Methadone Treatment as a Harm Reduction Strategy, Gender Sensitive Programming and Evidence-based Strategies

Transcription

1 Methadone Treatment as a Harm Reduction Strategy, Gender Sensitive Programming and Evidence-based Strategies Wendee Wechsberg, PhD, Senior Director Substance Abuse Treatment Evaluations and Interventions Wednesday, October 20th RTI International is a trade name of Research Triangle Institute.

2 Premature Death Among IDUs Natural Causes HIV Hepatitis Endocarditis Non-Natural Causes Overdose Suicide Violence Accidents

3 What is Methadone Treatment? Opioid substitution therapy (OTP) Majority are maintenance programs to prevent withdrawal symptoms, less detox Highly regulated pharmacologic adjunctive treatment for opiate dependence Currently, 1,250 public, private, nonprofit OTPs in the US

4 MMT as Harm Reduction in the US Higher methadone dose less cravings, less need to seek, inject drugs Minimize negative consequences of continued use through education on Safer injection Overdose Needle exchange Need for drugs Since % of US programs have offered risk reduction and HIV testing, 89% have offered TB testing

5 Impact of MMT Programs Studies from 1980s to 2003 reported Significant reductions in HIV risk behaviors Significant reductions in hepatitis Slower progression to AIDS Reductions in crime Positive effects on employment Buprenorphine is available and also available in the Southeast Asia region

6 Global Estimates of IDU

7 Methadone Treatment expansion in Southeast Asia Although less than 5% overall are getting into OST Persistence is working: Bangladesh just approved MMT this April Indonesia completed pilot studies and is now expanding MMT India has plans this year to open 220 clinics, including prisons OTP is free in Bangkok but limited

8 Proportion of Female IDUs is Growing Recent rapid increase, especially in Asia Higher than men in some places, including Yunnan, China Probably underestimated because of lower visibility, particularly in gender-segregated societies

9 Double Jeopardy of Women s Injection Risk Women tend to Engage in receptive syringe sharing, across regions and cultures Access drugs and injection equipment through male partners Be injected by men Have partners who inject with others and who have other sexual partners Unprotected sex

10 Challenges of Gender-Specific Response Lack of knowledge regarding women s drug use in some cultures Scarce research into culturally appropriate interventions and treatment Intersecting risks within cultures Survival sex, sex work Trading sex higher prevalence of HIV and STIs, higher-risk activities

11 Poor Access to Services for Female DUs Insufficient access to gender-appropriate drug treatment Access to harm reduction services is often second-hand, through male partners, meaning women don t get full range of services Drug treatment services don t accommodate children, can jeopardize custody Few gender-specific drug treatment or harm reduction programs in Eastern Europe HIV testing should not violate women s rights or make them more vulnerable to stigma and discrimination

12 Inequity and Equality Globally, the leading cause of death among women of reproductive age is HIV/ AIDS. Girls and women are particularly vulnerable to HIV infection due to a combination of biological factors and gender-based inequalities, particularly in cultures that limit women s knowledge about HIV and their ability to protect themselves and negotiate safer sex. WHO, November 2009

13 Women/Family Friendly MMT Treatment Childcare Transportation Gender matching Family and social services Life skills training Medical assistance Psychological counseling

14 Scaling Up the Women s Health Coop Harm reduction program Evidence-based Woman-focused Addresses intersecting risk behavior related to HIV Packaged, can be adapted for treatment, community, or mobile settings Empowerment framework based on core elements: Alcohol and other drug use Sexual risk reduction Sexual violence and trauma Gender inequity

15 Some Global Thoughts Effective methods to reduce IDU risk are known, but access to treatment for rural populations and alternatives with access to syringes are necessary. Outreach methods can be adapted to many populations for HIV education and interventions, but country norms must be studied first. Treatment programs can open and become gender sensitive and protective against HIV spread, but policy makers have to prioritize treatment as a harm reduction method. WOMEN who are IDUs, and sexual partners of IDUs or sex workers need specific targeted interventions.