A global perspective on scaling up harm reduction
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A global perspective on scaling up harm reduction
2nd National Harm Reduction Conference, Ukraine, 21-23 March 2007Dr Jos Perriens, Director PreventionDepartment of HIV/AIDS, WHO Headquarters, Geneva
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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 countries www.idurefgroup.org.
S. & S-E Asia: 3.33m
E. Europe & C. Asia: 3.2m
E. Asia & Pacific 2.35mMENA:0.44m
S. Saharan-Africa 0.009m
L. America: 0.97m
Caribbean: 0.028m
N. America 1.43m
W. Europe: 1.24m
Australia & N. Zealand:
0.19m
13,200,000 IDUs worldwide – 4 million of them living with HIV
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60%
71.1%
15%
4%
11%
5%
90%
68%
1%
84%
80%
81.2%
82.9%
73.6%
82%
0.12%
87%
1.3%
7.4% 86%
71%81.6%
51%
<20%
20-40%
40-60%
60-80%
64%
50% 29.2%
6.03%
12.9%
33.7%10%
14.5%
17% 19.3%
11%
3.8%
16%
32%
16%
16%
>80%
23.5%
60%
25%
56.5%14%3%
10%
1,8%
5.9%
IDU as % of all HIV/AIDSreported cases (end 2003)NOTE: % of AIDS cases in countries not reporting HIVSources: EuroHIV; national reports;
6%
0%
N/A
25%
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Comprehensive harm reduction programmes Needle and syringe programmes (NSP)Outreach programmesHIV testing and counselling Prevention and treatment of STI, access to condoms_______________________________Opioid Substitution Therapy (OST) other drug dependence treatment_______________________________HIV treatment and care, including ARTHepatitis B vaccination and treatment of viral hepatitis_______________________________in the community and in prison settings
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Needles Syringe Programming (NSP)Annual Change in HIV prevalence among IDU at city
level5,9 % annual increasein 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
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010203040
50
607080
90100
Belaru
s
Croatia
Czech R
ep
Estonia
Russia
Ukraine
Needle & syringe exchange coverage (% IDUs reached)IDU as % of all reported HIV cases
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Opioid Substitution Therapy (OST)
Demonstrated effectiveness:
Reduced illicit drug use and associated HIV riskImproved healthImproved social functioningReduced criminal activity
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Current provision of Opioid Substitution Therapy:Methadone and/or Buprenorphine in 59 Countries
Methadone 49 countriesBuprenorphine 33 countries
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0102030405060708090
100
Belaru
s
Russia
Estonia
Latvia
Ukraine
Lithuan
ia
Poland
Finland
Sweden
Norway
United K
ingdom
German
y
Irelan
d
Substitution treatment coverage (% IDUs treated)IDU as % of HIV cases
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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
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HIV/AIDS Treatment for IDUInjecting Drug Users are
Often excluded from HIV/AIDS treatmentLeast likely to receive ARTInitiate ART later
Clinicians reluctant to prescribe ARTConcerns regarding low adherence leading to resistance
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HIV treatment access among IDU in Eastern Europe
Serbia and
Montenegro Czech
Republic Moldova Estonia Ukraine
1009080
70605040302010
Lithuania Croatia
RussianFederation
IDU as % of people living with HIVIDU as % of people on ART
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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
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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).
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QualityHow well are we providing our services?
CoverageHow much services do we need to provide?