NSPs in Estonia: current situation and future challenges

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1 NSPs in Estonia: current situation and future challenges Aljona Kurbatova National Institute for Health Development Riga,

2 Background First NSP project was launched in May 1997 needle and syringe exchange was provided from a vehicle (car) in Tallinn (NGO AIDS Support and Information Centre). In 1998 HIV voluntary testing and counselling centre in Narva started second needle and syringe exchange project. In June 2000 NSP services were extended to other cities in North-East of Estonia - Narva (4 sites in total), Kohtla-Järve (2 sites in total), Jõhvi, Sillamäe and Kiviõli. 2

3 Background In the beginning of 2000-s national government and Tallinn City Government started to support the programmes, however resources allocated were very modest. In 2003 Global Fund Programme is launched and more systematic development of the NSPs becomes possible on national level. In 2004 European Commission PHARE project in collaboration with Netherlands is launched which allows to establish three new low threshold centres in cooperation with local municipalities Tallinn, Kohtla-Järve ja Paide. 3

4 Current situation National HIV and AIDS Strategy Committee of the Government of the Republic including different ministries, municipalities ang NGOs. Epidemic spread of HIV in two regions Tallinn and a county in East-Estonia. Mostly among IDUs. Most of the interventions are targeted at these regions and coordinated through the national level. 4

5 Current situation IDU population size: More than half of the IDU population is HIV infected. YEAR AGE Gender Main drugs injected average (M %) 23 (16-45) 88% Heroine 79% Opium poppy 29% 22 (18-49) 88% Heroine 59% Amphetamine 30% 24 (15-43) 83% Fentanyl 59% Opium poppy 20% Amphetamine 19% 27 (17-54) 84% Fentanyl 72%, Amphetamine 26% 27 (16-46) 81% Fentanyl 55%, Amphetamine 28% Other 17% (mainly 3-methylfentanyl) 5

6 Current situation In total 9 organisations and 36 syringe exchange sites/teams (including outreach teams): NGO Convictus Estonia NGO AIDS Support and Information Centre NGO We will help you NGO You will nit be alone LLC Corrigo NGO Allium (in cooperation with Kohtla-Järve City Government) NGO Tallinn Low Threshold Centre (in cooperation with Tallinn City Government) NGO Tapa Drug Prevention and Counseling Centre (in cooperation with Tapa Municipality) Paide Social Welfare Centre (Paide City Government) Financed and coordinated through NIHD. Annual budget ~ EUR. In 2009 compared to 2003, the amount of visits has multiplied eight times. 6

7 Work process NATIONAL STRATEGY: Long term objectives (united effort of different sectors and organisations) ACTIVITY PLAN OF THE STRATEGY 4- year and yearly plan the amount of services targeted at IDUs planned for the whole country (formed by the ministries involved, reviewed by the Government Commission) ACTIVITY PLANS OF SERVICE PROVIDERS IN THE REGION Yearly plan the amount of service planned for each organisation (in cooperation of service providers and NIHD). SERVICE DESCRIPTION the types of services provided, required conditions, safety requirements, etc (in cooperation of service providers and NIHD). 7

8 The roles of different partners NIHD in national level: coordinating the general development of the service, planning the budget and the service need for the country, conducting public procurements (syringes, needles, condoms etc) financing the service, organising staff trainings, conducting studies, analysing the results of the service Service providers in regional level: planning the service and the budget in their organisation, delivering service to the target group, questioning the clients of NSP, participating in preparing service descriptions and in other developments (including preparing the national strategy). 8

9 Harm reduction services Establishment of first contact Needle and syringe exchange Outreach and secondary needle and syringe exchange Provision of condoms, lubricants, pregnancy tests (when available), informational materials Psychological, motivational and social counselling Social services (second hand clothing, food etc) Medical first aids 9

10 Example of the data on monthly visits to NSPs in 2003 Tallinn 55 Narva 177 Sillamäe 378 Jõhvi 171 Kohtla-Järve 121 Puru 122 Kiviõli 38 Tapa Keskmine külastuste arv visits per month 10

11 Needle and syringe exchange in Tallinn Jagatud süstlad 11

12 Latest statistics on NSP in Estonia Indicator % No. of visits ,04% No. of regular clients * +31,79% No. of distribured needles and syringes ,01% No. of received syringes ,21% No. of consultations by social worker ,12% No. of consultations by health care worker ,20% * 52% of the IDU population 12

13 Quick glance at 2010 (January- September) Total number of visits to NSP sites has not changed significantly. Monthly average: visits 1,5 visits per client 20,5 syringes per client 13,6 syringes per visit 13

14 Results so far (study 2007) In % of IDUs in Tallinn and 79% in Kohtla-Järve did not share injecting equipment with others during last month. In % of new clients of NSP had injected one year or less previous to their first visit to services. 64% of IDUs in Tallinn and 75% in Kohtla- Järve got syringes from NSP during last month, 48% in Tallinn and 65% in Kohtla- Järve had NSP as the main source for syringes. 14

15 Main shortcomings Lack of indicators for measuring the quality of the service and lack of agreed system for reviewing the quality of the service. Lack of agreed professional qualification standards and standardised trainings. Lack of nationally applied and legally endorsed service standard. 15

16 Further challenges Legalization of the harm reduction services including NSP. Improving the status/reputation of the services in the society. Needle and syringe exchange and harm reduction in general is not a hobby but a professional service that employs social and health care workers, peer counsellors, needle exchange workers. Elaboration and endorsement of the professional standard for harm reduction workers and consequential elaboration and implementation of the continuous training system. Further elaboration of services: TB control HIV rapid testing Gynaecological services for women Overdose prevention with naloxone (currently not available) Needles and syringes are important, but there is so much more that we have to do. 16

17 THANK YOU! 17