hiv in a low endemicity country; country response turkey serhat Ünal, m.d, facp, fefim professor in...
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HIV in a low endemicity country;country response
Turkey
Serhat Ünal, M.D, FACP, FEFIMProfessor in Medicine
ChairHacettepe University, Faculty of Medicine
Department of Infectious Diseases
PresidentHacettepe University HIV/AIDS Treatment and Research Center
General Demographic Indicators Turkey
1990 2000 2010 2011
Total Population 56.473.035 67.803.927 73.722.988 74.724.269
Rural Population (%) 48,7 40,8 29,0 28,2
Urban Population (%) 51,3 59,2 71,0 71,8
0-14 y/o Population (%) 35,0 29,8 25,6 25,3
65 y/o and Over Population (%) 4,3 5,7 7,2 7,3
Population Growth Rate Per Year ( ‰) 17,0 13,8 13,0 12,8
Crude Birth Rate ( ‰) 24,1 20,3 17,5 17,3
Crude Mortality Rate ( ‰) 7,1 6,6 6,3 6,3
Total Fertility Rate (Number Of Children Per Woman) 2,9 2,4 2,1 2,1
Source: Turkish Statistical Institute
Ministryof Health, Turkey
HIV/AIDS CASES ACCORDING TO YEARS
1 October 1985 – 31 December 2013n:6802
0
200
400
600
800
1000
1200
1400
85 87 89 91 93 95 97 99 2001 2003 2005 2007 2009 2011 2013
HIV (+) AIDS
7000/ 7000000 = 0.1 %
Ministry of Health, Turkey
0
50
100
150
200
250
300
350
0 '1-4 '5-9 '10-14 '15-19 '20-24 '25-29 '30-34 '35-39 '40-49 '50-59 '60+
Male Female
HIV/AIDS CASES ACCORDING TO AGE AND SEX
1 October 2013 – 31 December 2013n:1313
1985
Ministry of Health, Turkey
HIV/AIDS CASES BY MODE OF TRANSMISSION AND SEX
1 October 2013 – 31 December 2013n:1313
8.5%
0%
56%
4.5%
1,6%
32,60%
Homosexual intercourse
IDU
Heterosexual contact
Mother-to-child
Nosocomial infection
Undetermined
1985
CONDITION OF EPIDEMIC DISEASES AMONG THE GROUPS HAVING BEHAVIOURS OF RISK (TADOC – 2010)
Intravenous Drug Users
Number %
HIV/AIDS 1 1.5
Hepatitis B 2 2.9
Syphilis 1 1.5
Gonorea 1 1.5
Chlamydia 2 2.9
Main Factors That Lead To Increase The Number of HIV/AIDS Cases In Turkey
Turkey has a very young population (15-49 ages groups)
General knowledge of population regarding HIV/AIDS and sexual transmitted infections are limited
Increase in useage of intravenous drugs Growth of the Turkish tourism Large number of Turkish men working abroad Increase in number of commercial sex workers
Important Milestones in HIV/AIDS Turkey
1985 Detection of the first AIDS case1985 HIV/AIDS; mandatory notifiable disease1986 HIV testing1987 Serological testing for:
• Blood/tissue/organ donors• Registered sex workers• Before major surgical operations
1994 Medical treatment became free of charge1994 Coding system for notifications for HIV/AIDS cases
1996 Establishment of National AIDS Commission
2004 Gonorrhea and Chlamydia; mandatory notifiable diseases
2005 “HIV/AIDS Prevention and Support Programme” funded by the Global Fund
2007 Approval of 2007-2011 HIV/AIDS National Strategic Action Plan
2010 Establishment of Sexual Transmitted Diseases Scientific Committee
PMSocial Services
and Child Protection
ReligiousAffairs
Ministry ofFinance
Ministry ofDefence
Ministry ofJustice
PrimeMinistry
PMYouth andSport GD
State Instituteof Statistics
PMWomen’s Status and Issues GD
StatePlanning
OrganisationMinistry of Labour
and Social Security
Ministry of Health
Ministry ofNational
Education
Ministry ofInterior
Ministry of Culture and
Tourism
TGNA Legal Affairs Dep.
