The Comprehensive Package: The simple truth about our response to drug related HIV. Dr. Monica Beg, Signe Rotberga UNODC

Transcription

1 The Comprehensive Package: The simple truth about our response to drug related HIV Dr. Monica Beg, Signe Rotberga UNODC

2 HIV among injecting drug users Why is it so important? 30% global HIV infections are now outside Sub-Saharan Africa 30% of these infections outside Sub-Saharan Africa are due to unsafe injecting drug use 13 million injecting drug users globally about 3 million HIV infected In Eastern Europe unsafe injecting drug use is the main transmission route

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5 HIV spreads among injecting drug users in a lightening speed

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7 Potential spread of HIV from MARPS to the general population in Central Bangladesh (Surveillance, 2002) 2% married 10% married MSW/HIJRA MSM 89% 22%* Rickshawpullers 73% married 27% IDUs are rickshaw pullers 10%* 11%* 72%* 28% M SM 9.6%* IDU 2-3%* 57%* FSW 47% married 1-3%* 76%* 18-23% of female SW mentioned their clients or non-commercial partners are IDU 42% married 16% married Truckers 54% married) *Star marked figures refer to last year Black font figures refer to commercial sex

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9 Projected impact* of injecting drug use on number of HIV infections in Jakarta, Indonesia HIV infections projected HIV infections in IDUs (independent of programs) HIV infections if there were no IDU epidemic *assuming no interventions Source: MAP Report Drug Injection and HIV/AIDS in Asia

10 The comprehensive package Needle and syringe programmes (NSP) Opioid Substitution Therapy (OST) Voluntary HIV Counselling and Testing (VCT) Anti-Retroviral Therapy (ART) Sexually Transmitted Infections (STI) prevention and treatment Condom programming for IDUs and partners Targeted Information, Education and Communication (IEC) Hepatitis diagnosis, treatment (Hepatitis A, B and C) and vaccination of A&B Tuberculosis (TB) prevention, diagnosis and treatment Source: WHO/UNODC/UNAIDS TECHNICAL GUIDE for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users (in press)

11 Why a comprehensive approach? 1,2 People living with HIV (millions) 1 0,8 0,6 0,4 0, baseline needle exhange only substitution (only) comprehensive harm reductions Source: Unpublished data on Asia Epidemic Modelling (AEM): courtesy Brown T, Siriopng S and Sarkar S 2008

12 new infections (thousands) What matters: Early intervention and scale baseline harm reduction harm reduction and condom use in commercial sex Source: Unpublished data on Asia Epidemic Modelling (AEM): courtesy Brown T, Siriopng S and Sarkar S 2008

13 Challenges for policy makers: Choose options for action Tailor interventions to meet country s unique context

14 HIV/AIDS prevention and care among injecting drug users and in prison settings in Estonia, Latvia and Lithuania Overall goal: to halt and reverse the HIV/AIDS epidemics among IDUs and in prisons, and to avoid generalised epidemic Duration: Government Focal Agencies: MOH, MOSA, MOJ Budget: USD Donor: The Netherlands

15 Project objectives: Build national and regional consensus on effective implementation strategies to address HIV/AIDS among IDUs and in prison settings Increase coverage of comprehensive HIV/AIDS prevention and care services Generate and share strategic information to respond appropriately to evolving HIV/AIDS epidemics

16 Project strategy: Involvement of all governmental and non-governmental stakeholders in project design, implementation and monitoring Comprehensive baseline measurements and needs assessment Review of the legislative, administrative and operational environments Development and introduction of relevant training curricula, accreditation and quality control protocols Training of HIV prevention service providers Introduction of comprehensive interventions for IDUs and in prisons

17 Main achievements to date: Objective 1 HIV strategies and action plans New national HIV programme for for Latvia RAR on drug use in prisons in Latvia and Lithuania MMT evaluation in Estonia and Latvia Legal assessments in Latvia and Lithuania Estimation of IDU population size in Lithuania Evaluation of national response to HIV in Estonia

18 Objective 1 HIV strategies and action plans (cont.) Increased involvement of criminal justice sector Coordination and collaboration between national drugs and HIV programmes Involvement of civil society organizations

19 Objective 2 service coverage and capacity building 21 training seminars, 460 participants 5 study tours, 47 participants 6 conferences/meetings, 400 participants Professional networking: participation in 6 international events, 24 persons

20 Training needs assessment Capacity building Training topics: substitution therapy, needle and syringe programmes, advocacy, monitoring and evaluation, estimating IDU prevalence, HIV estimates and projections Target groups: physicians, nurses, social workers, prison staff, policy makers, NGOs, police All training events evaluated, positive feedback received Training module on ST developed and approved in Lithuania

21 Coverage indicators Opioid substitution therapy Number IDU in OST Number of IDU % IDU in OST Estonia Latvia Lithuania WHO/UNODC recommendation % % % moderate: 10-19% good: 20-39% UNODC expert meeting, Vilnius, March 2007

22 Coverage indicators Needle syringe programmes NSP Estonia Latvia Lithuania WHO/UNODC recommendations IDUs in contact > once per month in last year Number of IDU % IDU regularly reached by NSP % % No data No data moderate: 20-39% good: 40-59% No. syringes distributed Number of IDU No. of syringes per IDU per year moderate: good: UNODC expert meeting, Vilnius, March 2007

23 Objective 2 service coverage and capacity building Financial support for service providers through small grants programme 20 grants to governmental and nongovernmental organisations: - 2 new methadone programmes started in Lithuania - 6 projects in prisons - Integration of services (TB and NSP) - Increased coverage through peer outreach

24 Activities for 2008 National HIV programme for Lithuania Scaling-up methadone maintenance therapy in Latvia Starting MMT in Tartu prison in Estonia Evaluation of pharmacotherapy in Estonia and Latvia Increase police involvement Assessment of ARV accessibility Development of training modules on NSP, VCT, MI Continued capacity building (priority prison staff) Small grants to service providers

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