The Comprehensive Package: The simple truth about our response to drug related HIV Dr. Monica Beg, Signe Rotberga UNODC
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
HIV spreads among injecting drug users in a lightening speed
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
Projected impact* of injecting drug use on number of HIV infections in Jakarta, Indonesia 120000 100000 80000 HIV infections projected HIV infections in IDUs (independent of programs) HIV infections if there were no IDU epidemic 60000 40000 20000 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 *assuming no interventions Source: MAP Report 2000. Drug Injection and HIV/AIDS in Asia
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)
Why a comprehensive approach? 1,2 People living with HIV (millions) 1 0,8 0,6 0,4 0,2 0 2000 2005 2010 2015 2020 2025 2030 baseline needle exhange only substitution (only) comprehensive harm reductions Source: Unpublished data on Asia Epidemic Modelling (AEM): courtesy Brown T, Siriopng S and Sarkar S 2008
new infections (thousands) 180 150 120 90 60 30 - What matters: Early intervention and scale 1995 2000 2005 2010 2015 2020 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
Challenges for policy makers: Choose options for action Tailor interventions to meet country s unique context
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: 2006 2010 Government Focal Agencies: MOH, MOSA, MOJ Budget: 5 000 000 USD Donor: The Netherlands
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
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
Main achievements to date: Objective 1 HIV strategies and action plans New national HIV programme for 2008-2012 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
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
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
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
Coverage indicators Opioid substitution therapy Number IDU in OST Number of IDU % IDU in OST Estonia Latvia Lithuania WHO/UNODC recommendation 555 13800 4% 124 12000 1.03% 402 8000 5.03% moderate: 10-19% good: 20-39% UNODC expert meeting, Vilnius, 21-23 March 2007
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 7169 13 800 52% 600-800 12 000 5-8% No data 8 000 No data moderate: 20-39% good: 40-59% No. syringes distributed Number of IDU No. of syringes per IDU per year 1606 989 13 800 116 117 237 12000 10 258 650 8000 32.3 moderate: 50-99 good: 100-199 UNODC expert meeting, Vilnius, 21-23 March 2007
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
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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