Report on the epidemiological situation of HIV and AIDS and the fulfilment of National HIV and AIDS Strategy for years in year 2012

Transcription

1 Report on the epidemiological situation of HIV and AIDS and the fulfilment of National HIV and AIDS Strategy for years in year 2012 Summary The purpose of the report is to provide information to the Estonian Government on the epidemiological situation of HIV and AIDS in Estonia and the implementation of the national HIV and AIDS strategy in year The general goal of the strategy for prevention of HIV and AIDS is to achieve a constant tendency of decrease in the spreading of HIV infection. Thereby, the goal for year 2015 is to decrease the number of new cases of HIV infection per 100,000 inhabitants to 20 (the relevant figure in 2004 was 55, 31 in 2009, 28 in 2010, 28 in 2011 and 24 in 2012), and prevent the wider spreading of the infection among the general population by the activities in the strategy. As of December 31 st, 2012, 315 persons were diagnosed with HIV infection in Estonia (55 cases less than in 2011). In total, throughout years HIV has been diagnosed for 8,377 persons, including HIV disease for 390 persons. As before, the majority of new HIV cases were registered in Ida-Virumaa and Tallinn respectively, 42% (n=131; 79 cases per 100,000 inhabitants) and 47% (n=148; 37 cases per 100,000 inhabitants). In comparison with year 2011, the discovery of new cases has decreased in Tallinn by 17 cases and in Ida-Virumaa by 2 cases per 100,000 inhabitants. Neither can a significant decrease be observed in Ida-Virumaa in absolute numbers (135 cases in 2011 and 131 cases in 2012). A positive aspect is a high level of testing of HIV and increase in the number of persons aware of the possibility of infection among injecting drug users in Ida-Virumaa. While in 2007 the prevalence of HIV was 70% and 49% of infected persons were previously aware of it (76% had taken a test before), then in 2012 the prevalence of HIV was 62% and 84% were previously aware of it (90% had taken a test before). Elsewhere in Estonia, a total of 36 new HIV cases were diagnosed in 2012 (4.7 cases per 100,000 inhabitants), and the figure is rather stable in the recent years. Out of the new cases in 2012, some 34% were women (n=106). The largest number of new cases were diagnosed in age groups of years (n=66) and years (n=64). Starting from the age group of 25 29, the number of men exceeds the number of women among diagnosed cases. Of the new cases of HIV identified during voluntary and anonymous testing (n=130; 41% of all cases of HIV) 25% were persons (n=32) who have engaged in injecting drugs. The proportion of injecting drug users was the largest in Narva 50% of new cases. Over years the proportion of injecting drug users among new cases has gradually decreased. According to the HIV treatment council, there were 145 pregnant women with HIV in Estonia in 2012, the total number of births was 13,845. Thus, in 2012 the proportion of pregnant women infected with HIV had increased to 1.05% and the target level of the strategy s indicator was not achieved. What is positive is that thanks to modern medicine it is possible to prevent the spreading of HIV infection from mother to child and the proportion of vertical infection with HIV of all new cases remains below 2%. In 2012, the HIV disease was diagnosed for 36 people (8% less than in 2011). Strategic goal 1. The number of injecting drug users has decreased and the spreading of HIV infection among injecting drug users shows a constant tendency of decrease. 1

2 To reduce harm connected with the injection of drugs, syringe exchange is provided in Estonia and substitution therapy is provided to opioid addicts. In syringe exchange points, sterile syringes and needles are provided to clients and used supplies are collected, counselling is provided to people regarding the possibilities for receiving help, safe injecting and sexual behaviour, people are encouraged to give up injecting and request substitution or aversion therapy. In low threshold centres social counselling and services are also offered. In 2012, a total of 37 syringe exchange and counselling points operated in nine organisations. The volumes of syringe exchange increased considerably in but have decreased somewhat in the recent years. Out of syringes distributed in 2012, 66% were distributed in Ida-Virumaa, 33% in Tallinn and 1% in other regions of Estonia. The number of first-time visitors was over 1,300 in 2012, and the total number of visits was over 150,000. The number of regular visitors with client code was about 6,700. The number of first-time visitors has decreased but the share of drug addicts having been involved in syringe exchange at least once in their life time is over 90%. The number of visits was somewhat smaller than in the previous years as regular clients