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Addressing HIV/AIDS Challenges in Eastern Europe: Prevention Strategies and Interventions

Explore the rapid increase in HIV infections in Eastern Europe, the impact on poverty, transmission groups and risks, and effective interventions including harm reduction approaches. Discover the challenges and opportunities for prevention in low prevalence countries.

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Addressing HIV/AIDS Challenges in Eastern Europe: Prevention Strategies and Interventions

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  1. HIV/AIDS in Eastern Europe Setting the Stage for Prevention Thomas E. Novotny, MD, MPH April 16, 2004

  2. HIV/AIDS in Eastern EuropeBackground • Most rapid rate of increase in new HIV infections among all regions of the world; • Transition and economic disruption may lead to increased risk behavior (IDU, trafficking) and reduced prevention and treatment services; • Prevention opportunities based on lessons learned in the region and from outside.

  3. Global HIV: Change in Prevalence Rates 1996–2001 + 1 300% +20% + 20% + 160% + 100% Adult prevalence rate 15.0% – 36.0% 5.0a% – 15.0% 1.0% – 5.0% 0.5% – 1.0% 0.1% – 0.5% 0.0% – 0.1% not available +60% + 40% + 30% + 20%

  4. Causing or Aggravating Poverty CONTRIBUTORS TO POVERTY • Loss of income • Catastrophic cost of care • Increased dependency ratio • Loss of productivity (companies) • Loss of social capital (countries) • Reduced national income? HIV Infection AIDS

  5. Impacts for Generalized Epidemic of HIV/AIDS • 0.5-1.0 percentage point decline in economic growth • 50-100% increase in health expenditures • Impact private sector development • Aggravate informalization of economy • Change in dependency ratio, straining social systems • Change in HH size and composition (single parents, orphans, elderly caring for children • Negative intergenerational effects: Poverty trap

  6. Transmission Groups and Risk • Main mode is heterosexual: IDU (80%) • Little MTCT • Romania: Nosocomial and now heterosexual (n=8,000) • MSM underreported • Structural factors in ECA: social disruption, open borders, economic crisis • Mobility and globalization • Increases in STIs • Youth most at risk (age 20-30 years)

  7. Mobile PopulationsExample: SE Europe • Merchant marines, truckers (37% have unsafe sex while traveling) • Peacekeepers • Roma and other ethnic minorities (8 mil.) • Trafficked women (and children) • Commercial Sex Workers (CSW) • Tourists

  8. Effective Interventions • CSW: 100% condom use, STI treatment, client education, peer education and outreach • IDU: demand reduction, condom social marketing, needle exchange and cleaning education, treatment • Youth: school reproductive health education and peer support • Contacts: tracing, voluntary testing and counseling, referral • STI surveillance, syndromic treatment

  9. Harm Reduction • Needle exchange • CSW outreach, reproductive health services • Drug abuse treatment (Methadone) • Condom distribution • Decriminalization of drugs and prostitution

  10. Challenges in Low Prevalence Countries of ECA • Lack of recognition of future potential • High levels of stigmatization (HIV+, IDU, CSW, ethnic minorities) • Lack of government ownership of harm reduction (HR) approaches • Lack of sentinel surveillance among most vulnerable populations • Most funds go to treatment and not prevention programs • Lack of evaluation on HR and other prevention interventions • Increase in sexual risk behavior

  11. Conclusions: HIV/AIDSin Low Prevalence Countries • Opportunity for prevention is now • Cross-border externalities important in addressing most vulnerable groups • Future burden on health systems and economic productivity may be enormous • Need sentinel surveillance in high risk groups and vulnerable populations • Harm reduction, harm reduction, harm reduction • Public information and professional education are essential

  12. IGH/CAPS Activities • ICOHRTA Supplement with Croatia (NIDA) • Regional training in the Balkans • Eastern Europe/Central Asia Working Group • Research and writing for World Bank publications (Central Asia, Balkan, ECA) • Modeling epidemic and economic impact in the Baltics

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