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The need to scale up HIV prevention for drug users

The need to scale up HIV prevention for drug users. Kasia Malinowska-Sempruch Director International Harm Reduction Development Program Open Society Institute Krakow, September 26, 2004. Fixing, Astrakhan. Overview. Injecting drug use globally and related HIV epidemics

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The need to scale up HIV prevention for drug users

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  1. The need to scale up HIV prevention for drug users Kasia Malinowska-Sempruch Director International Harm Reduction Development Program Open Society Institute Krakow, September 26, 2004

  2. Fixing, Astrakhan

  3. Overview Injecting drug use globally and related HIV epidemics Current state of knowledge about addiction OSI’s experience in supporting harm reduction Related policy issues

  4. HIV among injecting drug users • Primary characteristics -- an explosive epidemic /easy to contain (UK, Holland, Canada) • In 1992 -- 52 countries reporting HIV among IDUs; in 2002 -- 114. • Injecting Drug Use accounts for as much as 10% of new HIV infections globally • An estimated 1 of every 3 new infections outside of Africa is among IDUs

  5. Drug Use and Global HIV Epidemic • Especially in Asia and former Soviet Union, drug policy holds key to future of HIV • 52 countries report HIV among IDU’s in 1992, 114 in 2002 (Strathdee and Poundstone, 2002) • Outside of Africa, estimated 1 of every 3 new infections comes from contaminated needle (UNAIDS)

  6. HIV IN UKRAINE: estimated 1% prevalence UNAIDS Global Epidemic Update, 2002 Photo: Jacqueline Mia Foster

  7. Explosive nature of HIV infections among injecting drug users in Russia • In Svetlagorsk, Belarus, 1 year after the first HIV case, 67% of IDUs were estimated to be infected. • In St. Petersburg, prevalence among IDUs was 0.3% in 1998, 19.3% by 2000.

  8. Asia • China - as many as 1 million HIV cases, 70% among IDUs • Malaysia—76% of all HIV cases among IDUs • Iran—75% HIV cases are among IDUs • Vietnam—65% HIV cases are among IDUs • 80% IDUs HIV+ in Manipur (India) • 90% IDU’s HIV+ in Myitikina (Burma) • In Chiang Rai, Thailand, HIV prevalence among IDUs increased from 1% in 1988 to 61% in 1989

  9. Drug Addiction Prevalence Rate in KyrgyzstanNational Centre of Addictions of the Ministry of Health of Kyrgyzstan 5591 80-100 000 1290 5591

  10. HIV prevalence among IDUs National Centre of Addictions of the Ministry of Health of Kyrgyzstan 1 Jan 2001 1 Jan 2003 <20% 30.2% 69.8% Injecting Drug Users Non-Injection Infection >80%

  11. Ancient historyDr. Ernest Bishop (NYC), 1920 • “We have regarded failure to abstain from narcotics as evidence of weak will-power.” • “We have prayed over our addicts, cajoled them, exhorted them, imprisoned them, treated them as insane and made them social outcasts” – and we’ve consistently failed! Bishop, The Narcotic Drug Problem. Macmillan; NY 1920 The Baron Edmond de Rothschild Chemical Dependency Institute

  12. World Health Organization:Addiction is a brain disease, 1997 • “Research has shown that substance dependence is a chronic relapsing disorder with a biological and genetic basis, and is not simply due to lack of will. . . “ • “Substance dependence is as much a disorder of the brain as any neurological or psychiatric illness.” WHO. “Neuroscience of psychoactive substance use and dependence.” ISBN 92-4-159124-2 The Baron Edmond de Rothschild Chemical Dependency Institute

  13. National Institute on Drug Abuse Addiction is a brain disease, 1997 • “Addiction unequivocally is a disease of the brain that can be effectively treated” • “Strongly recommends expanding access to methadone treatment” • NIDA Notes, 1997 at http://www.drugabuse.gov/NIDA_Notes/NNVol12/NIPanel.html The Baron Edmond de Rothschild Chemical Dependency Institute

  14. Harm reduction1984 British Home Office publication perhaps earliest published reference to harm reduction: • “An important aspect of prevention is the reduction of harm associated with misuse –by measures directed at the user rather than the non-user.” * British Home Office Prevention – Report of the Advis Counc on misuse of drugs, 1984 The Baron Edmond de Rothschild Chemical Dependency Institute

  15. Albania Azerbaijan Belarus Bulgaria Croatia Czech Republic Estonia Georgia Kazakhstan Kyrgyzstan Latvia Lithuania Macedonia Moldova Poland Romania Russia Slovakia Slovenia Tajikistan Turkmenistan Ukraine Uzbekistan OSI-Supported Harm Reduction Programs

  16. Lessons learnt • Drug users are compliant, if services are organized in reasonable manner • HIV treatment must accompany prevention • Harm reduction is EASY • Pilots are not enough – programs need to be taken to scale • Drug policies need to be re-visited for HIV prevention to be effective

  17. Drug policies need to be re-visited Photo: Hans Jürgen Burkard

  18. OTHER CONSIDERATIONS -- Heroin overdose, Volgograd

  19. The need to scale up HIV prevention for drug users Kasia Malinowska-Sempruch Director International Harm Reduction Development Program Open Society Institute Krakow, September 26, 2004

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