visit the syringe exchange points less frequently and take more syringes at a time. In total, about 2.2 million syringes (245 syringes per injecting drug user), 400,000 needles and over 460,000 condoms were distributed. The number of distributed syringes was 11% smaller than planned. This can be partly explained by an increase in the share of Amphetamine users as Amphetamine is injected fewer times a day/week. As substitution therapy, Methadone substitution therapy is offered within the national strategy. In 2012, 7 service providers were providing the service in 9 locations (total number of therapy locations was 679), within the year, 1157 persons received therapy and at the end of the year 687 patients were receiving therapy (filling rate 101.2%). Over years the number of recipients of substitution therapy has considerably decreased in Ida-Virumaa whereas in Tallinn the number of patients has increased and almost all providers of substitution therapy in Tallinn have waiting lists. In cooperation with the Estonian Psychiatric Association and the Estonian Society for Infectious Diseases, a new clinical protocol of opioid addiction substitution therapy was prepared in 2012, which is implemented by the National Institute for Health (NIH) as of January In 2012, the provision of anonymous diagnostics service of sexually transmitted diseases (STD) continued free of charge for injecting drug users and their sexual partners in Jõhvi and Narva. The total number of therapy cases during the year was 951 (105% of the predicted number). A total of 243 people participated in trainings and seminars organised for specialists (main topics: prevention of overdose, infection checks). Foreign cooperation: By the leadership of the NIH, project Empowering public health system and civil society to fight tuberculosis epidemic among vulnerable groups financed by the European Commission is carried out (with partners from Latvia, Lithuania, Finland, Bulgaria, Romania, Russia, Ukraine, Georgia, Albania and Bosnia-Herzegovina) with the main goal to prevent tuberculosis among injecting drug users and people with HIV. A prevalence survey conducted in Ahtme among injecting drug users in 2012 was financed from project funds. Within the project BORDERNETWork, co-financed by the European Commission, a pilot method of informing contact people was implemented in the 4 th quarter of

3 and the 1 st quarter of 2012 in the course of providing the service provided to injecting drug users regarding sexually transmitted diseases (STDs). Strategic goals 2 and 4. The number of new cases of HIV among young people in the age of is continually decreasing (2). Knowledge of the population of the ways of spreading of HIV and abilities to evaluate the risk of being infected have increased, and negative attitude to people living with HIV and AIDS has decreased (4) Sexual education in school environment is coordinated by the Ministry of Education and Research (MER). Activities carried out with the financing of the NIH are mostly aimed at increasing the quality of prevention work in Estonia. Also, information regarding the HIV infection is distributed through various media channels. Teaching life skills is part of the schools study programme of personal education. In 2012, the national study programme was implemented in the second year of basic school stage, i.e. in year 2, 5 and 8. The final implementation deadline for the study programme is the beginning of the 2013/2014 academic year. Upon preparing the new version of the national study programme, respective health education modules corresponding to certain quality standard requirements were taken into consideration. Personal education remained in the study programme as a separate compulsory subject for all ages. The subject syllabus for personal education takes into consideration the modern trends and treatment of preventing risk behaviour, and prevention activities are integrated in the subject syllabus for personal education for years 2 to 12. The state shall not acquire specific literature for teaching personal education that corresponds to the national study programme. Every year the state allocates funds for local governments to purchase reference books. Acquisition of reference books is carried out on the basis of the individual requirements and opportunities of each school. After completing teacher training, teachers must possess knowledge and skills required for the implementation of national study programme, including the topic of HIV and drug use. Inservice training is offered at all institutions of higher education that specialise in preparing teachers. These are mostly directed at the teachers of personal education. It is not expedient to offer universal in-service training to all teachers on the topic of drug use prevention. The MER did not plan separate trainings for networking and