Download Drug policy and harm reduction: impact of US policy

Harm reduction evidence:
Eastern Europe and Central Asia
Raminta Stuikyte
Central and Eastern European Harm Reduction Network
Eastern Europe and Central Asia
• Fast epidemics among injecting drug users; up to 75% of
all registered HIV cases
• Drug policies could be indicated as harsh:
– attached to incarceration for possession of drugs for personal
use; drug users often fair to have needles with them because of
police
• Drug services are scarce
– No country has national scale of harm reduction interventions
(needle exchange, outreach work, substitution treatment neither
in community, nor in prisons)
– Coverage estimates varies 0-15%
• Research is limited; mainly RAR studies and project data
analysis
Needle syringe exchange (NSE) efficacy
• Russia:
– Behavioral 5-city research showed that level of needle sharing in
one month from participating at NSE from 38% to 11% in 2002
(n=1076)
Des Jarlais D et. al (2002): HIV risk behavior among participants of syringe exchange programs in central/eastern Europe and
Russia; International Journal of Drug Policy: 13: 165-170.
• Ukraine:
– 24% of IDUs reached by NSE do not share compared to 16% of
those never attending NSE sites
Yaremenko, Balakirieva (2004) Effectiveness of Harm Reduction Projects in Ukraine. Ukrainian Institute for
Social Research.
• Kyrgyzstan:
– Percent of clients reusing needles drops from 98% to <30% after
start of NSP
– Needle sharing drops from 68% to 14%;
Estebesova. The Role of NGOs in the Implementation of Harm Reduction Programs for Drug Dependency in
the Kyrgyz Republic. In Decreasing Vulnerability of Injection Drug Users of the Kyrgyz Republic: Conference
Proceedings (May 2003), edited by TK Asanov. Osh, 2003.
NSE efficacy II: changes in condom use
and AIDS knowledge
• Russia
– Condom use in last sexual intercourse ranges from
28% among non clients of NSE to 58% among NSE
clients
RAR in Russia; Open Health Institute 2003
• Kyrgyzstan
– Condom use increased from 14% to 46%;
– Knowledge about AIDS increased from 35% to 73%
Estebesova. The Role of NGOs in the Implementation of Harm Reduction Programs for Drug Dependency in
the Kyrgyz Republic. In Decreasing Vulnerability of Injection Drug Users of the Kyrgyz Republic: Conference
Proceedings (May 2003), edited by TK Asanov. Osh, 2003.
NSE Effectiveness III:
Cost analysis
• Belarus
– Economic evaluation of a harm reduction program in
Svetlogorsk: one HIV infection could be averted for
not more than US$68
Kumaranayake L et al. The cost-effectiveness of HIV preventive measures among injecting
drug users in Svetlogorsk, Belarus: Draft. Geneva, UNAIDS, 2000.
• Russia
– US$23,4 – costs per client served and $0,36 costs
per syringe exchanged
Bobrik A. et al. HIV prevention among drug users in Russian cities: cost-effectiveness analysis: Russian
Family Doctor, 4(6)30-36
Substitution treatment
• Evidence even more limited as limited and
mainly delayed application of substitution
treatment in the region
– Baltics – since 1995-1996; Kyrgyzstan – since 2002; Moldova –
since 2004; Ukraine, Georgia – 2005, Uzbekistan 2006
• Positive preliminary results about methadone
program in Lithuania:
– In conclusion, there is documented evidence on the efficacy,
feasibility, safety and acceptability of methadone programs in
Indonesia, Lithuania and Thailand.
WHO (2005) The WHO Collaborative Study on Substitution Therapy of Opioid Dependence and HIV/AIDS.
Preliminary results of study implementation in Indonesia, Lithuania, and Thailand
Substitution treatment
• Kyrgyzstan
– In Bishkek, percent of patients using opiates in
addition to methadone decreases from 44% in June
2002 to 15% in April 2003
– In Osh, decrease from 25% to <5%
– Only one HIV infection reported among program
clients and the person was not tested on opiates by
2003
Asanov, TK. “Methadone Maintenance Treatment Programs in the Kyrgyz Republic.” In
Decreasing Vulnerability of Injection Drug Users in the Kyrgyz Republic: Conference
Proceedings (May 2003), edited by TK Asanov. Osh, 2003.
Summary
• NSE showed being effective in reducing sharing
needles in different sites of Eastern Europe
• Some studies showed increased condom use
and HIV knowledge among NSE clients
• NSE is cost-effective and relatively low cost
• Substitution treatment studies are limited and
not completed, however their preliminary results
indicate positive results in its efficacy in
decreasing illegal opioids, decreasing injecting
and needle sharing