Download Injecting drug use

Recent policy developments and
research about effective interventions for injecting
drug users.
Vilnius, November 2009
Zhannat Kosmukhamedova, HIV Unit
HIV and injecting drug use: restatement of the priority area
Estimated Number of People who Inject Drugs:
1,044,000
15,861,500
3,476,500
247,000
2,270,500
3,957,500
2,018,000
1,778,500
(Source : UN Reference group for IDUs,2008)
173,500
Slide 2
HIV and injecting drug use: restatement of the priority area
Estimated Number of People who Inject Drugs:
15,861,500
2,997,500
Estimated Number of HIV Positive Among them:
940,000
29,000
347,000
114,000
661,000
580,500
221,000
(Source : UN Reference group for IDUs, 2008)
2,500
Slide 3
Why the area is important?
Injecting Drug Use were reported in 148 countries
HIV infections among People who Inject Drugs - in 120 countries
92 countries support harm reduction in policy or practice
71 countries have an explicit supportive reference to harm reduction in national
policy documents
HIV prevention service coverage - below 10 %
92% of people who inject drugs in low- and middle income countries have no
access to HIV prevention services of any kind
(Source : UN Reference group for IDUs, 2008)
Slide 4
Evidence informed HIV services 1961 Single Convention on Narcotic Drugs;
1971 Convention on Psychotropic Substances and
1988 UN Convention against Illicit Traffic in Narcotic Drugs
and Psychotropic Substances, and
the commitment to achieving universal access to HIV
prevention, treatment, care and support by 2010, including
for people who inject drugs
Slide 5
Injecting drug use - in 148 countries; HIV/IDUs – 120 countries
Global Availability of Pharmacological Treatment
63 countries have Pharmacotherapy
Slide 6
Injecting drug use - in 148 countries; HIV/IDUs – 120 countries
WHO European Region: Availability of PT
buprenorphine
diamorphine
codeine
injectable methadone
methadone
slow-release morphine
Slide 7
Injecting drug use - in 148 countries; HIV/IDUs – 120 countries
EU: Availability of PTM
Slide 8
Injecting drug use - in 148 countries; HIV/IDUs – 120 countries
EU: Availability of PT in prison
37 countries have PT in prison
Slide 9
Injecting drug use - in 148 countries; HIV/IDUs – 120 countries
Global: Availability of NSP
77 countries have needle and syringe programmes
10 countries have needle and syringe in prisons
Slide 10
Injecting Drug Use were reported in 148 countries
Only 61 low and middle income countries – HIV testing and counseling
Only 14 % of PLWH in EE and CA (current or former drug users) – ART
(Source : UN Reference group, 2008)
Slide 11
Obstacles: why it is not working
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Poor availability of harm reduction measures (abstinence-only
mentality)
Poor accessibility and quality of services
Restrictive inclusion criteria
Lack of gender responsive
Lack of confidentiality and protection of personal information
Punitive policies and legislation
Harassment by law enforcement personnel
Drug user as “a criminal” keeps people away from services
Increased prison populations - higher risk of HIV infection
Ineffective spending – focus on criminalizing, not treating
Absence of political and societal support,
Stigma, discrimination and violation of human rights…
Slide 12
What is working well and should be expanded
Commission on Narcotic Drugs (CND, 52 states), UNAIDS Programme Coordinating
Board (PCB, 22 states) and the United Nations Economic and Social Council (ECOSOC,54
members) in 2009: a common understanding in the UN on what is a comprehensive
package of HIV services for injecting drug users (harm reduction).
UNAIDS, WHO and UNODC recommend:
- Needle and syringe programmes
- Pharmacological treatment
- Anti-retroviral therapy
- Voluntary HIV counselling and testing
- Prevention and treatment of STIs
- Condom programing;
- Targeted information, education and communication
- Hepatitis diagnosis, treatment and vaccination
- TB prevention, diagnosis and treatment.
Source: WHO,UNODC,UNAIDS Technical Guide for countries to set targets for universal access to HIV
prevention, treatment and care for IDUs, 2008
Slide 13
WHO study on OST and HIV/AIDS, 2008
Aim: to examine effectiveness of OST in China, Ukraine, Indonesia, Thailand,
Lithuania, Poland, Iran, Australia.
Findings: 70% treatment retention rate after 6 months with significant
reductions in reported heroin and other illicit opioid use.
WHO/UNAIDS/UNODC position paper on Substitution treatment (2004)
‘…IDUs who do not enter treatment are up to six times more likely to
become infected with HIV than injectors who enter and remain in
treatment.’
Slide 14
Universality of OST effectiveness
BBV-TRAQ injecting risk score
The WHO Collaborative Study on Substitution Therapy of Opioid
Dependence and HIV/AIDS - injecting risk behaviour
25
China
20
Indonesia
15
Thailand
Iran
10
Australia
5
Lithuania
Poland
0
Ukraine
Baseline
3-month
6-month
Slide 15
Substitution treatment: Societal outcomes
Substitution treatment: Societal outcomes
- Associated with improved social functioning and
employment.
- Substantial reductions in criminal activity.
- 4 to 7 fold savings in reduced drug-related crime,
criminal justice costs and theft alone.
- No evidence for increased drug use in community.
Sources :
1WHO/UNODC/UNAIDS position paper: Substitution maintenance therapy in the management of opioid dependence
and HIV/AIDS prevention (WHO, 2004)
2WHO/UNOC/UNAIDS: Effectiveness of Drug Dependence Treatment in Preventing HIV among Injecting Drug Users,
Geneva 2005
Slide 16
New research on effectiveness of NSP
Over 30 million needles and syringes have been distributed every year in
Australia since 2000.
A recent study estimates that
this intervention has directly prevented more
than 32,000 cases of HIV infection
and almost 100,000 cases of
hepatitis C.
For every Australian dollar spent on NSPs, four were returned.
Source: UNSW’s National Centre in HIV Epidemiology and Clinical Research, Return on Investment 2: Evaluating
Slide 17
the cost-effectiveness of needle and syringe programs in Australia), 2009
‘…we have evidence that effective programmes for harm
reduction and substitution therapy can save billions of
dollars. During this crisis, UNAIDS will champion these
and other evidence informed prevention programmes
as smart investments for saving money, saving lives
and restoring health and dignity to people.’
Michele Sidibe, UNAIDS Executive Director,
PCB June 2009 speech
Slide 18
Thank you
www.unodc.org
www.who.int
www.unaids.org
Slide 19