SAULIUS ČAPLINSKAS MD, PhD

Transcription

1 Lithuanian experience in organization of intersectoral respose to HIV SAULIUS ČAPLINSKAS MD, PhD Director, Lithuanian AIDS Centre Assoc. Prof., Mykolas Romeris University, Vilnius, Lithuania

2 HIV/AIDS in Lithuania 3,4 mln. estimated population end of estimated liwing with HIV New HIV+ diagnosed in 2007 Incidence New AIDS cases in 2007 AIDS Incidence Cumulative HIV+ end of 2007 HIV Prevalence - 38 Incidence and Prevalence for population Source: LAC, 2008 Preliminary data 151- Cumulative AIDS end of 2007 AIDS Prevalence HIV deaths in 2007 (from them 11 from AIDS) Cumulative AIDS deaths end of 2007 (from them 58 from AIDS)

3 HIV/AIDS in Lithuania (Population 3,4mln.) 1306 cumuliative HIV positives diagnosed : 987 ( 76% ) IDU 156 ( 12 % ) hetero 83 ( 6% ) homo 79 ( 6% ) unknown 1 perinatal 188 (14 %) women 1118 ( 86 % ) man 151 AIDS 132 died (57 from AIDS ) Source: Lithuanian AIDS Center 2008

4 HIV and AIDS tendencies in Lithuania Source: Lithuanian AIDS Center 2008

5 Links between drug use and HIV in Lithuania 80% HIV cases in IDUs Majority of people with HIV have long history of drug use 5 years at average (there are cases of years use) 98% of IDUs with HIV are also infected with VHC This prove especially risky drug injection Equipment sharing, etc % of IDUs have mental problems High risk for spread of communicable diseases including HIV, which to be reduced One patient many illnesses, lot of problems

6 Dinamisc of drug and toxic substances addiction ( population) Drug and toxic substances addiction, % of drug users in prison settings and prevalence of HIV infection in penitentiaries. Lithuania Percent of drug users in prison settings Prevalence of HIV infection in penitentiaries (abs. Nu) State Mental Healths Centre, Lithuanian AIDS centre and Prison Department data, 2005

7 HIV/AIDS in Lithuanian prison settings Infected outside New inmates At any given time approximately people imprisoned ( 18 % IDU, 250 with HIV ) people pass annually Lithuanian penitentiary system Released inmates Infected in prison Sexual partners

8 Behavioural analysis of prison-released people with HIV (n=70) All have further injected drugs: 63% - opiates 37% - opiates along with sedatives 60% have injected drugs 5-6 times per day 46% have shared their injection equipment The Lithuanian AIDS centre data, 2005

9 Clients of the Low Threshold Site at LAC for drug users 2408 IDUs registered ( ) 90 live with HIV (only 4 seroconverted) 69.93% HCV Ab positive 85% male 82% inject drugs (all multiple drug users) At least 87 presently attend ST programme (out of 130 ) 39% with incomplete secondary education 36% maintain only instable relations, and 33% - no relations with a family at all 96% do not work 27 persons quit drugs In LTC IDUs have possibility to meat IDUs from other isolated groups The Lithuanian AIDS Saulius centre Čaplinskas, data, MD, 2005 PhD

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11 HIV and HCV prevalence IDU Tallinn, Estonia Riga, Latvia Vilnius, Lithuania Test result n % n % n % HIV-positive HCV-positive RDS study 2008, supported by EU

12 Prognosis of ARV treatment needs in Lithuania ( in Litas)* * apskaičiuota 2005 m. pradžioje, atsižvelgiant į tai, kad kiekvienas ŽIV užsikrėtęs asmuo gaus gydymą vidutiniškai po 8 metų nuo užsikrėtimo. 01/01/2005, Data of the Lithuanian AIDS Centre

13 Prevention efforts seek to: Risk Factors Things in the community or the systems that surround it that increase the probability of disease, injury, or death to community members Protective Factors Things in the community or the systems that surround it that increase members abilities to respond, adapt to, & transform the risks of life at the individual and community levels

14 Principles Underlying the Policy of Lithuanian AIDS Centre for Working With Target Groups Accepte them as equals Treatment on equal basis Openness in discussing drug use and sexual relations issues Availability and acceptability of healths and care services, peer education Double prevention, AIDA and ABCD...T conceptions

15 WORK WITH TARGET GROUPS Double prevention concept HIV/AIDS and STI STI and unwanted pregnancy HIV/AIDS and drug use Drug use and crime AIDS and TB Reducing risk behavior by half, we may significantly slow down the spread of HIV (UNAIDS)

16 Absolute number of newly identified cases of HIV infection through injected drug use TRANSMISSION OF HIV INFECTION AND RESPONSE IN LITHUANIA Intravenous drug use

17 Social norm Behavioural standard to regulate social behaviour of the people. Social norms could be formalised (e.g. legal norms). In this case prosecution of those is officially sanctioned. Prosecution of non-formalised social norms is sanctioned by societal ethics. Psychological dictionary. Vilnius 1993

18 Pooling vulnerable groups Persons living with HIV Women engaged in prostitution Men having sex with man Injection drug users Convicts and inmates Persons released from imprisonment institutions Migrants and ethnic minorities

19 Where do the new concepts lead? To what extent can we destigmatise socially unacceptable behavior?

20 Case management approach When a person is incapable to take responsibility for own behaviour harmful for himself, his environment and population Somebody has to take responsibility for this individual behaviour and take action for some time Rights and responsibilitys

21 Team work It is important to have similar sheet music and sing one song in one or several voices Specialist is like flux his completeness is one-sided How to speak - politically correctly or profesionally clearly?

22 Relevance of HIV/AIDS problem Show-business role: 1.To call attention to the problem 2.To convey information/message 3.To rise funds To capture attention of media: 1.Media can convey information on health issues to the society. 2.To rise awareness about AIDS problem.

23 Thank you

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