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HIV in a low endemicity country;
country response
Turkey
Serhat Ünal, M.D, FACP, FEFIM
Professor in Medicine
Chair
Hacettepe University, Faculty of Medicine
Department of Infectious Diseases
President
Hacettepe University HIV/AIDS
Treatment and Research Center
General Demographic Indicators Turkey
1990
2000
2010
2011
Total Population
56.473.035
67.803.927
73.722.988
74.724.269
Rural Population (%)
48,7
40,8
29,0
28,2
Urban Population (%)
51,3
59,2
71,0
71,8
0-14 y/o Population (%)
35,0
29,8
25,6
25,3
65 y/o and Over Population (%)
4,3
5,7
7,2
7,3
Population Growth Rate Per Year ( ‰)
17,0
13,8
13,0
12,8
Crude Birth Rate ( ‰)
24,1
20,3
17,5
17,3
Crude Mortality Rate ( ‰)
7,1
6,6
6,3
6,3
Total Fertility Rate (Number Of Children Per Woman)
2,9
2,4
2,1
2,1
Source: Turkish Statistical Institute
TURKEY - TÜRKİYE
HIV/AIDS CASES ACCORDING TO YEARS
Ministry of
Health, Turkey
1 October 1985 – 31 December 2013
n:6802
1400
1200
1000
800
600
400
200
0
85
87
89
91
93
95
97
99
HIV (+)
2001
AIDS
7000/ 7000000 = 0.1 %
2003
2005
2007
2009
2011
2013
HIV/AIDS CASES ACCORDING TO AGE AND SEX
Ministry of
Health, Turkey
1 October 2013
1985 – 31 December 2013
n:1313
350
300
250
200
150
100
50
0
0
'1-4
'5-9
'10-14
'15-19
'20-24
'25-29
Male
'30-34
Female
'35-39
'40-49
'50-59
'60+
HIV/AIDS CASES BY MODE OF TRANSMISSION
AND SEX
1985
1 October
2013 – 31 December 2013
n:1313
8.5%
4.5%
Homosexual intercourse
IDU
Heterosexual contact
56%
Mother-to-child
Nosocomial infection
32,60%
Undetermined
1,6%
0%
Ministry of
Health, Turkey
CONDITION OF EPIDEMIC DISEASES AMONG THE GROUPS
HAVING BEHAVIOURS OF RISK (TADOC – 2010)
Intravenous Drug
Users
Number
%
HIV/AIDS
1
1.5
Hepatitis B
2
2.9
Syphilis
1
1.5
Gonorea
1
1.5
Chlamydia
2
2.9
Main Factors That Lead To Increase The
Number of HIV/AIDS Cases In Turkey
 Turkey has a very young population (15-49 ages
groups)
 General knowledge of population regarding HIV/AIDS
and sexual transmitted infections are limited
 Increase in useage of intravenous drugs
 Growth of the Turkish tourism
 Large number of Turkish men working abroad
 Increase in number of commercial sex workers
Important Milestones in HIV/AIDS Turkey
1985
1985
1986
1987
1994
1994
Detection of the first AIDS case
HIV/AIDS; mandatory notifiable disease
HIV testing
Serological testing for:
• Blood/tissue/organ donors
• Registered sex workers
• Before major surgical operations
Medical treatment became free of charge
Coding system for notifications for HIV/AIDS cases
1996
Establishment of National AIDS Commission
2004
Gonorrhea and Chlamydia; mandatory notifiable diseases
2005
“HIV/AIDS Prevention and Support Programme” funded by the
Global Fund
2007
Approval of 2007-2011 HIV/AIDS National Strategic Action Plan
2010
Establishment of Sexual Transmitted Diseases Scientific
Committee
State Institute
of Statistics
AIDS Prevention
Society
PM
Youth and
Sport GD
Turkish Family
Planning Association
PLA
Human Resource
Development
Foundation
TGNA
Legal Affairs Dep.
Religious
Affairs
Turkish
Red Crescent
Association
Health Professional
Associations
NATIONAL AIDS
COMMISSION
Turkish Third
Sector Foundation
PM
Social Services
and Child Protection
Ministry of Labour
and Social Security
PODER
Association for
Combat with AIDS
Turkish Radio
and Television
Higher
Education
Council
State
Planning
Organisation
PM
Women’s Status
and Issues GD
Hacettepe AIDS
Prev., Treat. and
Research Center
Artisans and
Entrepreneurs
Confederation
Ministry of
Finance
PM – Family
Research
Institute
Ministry of
Health
Ministry of
Interior
Ministry of
Culture and
Tourism
TGNA
Population and
Development Group
Turkish
Journalists
Association
Ministry of
Defence
Ministry of
National
Education
Prime
Ministry
Ministry of
Justice
HIV/AIDS National Strategic Action Plan
Targets & Strategies
 Prevention & Support
 VCT
 Diagnosis and Treatment
 Supportive Environment
 Monitoring & Evaluation
 Social support
 Intersectoral Collaboration
Vulnerable Populations
 Commercial Sex Workers
 Men Having Sex With Man
 Intravenous Drug Users
 Prisoners
 HIV/AIDS (+)
 Refugees and asylum seekers……….
