Mahmood Nazar Mohamed

Absence of antiretroviral therapy and other risk factors for morbidity and mortality in Malaysian compulsory drug detention and rehabilitation centers.

Background Throughout Asia, people who use drugs are confined in facilities referred to as compulsory drug detention and rehabilitation centers. The limited transparency and accessibility of these centers has posed a significant challenge to evaluating detainees and detention conditions directly. Despite HIV being highly prevalent in this type of confined setting, direct evaluation of detainees with HIV and their access to medical care has yet to be reported in the literature. Methods We evaluated the health status of 100 adult male detainees with HIV and their access to medical care in the two largest Malaysian compulsory drug detention and rehabilitation centers holding HIV-infected individuals. Results Approximately 80% of all detainees with HIV were surveyed in each detention center. Most participants reported multiple untreated medical conditions. None reported being able to access antiretroviral therapy during detention and only 9% reported receiving any HIV-related clinical assessment or care. Nearly a quarter screened positive for symptoms indicative of active tuberculosis, yet none reported having been evaluated for tuberculosis. Although 95% of participants met criteria for opioid dependence prior to detention, none reported being able to access opioid substitution therapy during detention, with 86% reporting current cravings for opioids and 87% anticipating relapsing to drug use after release. Fourteen percent of participants reported suicidal ideation over the previous two weeks. Conclusion We identified a lack of access to antiretroviral therapy in two of the six compulsory drug detention and rehabilitation centers in Malaysia designated to hold HIV-infected individuals and found significant, unmet health needs among detainees with HIV. Individuals confined under such conditions are placed at considerably high risk for morbidity and mortality. Our findings underscore the urgent need for evidence-based drug policies that respect the rights of people who use drugs and seek to improve, rather than undermine, their health.

CO 09 : Profil épidémio-clinique et évolutif de la gale chez l’enfant à la région de Monastir

Introduction La gale est une pathologie frequente a tous les âges : Chez l’enfant, sa presentation et sa prise en charge sont assez differentes de celles de l’adulte. Materiel et methodes Il s’agit d’une etude observationnelle retrospective de tous les cas de gale de l’enfant qui ont ete suivi a la consultation de dermatologie de l’hopital Fattouma Bourguiba de janvier 2006 a septembre 2015. Resultats Nous avons collige 64 enfants chez qui nous avons diagnostique une gale. Le sex-ratio etait 1,46 et l’âge moyen etait de 5,04 (2 mois a 15 ans). Un prurit familial a ete retrouve dans 89,8% des cas. Chez les nourrissons le prurit etait presque exclusivement maternel (80% des cas), alors que chez les enfants plus âges l’origine etait fraternelle (31,8%) ou familiale multiple (22,72%). L’atteinte palmo-plantaire a type de pustulose et l’atteinte du visage ont ete note exclusivement chez les nourrissons avec des frequences respectives de 40 et 30%. La recherche de sarcoptes a ete realisee dans 28 des cas et elle est revenue negative dans 38,8% des cas. Le Benzoate de benzyle (as- cabiol) a ete administre dans 96,4% des cas associe au Crotamiton (prurex) dans 14% des cas. Chez 8 cas nous avons note une resistance au traitement, trois cas ont rechute dans les 3 mois suivant et treize sont gueris, le reste (62,6%) sont perdus de vue. Conclusion La gale est encore une maladie frequente chez l’enfant. La contamination est le plus souvent familiale. La presentation clinique varie en fonction de l’âge et peut etre parfois atypique et necessiter des explorations complementaires voir meme un traitement d’epreuve. Le traitement doit etre adapte a l’âge.