IMPLEMENTING HIV AND STI PROGRAMMES WITH KEY POPULATIONS

Dr. Alexandr Kossukhin, HIV Programme SpecialistUnited Nations Population Fund, Regional Office for Eastern Europe and Central Asia

Delivering a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled.

UNAIDS 90-90-90 STRATEGY

HIV treatment is a critical tool towards ending the epidemic. HIV treatment prevents illness, death and averting new infections

Treatment targets by 2020

90% diagnozed

90% on treatment

90% virally

suppressed

PROPORTION OF CD4 CELL COUNTS <350 REPORTED FOR HIV CASES OLDER THAN 14 YEARS, DIAGNOSED IN 2012

(DATA OF ECDC AND WHO EURO)

AlbaniaArmenia

AzerbaijanBelarus

Bosnia and HerzegovinaGeorgia

KazakhstanKosovo

KyrgyzstanFYRMacedonia

MoldovaMontenegro

SerbiaTajikistan

TurkeyTurkmenistan

UkraineUzbekistan

0 10 20 30 40 50 60 70 80

75

53

PEOPLE ARE NOT MUCH MOTIVATED TO KNOW THEIR HIV STATUS

PROPORTION OF CD4 CELL COUNTS <350 REPORTED FOR HIV CASES AMONG MSM, DIAGNOSED IN 2012 (DATA OF ECDC AND WHO EURO)

AlbaniaArmenia

AzerbaijanBelarus

Bosnia and HerzegovinaGeorgia

KazakhstanKosovo

KyrgyzstanFYRMacedonia

MoldovaMontenegro

SerbiaTajikistan

TurkeyTurkmenistan

UkraineUzbekistan

0 10 20 30 40 50 60 70 80 90

78

46

5

ESTIMATED NUMBER OF ADULTS AND CHILDREN NEWLY INFECTED WITH HIV2013

Middle East & North Africa

25 000[14 000 – 41 000]

Sub-Saharan Africa1.5 million

[1.3 million – 1.6 million]

Eastern Europe & Central Asia

110 000 [86 000 – 130 000]

Latin America94 000

[71 000 – 170 000]

Caribbean12 000

[9400 – 14 000]

Total: 2.1 million Sub-Saharan Africa: 1.5 millionEastern and Southern Africa (ESA) Region: 1.1 million

Asia and the Pacific350 000

[250 000 – 510 000]

North America and Western and Central Europe

88 000 [44 000 – 160 000]

NEWLY DIAGNOZED HIV INFECTIONS BY COUNTRY (DATA OF ECDC, WHO EURO, 2012)

2006 2007 2008 2009 2010 2011 20120

20

40

60

80

100

120

140

160

SerbiaLinear (Serbia)AlbaniaLinear (Albania)Bosnia and HerzegovinaLinear (Bosnia and Herzegovina)MontenegroFYR Macedonia

HIV spread in Balkan countries is low, but trend to its increase is there

Between 40% and 50% of all new HIV infections among adults worldwide occur among people from key populations and their immediate partners Albania

ArmeniaAzerbaijan

BelarusBosnia

GeorgiaKazakhstan

KosovoKyrgyzstanMakedonia

MoldovaSerbia

TajikistanTurkey

TurkmenistanUkraine

Uzbekistan

0 40 80 120

160

200 0 50 100 150 200 250

HIV PREVALENCE AMONG KEY POPULATIONS PER 1000 IN COUNTRIES OF EECA REGION (DATA OF NATIONAL REPORTS OF IMPLEMENTATION

OF UNGASS DECLARATION (2012-2013)

Sex workers MSM PID

KEY POPULATIONS GUIDANCE

• WHO Consolidated Guidelines on HIV, Prevention, Diagnosis, Treatment and Care for Key Populations

• SWIT, MSMIT, DUIT, TRANSIT (by WHO, UNFPA, WB and others)

• Global Commission on HIV and the Law (by UNDP and others)• World Bank/JHSPH/UNFPA/UNDP/UNODC Global HIV

Epidemics series• UNAIDS Guidance Note on HIV and Sex Work

Focusing on populations with higher risk of exposure to HIV: sex workers, MSM, transgenders, prisoners and PID is a key to tackle the epidemic

