hiv/aids prevention and care among injecting drug users and in prison settings in estonia, latvia...
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HIV/AIDS prevention and care among injecting drug users and in prison settings in
Estonia, Latvia and Lithuania
Signe ROTBERGAUNODC, Baltic States
5 November 2009
Comprehensive strategy:
• Preventing drug abuse• Facilitating entry into drug dependence treatment• Establishing effective harm reduction measures to
reduce adverse health and social consequences of drug abuse
Project objectives:
• Develop strategies and action plans to address HIV/AIDS among IDUs and in prison settings
• Improve professional capacity to address HIV/AIDS• Increase coverage of comprehensive HIV/AIDS
prevention and care services• Generate and share strategic information to respond
appropriately to evolving HIV/AIDS epidemics
Indicators to measure access to services
• Availability (Y/N? number of sites per 1000 IDUs ) • Coverage (% IDU using services)• Quality (Adhering to WHO/UNODC guidelines)
Quality combined with scale-up will make a difference on the intervention’s impact on the epidemic.
Source: WHO/UNODC/UNAIDS TECHNICAL GUIDE for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users
Comprehensive package of HIV prevention services for IDUs
Needle and syringe programmes (NSP)
Pharmacotherapy (methadone, buprenorphine) and other drug dependence treatment
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
• WHO/UNODC/UNAIDS TECHNICAL GUIDE for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users
Small grants programme for HIV prevention among IDUs and in prisons
• Needle and syringe programmes 8 projects• Pharmacotherapy with methadone 4 projects• HIV education and care in prisons 2 projects
Total budget: 673 600 LTL
Grants for harm reduction services in 2009
Capacity building in 2009
• 20 training seminars, 449 participants• 2 study tours, 8 participants• 11 conferences/meetings, 413 participants• Professional networking and training: participation in 4
international events, 67 persons
Capacity building
• Training needs assessment • Training topics: pharmacotherapy, peer driven interventions
for IDUs, estimation of IDU prevalence, HIV and drug education
• Target groups: physicians, nurses, social workers, prison staff, policy makers, NGOs, police, pharmacists
• All training events evaluated, positive feedback received
Information and education materials• FHI material “HIV voluntary counselling and testing: a
Reference Guide for Counsellors and Trainers“ in cooperation with Lithuanian AIDS centre.
• Educational material "Diagnostic, Treatment and Social Support of Opioid Dependent People” in cooperation with Vilnius Centre for Addiction Disorders.
• Manual “Risk reduction for IDUs in prison” in cooperation with Prison department under MoJ.
• Information leaflet “Frequently asked questions about methadone or/and buprenorphine” in cooperation with Vilnius Centre for Addiction Disorders.
Training modules, guidelines
• Clinical protocol for psychiatrists “Pharmacotherapy of opioid dependence with methadone”
• Training module for social workers “HIV prevention and services for drug users”, Siauliai Medical College
Mid-term evaluation: conclusions
• Project is extremely useful and well-run• Highly relevant to national responses to HIV in the Baltic
states• Evidence of progress towards objectives and results
Mid-term evaluation: concerns
• Sustainability of activities and systems established• Strategic information is not always being used to shape
the national response• Access to HIV tests for IDUs• Discontinuation of pharmacotherapy with methadone in
prison settings
Mid-term evaluation: recommendations for Lithuania
• Revise National AIDS programme ensuring focus on IDUs and prison settings
• Piloting provision of methadone maintenance therapy in prisons
• Explore ways in which ARV therapy can be financed in prisons
Why prisons?
National average Prisons
HIV prevalence 0,04% 3,7%
Prevalence of drug use
1 % >20 %
OvercrowdingHigh turnover
Interaction between prison and society
International norms and standards guiding prison health care
• Prison health is part of public health• The principle of equivalence• A human rights approach to prison health
Health is a fundamental human right indispensible from the exercise of other human rights
UN Committee on Economic, Social
and Cultural Rights
Loss of liberty alone is the punishment, not the deprivation of fundamental human rights. Like all persons, therefore, prisoners have a right to enjoy the highest attainable standard of health.
Every country’s response to HIV ...
• ... is influenced by economic and social conditions, as well as by cultural, social, and religious traditions, but
• these national conditions do not reduce or negate government obligations to meet recognized international prison, health and human right standards.
• International law is clear that a lack of resourses does not excuse a state from its obligations to provide proper and humane prison conditions
Achievements in 2009
• Regulation on provision of methadone in arrest houses• Preparations for introduction of methadone therapy in
remand prisons
Costs of drug dependence treatment per person per year (in US$)Costs of drug dependence treatment per person per year (in US$)
43.200
39.600
16.691
12.467
3.500
2.722
Out-patient treatment
Methadone maintenance
therapy
In-patient treatment
(cocaine)
Probation
Inprisonment
Treatment not prov ided
www.unodc.org/balticstates
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