Improving Access to Test and Counselling Services for Injection Drug Users: Most Recent Experience from Portugal Henrique Barros Ministério da Saúde
HIV Testing Knowledge of HIV serostatus has been increasingly advocated as a prevention measure in its own right.
Most commonly stated barriers to HIV testing: being aware of a negative test a preference not to know perception of low risk for HIV concerns about losing employment and life assurance.
HIV Testing AIDS programmes need to be able to make comparisons about what works and doesn t work; and to estimate the resources required at country, regional, and global levels to provide universal access to HIV prevention services
HIV Testing Rapid point-of-care HIV testing is a very important component of HIV control initiatives and programs. Non-invasive, simple, accurate (blood or oral fluid-based) rapid tests have the potential to make a big impact on HIV screening programs, especially in areas where laboratory infrastructure is poor or unavailable
HIV Testing
HIV and Drug Users Over the past decade, a body of observational research has accumulated about the effects of outreach-based and peer added HIV interventions for drug users.
HIV and Drug Users Chen et al. AIDS Behav, 26
HIV and Drug Users Drug Users in Portugal 3, clients contact the public health and social services for drug users; Approximately 15, DUs are reached by harm reduction structures.
12 1 8 6 4 2 AIDS Cases - Portugal 1983 84 85 86 87 88 89 199 91 92 93 94 95 96 97 98 99 2 1 2 3 4 5 Date of diagnosis Date of declaration
HIV and Drug Users HIV Notifications 1.5 1.125 75 375 21 22 23 24 25 UDIs HS MSM MTCT
HIV and Drug Users AIDS Notifications 55, 412,5 275, 137,5, 21 22 23 24 25 IDUs HS MSM MTCT
HIV new infections in IDUs (per 1,, population) 14 11 7 36 2.7.9.7 3 2 3 21 1.8.2 3 18 9 28 24 63 3 7 5 43 3 5 98 72 3 12 17.1 12 2 31 1 NA NA 14 11 7 36 2.7.9.7 3 2 3 21 1.8.2 3 18 9 28 24 63 3 7 5 43 3 5 98 72 3 12 17.1 12 2 31 1 NA NA
HIV/AIDS patients on HAART (26), by region 15. 11.25 11.273 7.5 5.134 3.75 1.328 799 145 ARS Norte ARS Centro ARS LVT ARS Alentejo ARS Algarve
Distance from usual residence to hospital
23 24 25 26 n 3 25 2 15 1 5 Modes of Transmission HSJ, 1985-26 199 1991 1992 1993 1994 1995 1996 1997 1998 1999 2 21 22 Tx, Hemof MSM Heterosexual IDUs 1989 1988 1987 1986 1985
HIV and Drug Users Programs for Injection Drug Users: Needle and syringe exchange Substitution therapy Medically assisted injection facilities
HIV and Drug Users Syringe Exchange Kit
HIV and Drug Users syringes 1.8. 1.6. 1.4. 1.2. 1.. 8. 6. 4. 2. Pharmacies Partnerships protocols w ith NGO Mobile Units 23 24 25
HIV and Drug Users - Portugal Modelling of the effect of the Needle Exchange Programme on HIV prevalence among IDUs. NO YES
Survey of two Portuguese Prisons HIV prevalence according to lifetime drug use. Men Women n HIV + n HIV + None 64 1 (1.6%) 223 15 (6.7%) Only cannabis 51 1 (2.%) 72 4 (5.6%) Only heroin 1 (.%) 1 (.%) Only cocaine 3 (.%) 7 (.%) Only other drugs* 1 (.%) 2 (.%) Cannabis+heroin - 1 (.%) Cannabis+cocaine 16 (.%) 27 2 (7.4%) Cannabis+other drugs* 18 (.%) 6 (.%) Cannabis+heroin+cocaine 24 9 (37.5%) 18 5 (27.8%) Cannabis+heroin+other drugs* - - Cannabis+cocaine+other drugs* 19 (.%) 15 (.%) Heroin+cocaine 1 (.%) - Heroin+other drugs* - 1 (.%) Cocaine+ other drugs * 1 (.%) - Heroin+cocaine+ other drugs * - - Cannabis+heroin+cocaine+ other drugs * 51 13 (25.5%) 39 15 (38.5%)
