Martin C. Donoghoe & Annemarie Rinder Stengaard WHO Regional Office for Europe

1. Access to antiretroviral therapy (ART) for injecting drug users in the WHO European Region 20022008 Martin C. Donoghoe & Annemarie Rinder Stengaard WHO Regional Office for Europe XVIII International AIDS Conference Vienna 22nd July 2010 Abstract THAX0105

2. Background • IDUs have poorer levels of access to ART compared with non-IDUs • Provision of ART to IDUs has population-wide health benefits • IDUs can successfully undergo HIV treatment and benefit from ART • Antiretroviral therapy is one of nine interventions in the UNAIDS comprehensive package for the prevention treatment and care of HIV among IDUs. • We examined IDU access to ART (equity and change over time) in Europe. • We have reported that women and children have equitable access elsewhere

3. Cumulative number of reported casesin WHO European Region

4. New reported HIV cases (1989-2008) Cumulative figures, most recent data: HIV cases: 681 821 AIDS cases: 38 766 AIDS deaths: 15 987 HIV cases Cumulative figures, most recent data: HIV cases: 507 590 AIDS cases: 298 712 AIDS deaths: 168 392 Cumulative figures, most recent data: HIV cases: 39 712 AIDS cases: 17 574 AIDS deaths: 8 398 HIV cases HIV cases

5. <20% 20-40% 40-60% 60-80% >80% 9% 5% 6% 11% 2% IDU as % of all HIV/AIDS cases with known transmission routeNOTE: % of AIDS cases in countries not reporting HIV: France, Italy, Spain Sources: WHO/ECDC joint reporting & national reports 11% 25.5% 17% 15% 14% 82% 16% 88% 29% 75% 80% 5% 78% 71% 77% 73% 16% 23% 5% 66% 25% 28% 76% 57% 26% 2% 73% 16% 4% 42% 9% 65% 24% <1% 15% 17% 59% 61% 4% 13% 50% 9% 57% 0% 11% 5% 3% 1% 16%

6. Scaling up treatment in Europe (Patients on ART)

7. Objectives • To examine IDU access to ART in Europe • Equity (in access injectors and non injectors) • Change over time (between 2002 & 2008)

8. Method (1) • Four standardized national surveys were conducted between 2002-2008 • Annual WHO/UNICEF/UNAIDS reporting on health sector response to HIV/AIDS • Sent to WHO counterparts in 53 European countries

9. Method (2) WHO/UNODC/UNAIDS ART coverage for IDUs indicator • Compares proportion of ever diagnosed HIV cases reported in the IDU transmission category with proportion of ART recipients in the same category • Data were adjusted for HIV cases and ART recipients for whom HIV transmission route was unknown

10. Results Two simple questions: Do injectors have equitable access to ART ? Are there changes in access over time?

11. Injecting Drug Users’ ART Access WHO European Region 2002 to 2008

12. Injecting Drug Users’ ART Access WHO European Region 2002 to 2008

13. Conclusions • IDU access to ART in the European Region is inequitable • Scant improvement in DUU access 2002–2005 • Little evidence of further progress 2006–2008

14. Implications & recommendations (1) • Need to rapidly scale up IDU access to ART in Europe • Substance use status – for example current injecting – should not be a barrier to access • Restrictive policies should be lifted • Quality guidelines for providing ART to IDUs – including recommended regimens that consider hepatotoxicity and drug-drug interactions – should be developed

15. Implications & recommendations (2) • Services that integrate drug dependence and HIV treatment services are particularly effective • Opioid substitution therapy has been demonstrated to improve both access and adherence to ART and should be made more widely available – particularly in Eastern Europe where coverage is particularly poor • Rights HERE Right NOW for drug injectors

16. Contact Details Martin C. DonoghoeProgramme Manager: HIV/AIDS, STIs & Viral HepatitisCommunicable Disease and Environmental Health Unit (CDS) World Health Organization Regional Office for EuropeScherfigsvej 8, Copenhagen DK-2100Tel: +45 3917 1207mdo@euro.who.int