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