HIV/AIDS Prevention and Support Programme of
Turkey
Donor Organisation
Grant Number
Principal Recipient
Program Duration
Start- End Dates
Budget
The Global Fund
TUR-405-G01-H
Ministry of Health
36 Months
August 2005 - 15 June 2008
USD 3,891,762
85% out of the total budget has been disbursed
Programme cities
Ankara, Istanbul, Izmir, Gaziantep and Trabzon
Goal
To prevent the further spread of HIV through active
preventive interventions, especially among the most
vulnerable populations, like IDUs, MSM, CSWs and
detainees of penitentiary institutions and to support and
empower vulnerable populations including PLWHA
Objectives





To increase the access of CSWs, MSMs, IDUs to health
centers for preventive HIV/AIDS services
To increase the access of general population to VCT
services and carry out their instituationalisation
To improve the access of psychosocial support services
for PLHA and improve national legislative framework
To improve preventive HIV services in prisons and
detention centers
To improve national STIs/HIV/AIDS monitoring and
evaluation system
Activities













Awareness raising activities for NGOs
Training of outreach workers
Training of police officers
14 VCT centers, VCT Training for health staff
Produce and distribution of outreach services and VCT materials
(brochures, posters, VCT guidelines, outreach guidelines)
Procurement and distribution of rapid HIV tests, condoms, lubricants
Monitoring and evaluation
Behavioural Survey
13 NGOs; including PLA and PODER, 16 projects, 1,8 million US Dollar
Workshop on IDU and HIV/AIDS
Workshop on HIV/AIDS and Human Rights
Workshop on the Evaluation of VCT Services
VCT Media Campaign
Voluntary Councelling and Test Centers
Turkey
Begin to provide service in 2007 to high risk and
critical groups in terms of HIV/AIDS
• Information about transmission routes and protection
from HIV/AIDS
• Free and confidential HIV testing,
• Pre and post test councelling
• Guidance to a healthcare center for treatment
HIV/AIDS Tests in Turkey
HIV test groups
HIV Test Number in Years
(2002-2013*)
a) Blood donors (mandatory)
b) Sex workers (mandatory)
c) Volentary Councelling &
Test Centers
d) Pre-marital councelling
e) After risky behavior,
f)
Pre surgery
*Until Oct 2013
Diagnosis Time in Turkey
60,0%
CD4+
Hücre/mm3
<200
50,0%
40,0%
30,0%
20,0%
n=59
200-500
n=55
n=36
n=33
n=39
n=15
10,0%
0,0%
<2006
≥2006
Şekil. Vakaların CD4+ Hücre Sayılarına Göre İki Döneme Göre Dağılımları
>500
Barriers to Testing in Turkey
•
•
•
•
•
•
•
Lack of awareness
Stigmatisation- social isolation
Cost
No quidelines
Low numbers of centers for testing
Social aspect – patient privacy
 Homosexual men
Hard ro reach groups
 Sex workers
 Injecting drug users
 Prisoners
 Refugees , illegal immigrants
HIV/AIDS TANI TEDAVİ REHBERİ – TÜRKİYE
HIV/AIDS Diagnose and Treatment Guideline
Turkey 2013
KLİNİK KATEGORİ
CD4 T HÜCRESİ SAYISI
ÖNERİLEN
Semptomatik hasta
Herhangi bir değer
Tedavi başlanmalı
Asemptomatik hasta
<350 hücre/mm3
Tedavi başlanmalı
350-500 hücre/mm3
Tedavi başlanması yararlıdır.
Hastanın özel koşullarına göre
tedavi önerilir.
Asemptomatik hasta
Asemptomatik hasta
>500 hücre/mm3
Tedavi başlanabilir. Hastanın
özel koşulları
değerlendirilerek, istekli ve
hazırsa tedavi önerilebilir.
Turkish Ministry of Health 2013
TURKEY - TÜRKİYE
People newly infected with HIV
UNAIDS global AIDS epidemic report 2012
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