnbHOL A3mm 85 o6cuqcHeeTcH OieHb BbICOKI14M rIoKa3aTejHMMH HapymieHiA rIaLWeiHTMrram peHMa neqe- H15 (13%) H HeygaxHoro Hcxo,a nieqeHHA (99%). 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OpraHH3auxim PSI, pI1IH qEHHaHCOBOfA noggep)RKe USAID, HpOBOTJHT KaMraHHIO COLIAaRbHoro MapKeTHHra rpe3epBaTHBOB, B paMKaX KOTOPOEI npe3epBaT{BbI pacnpocrpaHmIroCai Ho HH3KOfi UeHe. Bonpocbl npopunaKmuKu, 8uazHocmuiKu u ne4eHUX rlporpaMMa OOH no 6opb6e c HapKOTHKaMHi H npe,poTBpamemu0o npecTynHoCTH (UNODCCP) Hi ripaBiTrrJIbCTBO HIIBefi4apim OKa3bIBaiOT COgeflCTBHe B co3gaHxH CeTr HapKO.OrH'qeCKHX jxeqe6HbiX yqpexc1eHH4i ,VS JieIeHHH HapKoMaH1HH. (DOH, Copoca/1,O0 H IHRD (IHRP Me)qyHapOAHaSi CeTb CHHDKeHHA Bpega) BbICTyIlOaYT 3a rpHHSITHCe IOJITHKH BHegpeH4HS 3aMeCT14TeJIbHOf4 TepanEim A ,Sii jeIeHH HapKoMaHHH4. MeTa,AoH BXO,AIT B nepexeHb 3anpenieHHbIX B crpaHe npenapaToB, o,HaKo gejiaioTcq HOIbITKx CO3JaTh bHHOTHbIl1 npoeKTnio npHmeHeHHH1O 3aMecTilTejibHO TepaniH c HCHoJIb3oBaHHeM MeTa4raoHa. HegaBHO cemepo ceUHanJIHCTOB nOCeTHJI ClIA, rge npoBeJIxi MeCSil, H3y'aS npiPMeHeHHe 3aMeCTxTeJIbHor4 TepanHx. IHHcOpMaLjHR 0 njIieHxeH OriOpTyHHCTHeCCKHX MH4eKEi4w OTCyrCTByeT, i, KaK npaBluo, BW-H4H1HupoBaHHbIM JIO.1RM Heoc.OCTyriHO jemeHi4e aHTHpeTpOBHpyC- HbIMH nperiapaTaMxi. 94 PA6OqML AqOKnAA BCEMIPHoro SAHKA ,AezmenbHocmb HnO u napmHepos B Y36emccTaHe npo6JieMof BHN/CrIH a 3aHHMaioTc3i MHoroqHcjIeHHbIe HIIO: "KaMoBOT" pa6oTaeT c MoJIogexKbio; "Ca6ox" H TEnanvi Asno," pa6oTaioT c PKC (2 npoeicra); "AHm-CrIHH," pa6oTaeT c MCM; a "Maxanna" pa6oTaeT c IThH (2 ripoeKTa). HIlO B OCHosHOM cpHHaHCHpyi0TCq MexyHapO,lHbIM1 H1 ,AByCTOpOHHHMH areHTCTBaMH. B TeMaTnecKylo rpyiny OOH Bxo,rr MHHHcTepcTBa 3,ApaBooxpaHeHHs, o6opOHbI H BHyrpeHHHx Aen, BceM1pHbIi 6aHI, USAID, (DOH,g Copoca/1400, UNAIDS, rIPOOH, UNFP, UNICEF, UNDCP [rIporpaMMa 60pb6bI C HapKoTmKaMH OOH], B03 H pHg HIO. TeMaTHiecKa5I rpynna HMeeT e,zHbH4 pa6o0nH njiaH, co,gepwaiuji nepeqeHb H3 29 HrIO, 3aHi4maiomxccs npo6AieMaMH BH4I/CrIMa B crpaHe. 