a global perspective on scaling up harm reduction 2 nd national harm reduction conference, ukraine,...
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A global perspective on scaling up harm reduction
2nd National Harm Reduction Conference, Ukraine, 21-23 March 2007Dr Jos Perriens, Director PreventionDepartment of HIV/AIDS, WHO Headquarters, Geneva
1998-2004. 91% of the world adult population (4 billion) covered by the data.UN Reference Group on HIV/AIDS prevention and care among IDUs in developing and transitional countries www.idurefgroup.org.
S. & S-E Asia: 3.33m
S. & S-E Asia: 3.33m
E. Europe & C. Asia: 3.2mE. Europe &
C. Asia: 3.2m
E. Asia & Pacific 2.35m
E. Asia & Pacific 2.35mMENA:0.44mMENA:0.44m
S. Saharan-Africa
0.009m
S. Saharan-Africa
0.009mL. America:
0.97mL. America:
0.97m
Caribbean: 0.028m
Caribbean: 0.028m
N. America 1.43m
N. America 1.43m
W. Europe: 1.24m
W. Europe: 1.24m
Australia & N. Zealand:
0.19m
Australia & N. Zealand:
0.19m
13,200,000 IDUs worldwide – 4 million of them living with HIV
60%
71.1%
15%
4%
11%
5%
90%
68%
1%
84%
80%
81.2%
82.9%
73.6%
82%
0.12%
87%
1.3%
7.4% 86%
71%
81.6%
51%
<20%
20-40%
40-60%
60-80%
64%
50% 29.2%
6.03%
12.9%
33.7%10%
14.5%
17% 19.3%
11%
3.8%
16%
32%
16%
16%
>80%
23.5%
60%
25%
56.5%14%3%
10%
1,8%
5.9%
IDU as % of all HIV/AIDSreported cases (end 2003)NOTE: % of AIDS cases in countries not reporting HIVSources: EuroHIV; national reports;
6%
0%
N/A
25%
Comprehensive harm reduction programmes Needle and syringe programmes (NSP)
Outreach programmes
HIV testing and counselling
Prevention and treatment of STI, access to condoms
_______________________________
Opioid Substitution Therapy (OST) other drug dependence treatment
_______________________________
HIV treatment and care, including ART
Hepatitis B vaccination and treatment of viral hepatitis
_______________________________
in the community and in prison settings
Needles Syringe Programming (NSP)
Annual Change in HIV prevalence among IDU at city level
5,9 % annual increasein 52 cities without NSP
5,8 % annual decrease in 29 cities with NSP
Hurley SF, Jolley DJ, Kaldor JM. Effectiveness of needle-exchange programme for prevention of HIV infection. Lancet 1997, 359 (9068): 1797-800
0
10
20
30
40
50
60
70
80
90
100
Belar
us
Croat
ia
Czech
Rep
Eston
ia
Russi
a
Ukrai
ne
Needle & syringe exchange coverage (% IDUs reached)
IDU as % of all reported HIV cases
Opioid Substitution Therapy (OST)
Demonstrated effectiveness:
Reduced illicit drug use and associated HIV riskImproved healthImproved social functioningReduced criminal activity
Current provision of Opioid Substitution Therapy:Methadone and/or Buprenorphine in 59 Countries
Methadone 49 countriesBuprenorphine 33 countries
0
10
20
30
40
50
60
70
80
90
100
Belar
us
Russia
Estonia
Latvi
a
Ukrai
ne
Lithuan
ia
Poland
Finla
nd
Swed
en
Norway
United
Kingdom
Ger
man
y
Irela
nd
Substitution treatment coverage (% IDUs treated)
IDU as % of HIV cases
Misconceptions about OST
Does not breach UN conventions Is supported by the UN System (including WHO,
UNODC and UNAIDS) Does not “trap” people into dependency Does not reduce demand for drug-free treatment Does not lead to an increase in drug use in the
community
HIV/AIDS Treatment for IDU
Injecting Drug Users are
Often excluded from HIV/AIDS treatment
Least likely to receive ART
Initiate ART later
Clinicians reluctant to prescribe ART
Concerns regarding low adherence leading to resistance
HIV treatment access among IDU in Eastern Europe
Serbia and
Montenegro Czech
Republic Moldova Estonia Ukraine
100
90
80
70
60
50
40
30
20
10
Lithuania Croatia
RussianFederation
IDU as % of people living with HIV
IDU as % of people on ART
HIV Treatment and Care for IDUs
HIV care for IDUs often successful
ART resistance levels similar in IDUs and non IDUs
IDUs can adhere to ART as well as non IDUs
OST improves retention and adherence to ART
Harm Reduction in Prisons
Prisoners and detainees have a rights to the protection of their physical and mental health of the same quality and standard as is afforded to those who are not imprisoned or detained.
Adopted by United Nations General Assembly resolution 37/194 of 18 (December 1982).
QualityHow well are we providing our services?
CoverageHow much services do we need to provide?
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