drug use prevention in Under the programme Improving the quality of youth work of the European Social Fund (ESF) the Estonian National Agency for Youth in Action carried out 43 training activities in 2012 with about 1034 young persons and youth workers as participants. Among other things, training was conducted for working with specific target groups and improving special knowledge and skills, incl. prevention of drug use (528 specialists participated). Funds for training the staff of state schools (teachers) on the topic of awareness of HIV and AIDS are included in the school budget among training expenses. Based on this and actual needs of school personnel the schools prepare their own training plans for teachers. In 2012, a sexual education training was carried out for the teachers of state schools and schools for students with special needs with the total cost of 5000 EUR. All personal education teachers from said schools were included. Since 2007, a separate trend in informing young people of the risks accompanying drug use has been training for the young people by young people which are also funded from the resources of the national HIV/AIDS prevention strategy. In 2012 an agreement was concluded with three partners for the preparation of persons carrying out training for the young people by young people: Social Centre of Central Estonia, Anti-AIDS Association and Living for Tomorrow. The total number of new young training providers prepared by these associations was 233. Continuous training was offered to 14 young persons who had 3

4 previously completed this training. Unfortunately, young training providers have not established a network. A significant innovation was included in the preparation of the training plan for the new period that began in autumn. Trainings were directed to a more specific and smaller target group. Special attention was paid to young people studying at vocational schools and schools for students with special needs as well as to the personnel of said schools and areas that lie further away from major centres. Current period of contract ends in the summer of In the schools for students with special needs prevention activities regarding HIV/ AIDS and drug use are carried out in the course of providing general schooling and educational activities. Prevention programmes are not conducted outside school activities; it is included in the provision of general schooling and educational activities. Topics are addressed as part of the study programme in personal education classes. Prevention activities include all students of specialized schools, i.e. 80 students in In 2012, the NIH carried out four trainings in specialized schools that included both HIV and drug prevention. 40% of the students of specialized schools visited specialists who carry out testing of HIV/AIDS (a total of ca 30 students). All girls studying in specialized schools have visited a gynaecologist; some of the boys have visited a relevant specialist and had themselves tested. Ministry of Defence contributes to the decrease in the number of cases of HIV among the age group by providing training to conscripts and opportunities for testing of HIV during conscription. In 2012, the Estonian Sexual Health Association carried out 40 trainings for 799 conscripts and conducted 50 trainings for 1019 conscripts under the DHAPP project. Topics covered in trainings included an overview of the nature of HIV infection and sexually transmitted diseases, their ways of spreading and means of prevention, ways of contracting HIV through abuse of drugs and alcohol. Information was also provided on potential HIV counselling. Condoms and information booklets were distributed. Additionally, the University of South Carolina and National Institute for Health conducted a survey among conscripts to evaluate the prevalence of STDs, incl. HIV, and related risk behaviour among conscripts. Participation in the survey was voluntary. 584 young men took part in the survey, i.e. 18.6% of all conscripts who started conscript service in No cases of HIV were identified. The NIH provided several trainings in 2012 ( Children and young people with behavioural problems, training on the topic of teacher s book) to specialists dealing with young people (teachers, social pedagogues, personnel at children s homes). In cooperation with the Estonian Sexual Health Association and NUKU theatre a manual of a youth musical Spring Awakening was adapted to the situation in Estonia to encourage the discussion of the musical s topics in class, and said manual was printed and distributed both electronically and on paper (a total of 500 manuals). From 20 th May to 17 th June 2012 an information campaign Rubber is sex! that covered the entire country was carried out with the help of funding from the ESF. Several information booklets in both Estonian and Russian ( Safe sex, Sexually transmitted diseases, HIV and AIDS ) were reprinted and distributed. Youth counselling centres provided services related to STDs to young people without health insurance in 937 cases (in 16 centres across Estonia). In 2012, the number of visits of young people covered by health insurance to counselling centres was 32,679. Services were used by 31,907 young people, 6% of visitors were young men. Approximately one fifth of young people were first-time visitors to the youth centre. Sexually transmitted diseases were identified for 2% of young people but there were no new cases of HIV. 4

