HIV and drug prevention in Estonia

Harm reduction services

Aljona Kurbatova

National Institute for Health DevelopmentTallinn, Estonia

Republic of Estonia:

• Population – 1.29 million people

• 276 newly diagnosed HIV cases per million population in 2011 (n=370)

• Decrease in the number of new HIV cases (2012; n=315)

• A total of 8 377 HIV-cases in 1988–2012

• Main risk group – people who inject drugs

• Highest rate of overdose deaths in EU

• All possible comorbidities – HIV/IDU, HIV/TB, TB/IDU, IDU/HIV/TB, IDU/HIV/MDR-TB.

People who inject drugs Old estimate: 13 801 IDUs in Estonia in 2004, which

translated into a prevalence of 2,4% (95% CI 1,4-5.9) among people 15-44 years.

New estimate: 5 362 IDUs in Estonia in 2009, which translated into a prevalence of 0,9% (95% CI 0,7–1,7%) among people 15-44 years.

Experts’ estimate: around 8 000 – 9 000

IDU prevalence is mostly confined to two (out of 15) counties – Harjumaa including Tallinn and Ida-Virumaa (North-East).

According to the available data the age and injecting period of IDUs is increasing - the population seems to have stabilized.

Main drug – fentanyl, 3-methylfentanyl There is evidence that injecting of amphetamines has

increased.

Background

• First NSP project was launched in May 1997 – needle and syringe exchange was provided from a vehicle (car) in Tallinn (NGO AIDS Support and Information Centre).

• In 1998 HIV voluntary testing and counselling centre in Narva started second needle and syringe exchange project.

• In June 2000 NSP services were extended to other cities in North-East of Estonia - Narva (4 sites in total), Kohtla-Järve (2 sites in total), Jõhvi, Sillamäe and Kiviõli.

• First opioid substitution programms in 1997, however officially OST started in 2002.

Background

• In the beginning of 2000-s national government and Tallinn City Government started to support harm reduction programmes, however resources allocated were very modest.

• In 2003 Global Fund Programme is launched and more systematic development of the harm reduction becomes possible on national level.

• In 2004 European Commission PHARE project in collaboration with Netherlands is launched which allows to establish three new low threshold centres in cooperation with local municipalities – Tallinn, Kohtla-Järve ja Paide.

• From the end of 2007 harm reduction programmes are fiannced from the state budget.

• 2010-2013 additional funding for counselling services from European Social Fund

National HIV PolicyMain action areas: Harm reduction programs for people who inject drugs

Syringe exchange programs Opioid substitution treatment Counselling Overdose prevention

HIV testing and counselling (based on risk behaviors and indicator conditions) and STI testing

Voluntary HIV testing and counselling Piloting of the Internet-facilitated STI testing for MSM Piloting of the partner notification and testing (STI services for IDUs and

their sexual partners STI testing, treatment and counselling services for CSW STI testing, treatment and counselling services for IDU STI testing, treatment and counselling services for uninsured young

people

HIV-related health care services including ARV treatment (free of charge for all)

National drug policy

Main action areas relevant to the injecting drug use: Drug treatment and rehabilitation

DetoxificationLong-term medical rehabilitation (psychotherapy etc)Counselling

Basic structure of services for drug users

Low threshold Establishment of the first contact, provision of motivation for

treatment – family physicians, harm reduction sevices, counselling etc.

Addiction treatment, rehabilitation Health care organisations, rehabilitation centres.

Aftercare, reintegration Counselling services - social, psychological, peer counselling. Support services and possibilities for the reintegration of former drug

addicts in the labour market (limited).

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Work process NATIONAL STRATEGY:

Long term objectives (united effort of different sectors and

organisations)ACTIVITY PLAN OF THE STRATEGY

yearly plan – the amount of services targeted at people who inject drugs is planned for the whole

country

ACTIVITY PLANS OF SERVICE PROVIDERS IN THE REGION Yearly plan – the amount of service planned for each organisation (in cooperation of service providers and NIHD).

SERVICE DESCRIPTION – the types of services provided, required conditions, safety requirements, etc (in cooperation of service providers and NIHD).

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The roles of different partnersNIHD in national level: coordinating the general development of the service,

planning the budget and the service need for the country,

conducting public procurements (syringes, needles, condoms etc)

financing the service, organising staff trainings, conducting studies, analysing the results of the service.

Service providers in regional level: planning the service and the budget in their organisation,

delivering service to the target group,

participating in preparing service descriptions/standards

Participating in research and development.

Some of the latest developments National HIV policy has been integrated into

Health Action Plan 2009-2020. Ministry of Interior has taken over coordination of

the national drug policy

New national HIV testing guidance Rapid testing in community settings in

collaboration of NIHD, health care and community based organisations (although legally restricted to health care settings)

Regional expansion of OST Piloting of the take-home naloxone programme in

2013, preparations underway

Thank you!