Turkish Radioand Television
HigherEducation Council
PM – FamilyResearchInstitute
Health Professional Associations
Turkish Red CrescentAssociation
Turkish FamilyPlanning Association
AIDS PreventionSociety
Association forCombat with AIDS
Human ResourceDevelopmentFoundation
Turkish ThirdSector Foundation
Artisans and Entrepreneurs Confederation
TurkishJournalistsAssociation
TGNAPopulation and
Development Group
Hacettepe AIDS Prev., Treat. andResearch Center
NATIONAL AIDS COMMISSION
PLA PODER
HIV/AIDS National Strategic Action Plan
Targets & Strategies
Prevention & Support VCT Diagnosis and Treatment Supportive Environment Monitoring & Evaluation Social support Intersectoral Collaboration
Vulnerable Populations
Commercial Sex Workers
Men Having Sex With Man
Intravenous Drug Users
Prisoners
HIV/AIDS (+)
Refugees and asylum seekers……….
HIV/AIDS Prevention and Support Programme of Turkey
Donor Organisation The Global FundGrant Number TUR-405-G01-H Principal Recipient Ministry of HealthProgram Duration 36 MonthsStart- End Dates August 2005 - 15 June 2008Budget USD 3,891,762
85% out of the total budget has been disbursed
Programme cities Ankara, Istanbul, Izmir, Gaziantep and Trabzon
Goal To prevent the further spread of HIV through active preventive interventions, especially among the most vulnerable populations, like IDUs, MSM, CSWs and detainees of penitentiary institutions and to support and empower vulnerable populations including PLWHA
Objectives To increase the access of CSWs, MSMs, IDUs to health
centers for preventive HIV/AIDS services To increase the access of general population to VCT
services and carry out their instituationalisation To improve the access of psychosocial support services
for PLHA and improve national legislative framework To improve preventive HIV services in prisons and
detention centers To improve national STIs/HIV/AIDS monitoring and
evaluation system
Activities
Awareness raising activities for NGOs Training of outreach workers Training of police officers 14 VCT centers, VCT Training for health staff Produce and distribution of outreach services and VCT materials
(brochures, posters, VCT guidelines, outreach guidelines) Procurement and distribution of rapid HIV tests, condoms, lubricants Monitoring and evaluation Behavioural Survey 13 NGOs; including PLA and PODER, 16 projects, 1,8 million US Dollar Workshop on IDU and HIV/AIDS Workshop on HIV/AIDS and Human Rights Workshop on the Evaluation of VCT Services VCT Media Campaign
Voluntary Councelling and Test CentersTurkey
Begin to provide service in 2007 to high risk and critical groups in terms of HIV/AIDS
• Information about transmission routes and protection from HIV/AIDS
• Free and confidential HIV testing,• Pre and post test councelling• Guidance to a healthcare center for treatment
HIV/AIDS Tests in Turkey
HIV test groups
a) Blood donors (mandatory)
b) Sex workers (mandatory)
c) Volentary Councelling & Test Centers
d) Pre-marital councelling
e) After risky behavior,
f) Pre surgery
HIV Test Number in Years (2002-2013*)
*Until Oct 2013
Diagnosis Time in Turkey
Şekil. Vakaların CD4+ Hücre Sayılarına Göre İki Döneme Göre Dağılımları
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
<2006 ≥2006
n=59
n=36n=33
n=55
n=15
n=39
<200
200-500
>500
CD4+Hücre/mm3
Barriers to Testing in Turkey
• Lack of awareness• Stigmatisation- social isolation• Cost• No quidelines• Low numbers of centers for testing• Social aspect – patient privacy• Hard ro reach groups Homosexual men
Sex workers Injecting drug users Prisoners Refugees , illegal immigrants
HIV/AIDS TANI TEDAVİ REHBERİ – TÜRKİYEHIV/AIDS Diagnose and Treatment Guideline
Turkey 2013
KLİNİK KATEGORİ CD4 T HÜCRESİ SAYISI ÖNERİLEN
Semptomatik hasta Herhangi bir değer Tedavi başlanmalı
Asemptomatik hasta <350 hücre/mm3 Tedavi başlanmalı
Asemptomatik hasta 350-500 hücre/mm3Tedavi başlanması yararlıdır. Hastanın özel koşullarına göre tedavi önerilir.
Asemptomatik hasta >500 hücre/mm3Tedavi başlanabilir. Hastanın özel koşulları değerlendirilerek, istekli ve hazırsa tedavi önerilebilir.
Turkish Ministry of Health 2013