5 Strategic goal 3. Spreading of HIV has not increased and spreading of STDs has decreased among the people engaged in prostitution Two organisations in Tallinn offered health services and counselling to people engaged in prostitution. Diagnostic of HIV and STDs was provided, also therapy, if necessary, counselling on safe sex and other topics, means for safe sex were distributed. In 2012, counselling service was provided 615 times, 38 of these were cases of first-time counselling. The number of contacts acquired during field work was 763, 89 of these were first-time contacts. During the year there were a total of 112 therapy cases (25% less than predicted). In total, over 40,000 condoms were distributed (75% more than planned). Similar service offered in Jõhvi to injecting drug users and their sexual partners is among other things also aimed at women receiving drugs or money for drugs against sex. Three information days Prostitution and accompanying risks took place in Tartu, Jõhvi and Tallinn with a total of 138 participants. Information days were organised under the BORDERNETwork project. A training called HIV and women was carried out under the same project, with 30 participants from different organisations. Foreign cooperation: By leadership of SPI Forschung GmbH (Germany), project BORDERNETWorkfurther development of hands-on HIV/AIDS/STI prevention, diagnostic and treatment in Central and Eastern Europe was started. One of the main target groups of the project are women engaged in prostitution. The NIH participates in 8 activities and is the leading partner of one activity (the purpose is to pilot various models of service provision to vulnerable groups). Within the project the service of testing of STDs provided to MSMs free of charge was partially funded (see also strategic goal 7). Strategic goal 5. Spreading of HIV has not taken place in custodial institutions (incl. temporary custodial institutions) Pre-testing and post-testing counselling of HI virus takes place in all prisons. Testing is done upon the arrival to prison, in one year from the last testing and, if medically indicated, also more frequently. Such testing makes it possible to monitor the spreading of HIV in prison with good results. Testing of HIV in prison is voluntary and pre-testing and post-testing counselling are of significant importance. Drug addicts belong to a risk group and thus must get information regarding the avoiding of HIV infection. Testing and counselling are organised and accounted for by the medical department of the prison. In 2012, 44 new cases of HIV were diagnosed. These persons were generally HIV positive already upon arrival to prison, the only exception was an imprisoned person in Harku and Murru Prison who was presumably infected as a result of prolonged contact. In 2012, the number of people receiving ARV therapy in prisons was 281. ARV therapy is provided to all imprisoned persons with relevant medical indications. The number of people receiving ARV therapy has steadily increased throughout the years. In regard to Hepatitis B and C, testing and counselling is provided only for risk groups (injecting drug users, HIV-positive people, etc.) or on medical indications when prescribed by a doctor. Testing for Hepatitis in prison is voluntary. Prisoners belonging to the risk group are vaccinated against Hepatitis B if they do not refuse it, if they have not had Hepatitis B earlier, if they have not been vaccinated before and if they have no allergy for any component of the vaccine. Availability of condoms in prisons is ensured in the rooms designed for long meetings. 5