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OgHaKo K KOHL 2002 roja B nmTH pecny6niKax 6bv1o 3apercTpnpoBaHo noitiox 6000 BHTI-RHHIHUpOBaHHb. JJIaBHbIM IIOBOgOM AJM cepbe3HoA o3a6oqeHHoCTH CJ1ywaT Mapmpyrbl HapKoToproBnn, npoxogaWvie qepe3 1leHTpanbHy1o A3uo. OHH cnoco6cTByloT pOcTy BHypHBeHHOro ynoTpe6eneHm HapKOTHKOB B cy6-perHoHe; coriiacHo 3KciepTHbIM oieHKaM, B pero4He MO)KeT HacHTbIBaTbcH CBbImIUe nojiMmUnioHa noTpe6HTenIef! HapKOTHKOB, H BCrbIblCIu CBH3aHHOfi c BUM HHHbeKUHOHHOfi HapKoMaHHi 3aperHCTpHpOBaHbI BO Bcex CeHTpaRbHOa3HaTCK1XcTpaHaX, 3a CKicioqeHHeM TypKMeHHcTaHa. B Hacroqntee BpeMq 3migeM1s cocpegoToieHa cpeAH rILH H PKC, oAHaKo oHa MOXCeT pacnpocrpaHInIbcA (cKopee Bcero, TaK H ripom3ofeT) Ha y3i3BHMbie rpyrimi, TaiKHe KaK MojiozexKypHaji. lapHeTr r. HI Ap. (Heony6nHKoBaHHaA1 pyKorIHcb). MogeflHpoBaH1ie BW1/CfrI4Ba B Poccim. KaM6y r., J1eBapaAxcaH C. 14 OyBep M. (1992). 3KoHoMH1qecKoe BnJIHHHe CrIHAa B 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 UeHTpajibHofl A3HH. Hpo6AembI mewxyHapoAHoro co0eCfCTBH5. Hbio-f4opK I4HcTHryT OThKpbToe O6mnecTBo. rlporpaMMa Anf IJeHTpaJbHofi EBpa3HI4/2eHcKaff 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. 105 106 PAsOwoI pgoKnAg BCEMIPHOrO 6AHKA PIOAb K H gp., 2002. 3KOHOMHqeCKHe ioc7iegcTBsA BT-1 B POCCI. 1HTepHeT-cTpaHHua BceMHpHoro 6aHKa o PoccHu. IlUBehmapcKas 3KCnepTHaq KOMHCCiHH PeKOMeH,YeT ,geKpHMHHaRH3auio ynoTpe6.neHHR HaPKOTHKOB (1996). KaHa,gCKHSi BioJIeCTeHb no rIoimKe BHT-I/CrII4a H 3aKOHODaTeCIbCTBY. BCeMHpHHbri 6aHI, 1997. BOPb6a Co CrIMoM. ---. (nipoeKTo rKyMeHTa paCCMaTpHBaeTCq). KoHiAenrm cTpaXOBaHi, oTpacieBau pa6oTa no BWII/CrII y E¢ Ty6epiyxe3y; -- -, (IpoeKKT gOKyMeHTa rOTOBHTCq). KoHAeniuHI ToMac M., 1997. OIgeHKa cHryaT KoMMepqecKHix ceKcyaabHbix ycjiyr B TaIIIKeHTe. OTBeTHbIe mepbi nIo BII4/CrIMIy, HFHIr H HapKOMaHHH IpH cogeM i cTBm UNAIDS B cTpaHax lAeHTpa)TbHOA A3iH. AAMaTbI. 2002a. 3riHACMemOAiOrmqeCKKHC 4aKThI B Ka3axcTaHe. 2002b. (Daimi B KbIprbI3CTaHe 2002c. 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 Ha 2002-2004 rr. Aimami. Y36eKcKas AccoLHaLaw penIpOgYIMBHOrO 3.OpOBbq/IPPR (2001). Pa6oTa YAP3 c Mo.noIaemIO Ha mecrax no npocpwaKTIIKe B{/CGH1ia B Y36eEI4cTaHe. TamIKeHT. MexceAoMcTBeHHa3i pa6oYas rpynna Y36emHcTaHa no BW4I/CrIHy (2002). CTpaTerHtecKasI nporpamma 60pb6bI c pacnpocTpaHeHuem 3BnHeMH BH14t/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/CfIma B PoccicKoI (DPe,gepaumH. BaUHHrrOH: BCeMHpHbIf 6aHK B03, 2001. PerHOHajibHaA cTpaTerma B03 no ceKcyanbHoMy H pepogyBHoMy 3.0pOBbMO. KoneHrareH. 3aplmoBa H ,p., 200 1. PacnpocTpaHeHHocT HHbeKUHOHHOfi HiapKoMaHHH H BH- HH43eKiMH B CaMapKaH,e. CaMapKaHA: MHH3gpaB, LleHTp C11a