The guidelines addresses: • comprehensive package of • clinical interventions critical

enablers • service delivery • decision-making,• planning and monitoring and

evaluation

WHO CONSOLIDATED GUIDELINES ON HIV, PREVENTION, DIAGNOSIS, TREATMENT AND CARE FOR KEY POPULATIONS

Summary of recommendations

ALL KEY POPULATIONS• Condoms and condom-compatible lubricants• Post Exposure Prophylaxis (PEP) • Interventions to fix problems with alcohol and substance abuse

MEN WHO HAVE SEX WITH MEN• Pre-Exposure Prophylaxis (PrEP )

PEOPLE WHO INJECT DRUGS• Sterile injecting equipment• Opiate substitution treatment• Naloxone

PREVENTION OF HETEROSEXUALLY ACQUIRED HIV IN MEN • Voluntary medical male circumcision (VMMC)

HIV PREVENTION

HEALTH SECTOR INTERVENTIONS:HIV TESTING AND COUNSELLING. TREATMENT AND CARE

• Voluntary HTC (including community-based) linked to prevention, treatment and care;

• Anti-retroviral treatment (ART);• Prevention of mother to child transmission (PMTCT);• TB prevention, screening and treatment services;• Hepatitis B and C prevention, screening and treatment

services ;• Screening and management of mental health

Summary of recommendations

SEXUAL AND REPRODUCTIVE HEALTH

• Screening, diagnosis and treatment of STIs • Cervical cancer screening • Contraception and pregnancy care• Range of reproductive options and full, pleasurable

sex lives• Abortion laws and services should protect the health

and human rights of all women (WHO accent)

Summary of recommendations

CRITICAL ENABLERS

Summary of recommendations

• Laws, policies and practices - decriminalization of behaviours / elimination of the unjust application towards:

- drug use/injecting, - sex work, - same-sex activity and - non-conforming gender identity

• Eliminate stigma, discrimination and violence against key populations;• Health services should be made available, accessible and acceptable; • Package of interventions to enhance key populations; • Communities empowerment;• Preventing and addressing violence against key populations in

partnership with key population- led organizations .

KEY POPULATIONS ARE RIGHTS HOLDERS. TO INSURE THAT CRITICAL ENABLERS ARE REALIZED KEY POPULATIONS

MUST BE EPOWERED TO CLAIM THEIR RIGHTS

• Human rights are fundamental. People are inherently entitled to them;

• Human rights are universal, indivisible and interdependent and related;

• Human rights are egalitarian they are the same for everyone

Standards of human behavior that are regularly protected as legal rights in international law include• Righto highest standards of health care, • Right to decide the timing, number and spacing of one’s children.• Freedom from discrimination, • Fight to fair trial, , • Freedom from tortures• Freedom of speech, • Freedom of thought, conscience and religion, • Freedom of movement and so on.

• Reaching out to key populations• Condom and lubricant programming: forecasting, quality assurance

and distribution • Supporting safer behavior (including SRH care seeking behaviors and

in particular;• STI health care seeking behavior as a community norm; • Generating demand and implementation of HTC through mobile

outreach; • Connecting key populations to health care and supportive services;• Insuring observance of human rights• Feedback on the quality of services from the point of clients’

satisfaction;• Training duty bearers (health care providers, social workers, law

enforcement bodies etc.)

KEY POPULATIONS ARE PARTNERSEMPOWERING KEY POPULATIONS TO PROTECT THEIR HEALTH:

UNIQUE ROLES OF COMMUNITIES

IMPLEMENTING COMPREGENSIVE PROGRAMMES JOINTLY

Human rights based approach works

Community-empowerment-based responses to HIV in sex workers were consistently associated with significant reductions in HIV and STIs, and increases in condom use.-- Lancet series 2014

• Securing adequate financial resources for sustaining and further improving the national responses through continuity of outreach services and partnership with civil society is crucial;

• Some countries made a way to amend the social contracting and NGO funding legislations and ensured sustainability of NGOs engagement in the situation of decreased international support to NGOs;

• Local authorities have a particular role to cooperate with NGOs

THANK YOU!

• Addressing HIV is integral to UNFPA’s goals of achieving universal access to sexual and reproductive health, and realizing human rights and gender equality

• UNFPA promotes integrated HIV and sexual and reproductive health services for young people, key populations, and women and girls, including those living with HIV.

• UNFPA supports the empowerment of these populations to claim their human rights and access the services they need

• All of UNFPA’s work on HIV is done by engaging and empowering the

communities it is mandated to serve.