Survey of two Portuguese Prisons Prevalence of infection according to IDU and sharing of injection material in men. n HIV HBV HCV Syphilis Chlamydia n (%) n (%) n (%) n (%) n (%) Overall 271 24 (8.9) 5 (1.9) 59 (21.8) 6 (2.2) 19 (6.) Never used injected drugs 198 2 (1.) 1 (.5) 7 (3.5) 3 (1.5) 19 (8.1) Used injected drugs/never shared injection material 23 6 (26.1) 1 (4.4) 21 (91.3) (.) (.) Used injected drugs/ever shared injection material 32 16 (5.) 1 (3.1) 3 (93.8) 1 (3.1) (.) Prevalence of infection according to IDU and sharing of injection material in women. n HIV HBV HCV Syphilis Chlamydia n (%) n (%) n (%) n (%) n (%) Overall 445 44 (9.9) 9 (2.) 51 (11.5) 16 (3.6) 5 (1.) Never used injected drugs 37 21 (5.7) 6 (1.6) 13 (3.5) 11 (3.) 4 (1.) Used injected drugs/never shared injection material 17 4 (23.5) 1 (5.9) 9 (52.9) 1 (5.9) (.) Used injected drugs/ever shared injection material 28 16 (57.1) 1 (3.6) 22 (78.6) 2 (7.1) 1 (3.2)
Survey of two Portuguese Prisons Men Non IDUs IDUs never sharers IDUs ever sharers n HIV HCV HIV/HCV 198 23 32 2(1.) 6 (26.1) 16 (5.) 7 (3.5) 21 (91.3) 3 (93.8) (.) 6 (26.1) 16 (5.) p <.1 <.1 <.1 Women Non IDUs IDUs never sharers IDUs ever sharers 37 17 28 21 (5.7) 4 (23.5) 16 (57.1) 13 (3.5) 9 (52.9) 22 (78.6) 5 (1.4) 2 (11.7) 14 (5.) p <.1 <.1 <.1
HIV and Drug Users Drug treatment public services [1] Public Detoxification Units 23 % 24 % 23 % 24 % First-time clients 5212 523 Clients 1873 1792 HIV testing 1443 27, 1154 23, HIV testing 1812 96,7 1641 91,6 HIV+ 219 15,2 141 12,2 HIV+ 289 15,9 225 13,7 ARV treatment 62 4,3 27 2,3 ARV treatment 98 5,4 71 4,3 Certified Detoxification Units 23 % 24 % Clients 1493 1579 HIV testing 955 64, 1183 74,9 HIV+ 151 15,8 147 12,4 ARV treatment 8 8,4 63 5,3 [1] IDT. Relatório Anual. 23 A Situação do País e Matérias de Drogas e Toxicodependências. Vol.I Informação Estatística.23. IDT. Relatório Anual. 24 A Situação do País e Matérias de Drogas e Toxicodependências. Vol.I Informação Estatística.24
UD 1st visit (1) Evaluation UD Active (2) screening N&Psy Information + questionnaire Usual Situation (3) Pre-test counselling N&Psy TEST (+) TEST (-) (4) Test N&Psy MEDICAL DOCTOR 5(VIH+) Post-test counselling N&Psy (6) Test confirmation (7+) Post-test counselling N&Psy 5(VIH-) Post-test counselling N&Psy 7(VIH-) Post-test counselling N&Psy (8) Referal Or Social worker Discussion about options (9) Hospitalar (1) Social work services
HIV and Drug Users Portuguese Programme
HIV and Drug Users Portuguese Programme
HIV and Drug Users Portuguese Programme
HIV and Drug Users Portuguese Programme
HIV and Drug Users Portuguese Programme
HIV and Drug Users Portuguese Programme
HIV and Drug Users Portuguese Programme Norte 13 CAT 1 2 8 1+2 1 2 1 1+1 Centro 11 CAT 3+2 2 2 9+6 2 2 LVT 15 CAT 4+3 1+1 Alentejo 4 CAT 1+1 2+2 Algarve 2 CAT
HIV and Drug Users (Rapid tests)
National Survey of IDUs Pilot test results IDU Never Ever Injection material sharing Never Ever First visit Never IDU Ever IDU n HIV+ p 25 325 128 177 47 38 (.%) 14 (4.3%) 3 (2.3%) 11 (6.2%) (.%) 2 (5.3%).1.165.197
HIV and Drug Users
The AIDS epidemic is not only about revealing injustice, but also about overcoming injustice. Peter Piot, February 27