HIV/AIDS in Eastern Europe
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HIV/AIDS in Eastern Europe Setting the Stage for Prevention. Thomas E. Novotny, MD, MPH April 16, 2004. HIV/AIDS in Eastern Europe Background. Most rapid rate of increase in new HIV infections among all regions of the world;

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HIV/AIDS in Eastern Europe Setting the Stage for Prevention

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Hiv aids in eastern europe setting the stage for prevention

HIV/AIDS in Eastern Europe

Setting the Stage for Prevention

Thomas E. Novotny, MD, MPH

April 16, 2004


Hiv aids in eastern europe background

HIV/AIDS in Eastern EuropeBackground

  • Most rapid rate of increase in new HIV infections among all regions of the world;

  • Transition and economic disruption may lead to increased risk behavior (IDU, trafficking) and reduced prevention and treatment services;

  • Prevention opportunities based on lessons learned in the region and from outside.


Hiv aids in eastern europe setting the stage for prevention

Global HIV: Change in Prevalence Rates 1996–2001

+ 1 300%

+20%

+ 20%

+ 160%

+ 100%

Adult prevalence rate

15.0% – 36.0%

5.0a% – 15.0%

1.0% – 5.0%

0.5% – 1.0%

0.1% – 0.5%

0.0% – 0.1%

not available

+60%

+ 40%

+ 30%

+ 20%


Hiv aids in eastern europe setting the stage for prevention

Causing or Aggravating Poverty

CONTRIBUTORS TO POVERTY

  • Loss of income

  • Catastrophic cost of care

  • Increased dependency ratio

  • Loss of productivity (companies)

  • Loss of social capital (countries)

  • Reduced national income?

HIV Infection

AIDS


Impacts for generalized epidemic of hiv aids

Impacts for Generalized Epidemic of HIV/AIDS

  • 0.5-1.0 percentage point decline in economic growth

  • 50-100% increase in health expenditures

    • Impact private sector development

    • Aggravate informalization of economy

  • Change in dependency ratio, straining social systems

  • Change in HH size and composition (single parents, orphans, elderly caring for children

  • Negative intergenerational effects: Poverty trap


Transmission groups and risk

Transmission Groups and Risk

  • Main mode is heterosexual: IDU (80%)

  • Little MTCT

  • Romania: Nosocomial and now heterosexual (n=8,000)

  • MSM underreported

  • Structural factors in ECA: social disruption, open borders, economic crisis

  • Mobility and globalization

  • Increases in STIs

  • Youth most at risk (age 20-30 years)


Mobile populations example se europe

Mobile PopulationsExample: SE Europe

  • Merchant marines, truckers (37% have unsafe sex while traveling)

  • Peacekeepers

  • Roma and other ethnic minorities (8 mil.)

  • Trafficked women (and children)

  • Commercial Sex Workers (CSW)

  • Tourists


Effective interventions

Effective Interventions

  • CSW: 100% condom use, STI treatment, client education, peer education and outreach

  • IDU: demand reduction, condom social marketing, needle exchange and cleaning education, treatment

  • Youth: school reproductive health education and peer support

  • Contacts: tracing, voluntary testing and counseling, referral

  • STI surveillance, syndromic treatment


Harm reduction

Harm Reduction

  • Needle exchange

  • CSW outreach, reproductive health services

  • Drug abuse treatment (Methadone)

  • Condom distribution

  • Decriminalization of drugs and prostitution


Challenges in low prevalence countries of eca

Challenges in Low Prevalence Countries of ECA

  • Lack of recognition of future potential

  • High levels of stigmatization (HIV+, IDU, CSW, ethnic minorities)

  • Lack of government ownership of harm reduction (HR) approaches

  • Lack of sentinel surveillance among most vulnerable populations

  • Most funds go to treatment and not prevention programs

  • Lack of evaluation on HR and other prevention interventions

  • Increase in sexual risk behavior


Conclusions hiv aids in low prevalence countries

Conclusions: HIV/AIDSin Low Prevalence Countries

  • Opportunity for prevention is now

  • Cross-border externalities important in addressing most vulnerable groups

  • Future burden on health systems and economic productivity may be enormous

  • Need sentinel surveillance in high risk groups and vulnerable populations

  • Harm reduction, harm reduction, harm reduction

  • Public information and professional education are essential


Igh caps activities

IGH/CAPS Activities

  • ICOHRTA Supplement with Croatia (NIDA)

  • Regional training in the Balkans

  • Eastern Europe/Central Asia Working Group

  • Research and writing for World Bank publications (Central Asia, Balkan, ECA)

  • Modeling epidemic and economic impact in the Baltics


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