6 Single-use means for improving personal hygiene and maintenance of the living premises necessary in prison are ensured for the prisoners. Protective equipment necessary for ensuring a safe work environment are available for employees. Training of prison personnel took place from the funds of UNODC for years and the training budget for prisons. Non-profit association Convictus provides the support group service for HIV-positive people in prison. The group work service is provided to both HIV-positive prisoners and prisoners with drug addiction. Various trainings are offered to prison personnel. In 2012, 20 officials were trained to implement in the prison system the social programme Lifestyle training for offenders, aimed at the abusers/addicts of substances for whom such addiction leads to unlawful behaviour. Training of motivational interviewing/counselling is also provided to prison personnel and probation supervisors. Motivational interviewing is a basic skill that is trained every year as necessary. In 2012, eight trainings were carried out and 85 officials were trained. 20 officials were provided three trainings under the programme The Right Moment. This is an individual programme which aims to help the convicted person acquire, develop and apply skills related to resolving social problems to cope with problematic situations. Prisons also provide treatment for drug addiction, financed from the funds of national HIV and AIDS strategy. Primary aversion therapy of drug abuse generally takes place with nonopiate medicines in the medical department but it is also possible to carry out Methadone aversion therapy. The volume of starting and continuing Methadone aversion and substitution therapy has increased in prisons year by year. If in 2009 the relevant indicator was 12, in 2010 it was 123, in 2011 it was 217 and in 2012, Methadone aversion or substitution therapy was started/continued on 130 occasions. Strategic goal 6. Vertical infection with HIV has decreased Pregnant women infected with HIV are supplied with prophylactic treatment both during pregnancy and child birth, and it is also provided for the newborn child. In 2012, 199 babies received free feeding formula to avoid the spreading of illness through breast milk. Teams consisting of medical nurses and social workers are operating in three larger out-patient departments of communicable diseases (AS Lääne-Tallinna Keskhaigla, SA Ida-Viru Keskhaigla, SA Narva Haigla) specialising in case management of the HIV-infected, including HIV-infected pregnant women. Strategic goal 7. The prevalence of HIV among men having sex with men (MSMs) has not increased In 2012, equipment for safe sex were distributed in clubs with gay orientation in Tallinn and Tartu (4752 condoms and 4500 lubricants). 337 people were tested in the quick testing events of HIV (in Tallinn) in G-punkt, X-baar, Saun 69, Ring Club and OMA Keskus. Under the BORDERNETWork project, co-financed by the European Commission, a service of STD aimed at MSMs was introduced in the 4 th quarter of Sampling equipment necessary for STD analyses could be ordered online and return by post. The service was used by 23 men with one case of Chlamydia identified. Representatives of Estonia participated in the Northern Dimension working group where they discussed the issue of the countries of the Northern Dimension submitting a common project application on the topic of MSM to the European Union Public Health Programme. 6

7 Strategic goal 8. Spreading of STD among population has decreased. Activities were not carried out in Strategic goal 9. No infection with HIV has taken place during professional work This activity include mostly the activities of the Ministry of the Interior in police and rescue institutions. Police and rescue institutions have acquired an adequate amount of protective equipment to ensure the safety of their personnel. All rescue service employees, police officers and police employees directly exposed to the risk of infection are equipped with single-use safety devices (personal protection and disinfection devices protective gloves, protective masks, masks for CPR, etc.). By directive No. 196 of of the Director General of the Police and Border Guard Board, a procedure for vaccination of rescue service employees has been established, according to which the groups of vaccination are: Hepatitis B, tetanus, tick-borne viral encephalitis and rabies. All police officers and police employees directly exposed to the risk of infection are vaccinated. In 2012, the total number of vaccinations for Hepatitis B and Hepatitis A+B in the Police and Border Guard Board was 804. A total of 22,514 EUR was spent on said vaccinations. A framework agreement for purchasing vaccines has been concluded with OÜ Magnum Medical. In Northern precinct, Southern precinct and Police and Border Guard Board vaccinations are carried out on site by work environment specialists with medical education who have receive relevant training. In Western and Eastern precinct the service of vaccination is bought in. Every year, as necessary, work environment specialists organise information days on safety in different divisions where the main topics are safe working methods and avoiding risk factors, incl. avoiding infectious injuries (by using personal protective equipment and vaccination), and working with infectious materials and persons. Drug substitution therapy was provided in the detention houses in the Northern precinct and in Jõhvi, with 257 detainees