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A global perspective on scaling up harm reduction

A global perspective on scaling up harm reduction. 2 nd National Harm Reduction Conference, Ukraine, 21-23 March 2007 Dr Jos Perriens, Director Prevention Department of HIV/AIDS, WHO Headquarters, Geneva. 13,200,000 IDUs worldwide – 4 million of them living with HIV.

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A global perspective on scaling up harm reduction

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  1. A global perspective on scaling up harm reduction 2nd National Harm Reduction Conference, Ukraine, 21-23 March 2007 Dr Jos Perriens, Director Prevention Department of HIV/AIDS, WHO Headquarters, Geneva

  2. 13,200,000 IDUs worldwide – 4 million of them living with HIV E. Europe & C. Asia: 3.2m N. America 1.43m W. Europe: 1.24m E. Asia & Pacific 2.35m Caribbean: 0.028m MENA:0.44m S. & S-E Asia: 3.33m S. Saharan-Africa 0.009m L. America: 0.97m Australia & N. Zealand: 0.19m 1998-2004. 91% of the world adult population (4 billion) covered by the data. UN Reference Group on HIV/AIDS prevention and care among IDUs in developing and transitional countrieswww.idurefgroup.org.

  3. 11% <20% 20-40% 40-60% 60-80% >80% 17% 19.3% 14.5% 90% 33.7% 87% 10% 81.2% 6.03% 82.9% 84% 71.1% 12.9% 82% 16% 80% 5% 23.5% 71% 1.3% 29.2% 25% 81.6% 50% 1% 73.6% 86% 7.4% 32% 11% 64% 0.12% 15% 51% 60% 68% 4% 60% 3% 14% 56.5% 10% 3.8% 16% 16% 0% 5.9% 6% 25% N/A IDU as % of all HIV/AIDS reported cases (end 2003) NOTE: % of AIDS cases in countries not reporting HIV Sources: EuroHIV; national reports; 1,8%

  4. Comprehensive harm reduction programmes • Needle and syringe programmes (NSP) • Outreachprogrammes • HIV testing and counselling • Prevention and treatment of STI, access to condoms • _______________________________ • Opioid Substitution Therapy (OST)other drug dependence treatment • _______________________________ • HIV treatment and care, including ART • Hepatitis B vaccination and treatment of viral hepatitis • _______________________________ • in the community and in prison settings

  5. Needles Syringe Programming (NSP) • Annual Change in HIV prevalence among IDU at city level 5,9 % annual increase in 52 cities without NSP 5,8 % annual decrease in 29 cities with NSP Hurley SF, Jolley DJ, Kaldor JM. Effectiveness of needle-exchange programme for prevention of HIV infection. Lancet 1997, 359 (9068): 1797-800

  6. Opioid Substitution Therapy (OST) • Demonstrated effectiveness: • Reduced illicit drug use and associated HIV risk • Improved health • Improved social functioning • Reduced criminal activity

  7. Current provision of Opioid Substitution Therapy:Methadone and/or Buprenorphine in 59 Countries Methadone 49 countries Buprenorphine 33 countries

  8. Misconceptions about OST • Does not breach UN conventions • Is supported by the UN System (including WHO, UNODC and UNAIDS) • Does not “trap” people into dependency • Does not reduce demand for drug-free treatment • Does not lead to an increase in drug use in the community

  9. HIV/AIDS Treatment for IDU • Injecting Drug Users are • Often excluded from HIV/AIDS treatment • Least likely to receive ART • Initiate ART later • Clinicians reluctant to prescribe ART • Concerns regarding low adherence leading to resistance

  10. IDU as % of people living with HIV 100 IDU as % of people on ART 90 80 70 60 50 40 30 20 10 Czech Republic Moldova Estonia Ukraine Lithuania Croatia Russian Federation HIV treatment access among IDU in Eastern Europe Serbia and Montenegro

  11. HIV Treatment and Care for IDUs • HIV care for IDUs often successful • ART resistance levels similar in IDUs and non IDUs • IDUs can adhere to ART as well as non IDUs • OST improves retention and adherence to ART

  12. Harm Reduction in Prisons • Prisoners and detainees have a rights to the protection of their physical and mental health of the same quality and standard as is afforded to those who are not imprisoned or detained. • Adopted by United Nations General Assembly resolution 37/194 of 18 (December 1982).

  13. Quality Coverage • How well are we providing our services? How much services do we need to provide?

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