participating. Strategic goal 10. The availability of HIV testing and counselling service has increased Eleven institutions in ten towns (Tallinn, Tartu, Narva, Puru, Pärnu, Paide, Rakvere, Tamsalu, Kunda, Võru) provided anonymous voluntary service of counselling and testing of HIV. Provision of service is supported through the NIH and the number of visitors has increased year by year. During the year, 12,652 persons received counselling and 12,037 persons were tested (half of tested persons were tested during field trips and outside events). Thus it can be said that the NIH has achieved adequate geographical coverage with the anonymous voluntary testing of HIV. 130 new cases of HIV were diagnosed during anonymous voluntary testing of HIV (41% of new cases of HIV diagnosed in Estonia in 2012), 32 of those (25%) had injected drugs at some point in their lives. The costs of all verification tests and transport from the primary laboratories to the reference laboratories were also covered from the funds of the national strategy. As of 2012, medical tests funded by the Health Insurance Fund for the testing of HIV are recorded as a separate service. A total of 57,718 tests were paid for in 2012, and the number of examinations ordered by family physicians was

8 A code of practice for the testing of HIV and referral of HIV-positive persons to treatment was prepared under the leadership of the Ministry of Social Affairs. In Ida-Virumaa 47 health care professionals completed the training on the instructions of testing of HIV. Strategic goal 11. The safety of donor blood and transferred donor organs and tissues for the recipient are guaranteed. Activities were not carried out in Strategic goal 12. The quality of life of people living with HIV and AIDS has improved In Estonia, infectionists in five hospitals specialise in health services of HIV-infected (AS Lääne-Tallinna Keskhaigla, SA Ida-Viru Keskhaigla, SA Narva Haigla, SA Tartu Ülikooli Kliinikum, SA Pärnu Haigla). They lead the monitoring of the state of health of the infected persons, additional research, counselling and specific treatment. The Estonian Health Insurance Fund covers all treatment costs of insured persons (except for ARV medicines) and funds have been allocated from the state budget also for health services designed for the HIV-infected people without medical insurance. ARV medicines are free for all patients and are distributed in departments of communicable diseases of hospitals. Additionally, within the national HIV and AIDS strategy, creation of a case management system for people with HIV has been started, coordinated by the NIH. In three larger outpatient departments of communicable diseases (in Tallinn, Narva and Kohtla-Järve), teams of nurses and social workers are operating, focusing on solving the problems of people with HIV both in regard to health and social counselling. In three hospitals a total of 374 first-time clients contacted the case management nurse. The total number of contacts was 12,289, 1831 persons received ARV medicines. 228 first-time clients contacted a social worker, and the number of regular visitors was 595. Support groups lead by specialists operate in several organisations in Tallinn and Ida- Virumaa with a purpose of informing and counselling of people with HIV and persons close to them. In addition to support groups, counselling offices have been opened in three hospitals. 2,236 persons received counselling and support services. In 2012, the number of insured persons with HIV who received in-patient health services was 881 and out-patient services were provided to 3255 persons. Of persons without medical insurance, 91 persons received in-patient health services and out-patient services were provided to 549 persons. Strategic goal 13. Planning of the area according to evidence-based data has expanded Major data collection and reports completed in 2012: Report of the 2010 survey on men having sex with men. Report of the survey conducted in Tallinn in 2011 among women engaged in prostitution (funded from the EU project Bordernetwork). Report of the survey on the risk factors and prevalence of HIV and STD among conscripts (funded by the United States Department of Defence). Transfer of the data of Global AIDS Response Progress Reporting (ECDC, UNAIDS, WHO, UNICEF) and preparation of report. First version of the report of the survey conducted among prisoners in 2011 (funded from the national strategy) which is currently being approved at the Ministry of Justice. Final report was completed in February Collection of data for the survey on injecting drug users in Ahtme, Ida-Virumaa (report was completed in April 2013) (survey was funded from the EU project TUBIDU, the national strategy and grant of the Department of Public Health of the University of Tartu). 8

9 Preparatory activities for the project Bridging the gap in knowledge and practice of prevention and care for HIV in Estonia (duration of project ) under the leadership of the Department of Public Health of the University of Tartu (funded by SA Archimedes) Preparatory activities for the survey For the Health of Men: Surveillance and Health Improvement on the Internet, funded by the Estonian Research Council (duration of project ) Preparation of the survey on the risk factors and prevalence of HIV and STD among active servicemen (funded by the United States Department of Defence). Current monitoring and evaluation of the services of HIV strategy (funded from the national strategy). Preparation of source material for the evaluation of HIV strategy Evaluation was completed in April, 2013 once it was possible to add data for year 2012 (funded from the national strategy). Translation of the report HIV epidemic in Estonia into Estonian and Russian (funded from the national strategy). Foreign cooperation The employees of the NIH participated in the work group of ECDC Monitoring the Dublin Declaration" and in the HIV coordination group. Strategic goals 14 and 15. The number of competent organisational and human resources actively operating in the area of HIV prevention has increased (14). The number of services provided according to the service description agreed by the specialists of the area has increased (15) A code of practice for the testing of HIV and referral of HIV-positive persons to treatment was prepared in The purpose of the manual for testing of HIV is to ensure early identification of HIVi-infected persons, thus reducing the proportion of people unaware of the possibility of infection, ensure the timely start of treatment and help prevent the further spreading of infection. Since 2011, by leadership of the Estonian Association of Infectionists, ARV treatment councils are held, the purpose of which includes avoiding the spreading of HIV infection and development of resistance of the virus, ensuring treatment with uniform quality and principles based on rational agreed treatment schemes and treatment guidelines in all medical centres providing anti-retroviral medicines. Activities shall be continued in

10 Use of resources The total amount of expenses of the HIV and AIDS strategy in 2012 was 19,037, euros. Planned in Actual cost in 2012 (EUR) 2012 (EUR) TOTAL HIV STRATEGY 15,816, ,035, MINISTRY OF SOCIAL AFFAIRS 15,580, ,693, incl. Estonian Health Insurance Fund 3,726, ,496, incl. Ministry of Social Affairs 9,241, ,598, incl. NIH 2,612, ,599, MINISTRY OF INTERNAL AFFAIRS 101,172,00 51,003,80 MINISTRY OF JUSTICE 95, , MINISTRY OF DEFENCE 11, , MINISTRY OF EDUCATION AND RESEARCH 76, , Unfortunately, it is not possible to list all used resources among actual costs as the topics related to HIV and AIDS often form a part of a larger activity or part of the institutions general operational expenditure. In addition to the state budget, ESF funds were used for financing the activities of HIV and AIDS strategy in Activities focused on the development and provision of counselling services aimed at HIV-positive persons. ESF funds were used in a total of 205, euros. Directions for development and priorities in 2013 and for the future In 2013, the priorities continually include the measures for reducing harm among injecting drug users; thereby, special attention is paid to the development of services aimed at female drug addicts and sexual partners of drug addicts. Another important direction of activity is the expansion of the availability of the service substitution therapy for opioid addiction. In 2013, a pilot programme shall be launched on the prevention of deaths by overdose, in the course of which the representatives of trained target group shall receive a medicine with Naloxone as active ingredient. In regard to the completion of the code of practice for the testing of HIV and referral of HIV-positive persons to treatment, it is important in 2013 to ensure cooperation between the Ministry of Social Affairs, providers of health services and the Estonian Health Insurance Fund in order to make the provision of testing of HIV more efficient in the course of provision of health services, focusing on the risk groups mentioned in the manual. Improving cooperation between the provider of case management service and providers of other services. Updating the surveillance and monitoring of services. 10

11 Preventing infection with HIV in prisons and ensuring that the number of persons who refuse testing of HIV (incl. repeat testing) remains below 1%. Continuing vaccination for Hepatitis B among prisoners and employees of prisons/ detention houses. Continuing the testing of Hepatitis C and its treatment in prisons. Conducting a survey on HIV/STD among active servicemen and preparing instructions for routine testing of HIV/STD in the Defence Forces. 11