UNODC response to HIVAIDS Baltic Forum "Drug Control in the Baltic Region: New Challenges" 27-28 September 2005 Vilnius Zhannat Kosmukhamedova, HIV/AIDS

UNODC response to HIVAIDS

Baltic Forum "Drug Control in the Baltic Region: New

Challenges"

27-28 September 2005 Vilnius

Zhannat Kosmukhamedova, HIV/AIDS Unit, UNODC

HIV/AIDS is more than a health issue.

It is also a socio-economic issue,an issue of human rights and gender-based discrimination

In 2004, of the 39,4 million people living with HIV/AIDS, 17.6 million (48 per cent) were women and 2.2 million were children (< 15)

~13 million people with HIVAIDS are between 15-24 years old

The HIVAIDS situation worldwide(estimated number of PLWHA)

E-Europe & Central Asia1.4 million

E. Asia & Pacific1.1 million

South & S-E. Asia7.1 million

Australia & N. Zealand 35,000

Sub-Saharan Africa

25.4 million

MENA540,000

Western Europe610,000

North America 1 million

Caribbean 440,000

Latin America 1.7 million

Worldwide, 5-10 per cent of all HIV infections are attributably to injecting drug use, mostly from the use of contaminated injection equipment by injecting drug users

Non-injecting drug use

Unsafe sex betweensex workers and

clients

Unsafe injecting drug use

HIV-infected mother to childtransmission

Commercial sex work

Unsafe sex withpartners

HIV transmission routes related to drug abuse

Epidemiology of HIVAIDS and injecting drug use

13.2 million people inject these drugs10.3 million (78%) in developing countries

Worldwide, more than 58 million people abuse opiates, cocaine and amphetamine-type stimulants

Estimated number of injecting drug users (IDUs)

East. Europe & Central Asia

3.2mE. Asia & Pacific

2.3m

Western Europe

1.2m

North Africa &Middle East

400,000

Sub-Saharan Africa

900,000

Australia &New

Zealand200,000

Latin America

1m

North America

1.5 m

South & S.East Asia

3.3 m

Caribbean13,800

Up to 73.7

Up to 84.0

Up to 1.23

Up to 2.0

Up to 59.4

Up to 90.1

Up to 80.0

Up to 55.2

Up to 42.0

Up to 66.5

and HIV prevalence among IDUs(mid-point estimates)

EASTERN EUROPE & CENTRAL ASIA. IDU population & HIV prevalence among IDUs (1998/2004)

IDU pop. over 100,000 people (mid point)

Russian Federation: 2,500,000

Ukraine: 495,682

Kazakhstan: 250, 000

Romania: 101,000

IDU pop. 20,000 – 100,000 people (mid point)

Moldova: 97,000

Uzbekistan: 109,431

Tajikistan: 53, 000

Belarus: 46,000

Poland: 96,514

Czech Rep: 26,164

Hungary: 25,007

Croatia and Kyrgyzstan: 21,146

Estonia: 22,500

IDU pop. under 20,000 people (mid point)

Armenia, Azerbaijan, Bosnia & H., Bulgaria, Georgia, Latvia, Lithuania, Slovakia and Turkmenistan

HIV prevalence among IDUs

Armenia Up to19%

Latvia Up to 19%

Azerbaijan

Up to 2.3%

Lithuania

Up to 3%

Belarus Up to 67%

Moldova Up to 4.9%

Estonia Up to 41%

Russia Up to 70%

Georgia Up to 4.7%

Ukraine Up to 73.6%

HIV/AIDS IN PRISON SETTINGS: GLOBAL EFFECT

there are annuallyabout 30 million

prisoners going through the prison system worldwide

At any given time there are approximately

10 millionpeople imprisoned

worldwide

New prisoners

Released prisoners

Epidemiological data in prisons on HIV/AIDS, tuberculosis, hepatitis and sexually transmitted infections need to be interpreted against a background

of high turnover among the persons incarcerated

infected outside prison system

infected while incarcerated

Estimated number of IDUs in prisons and HIV/AIDS prevalence among prison inmates in

selected countries

Number of IDUs in prisons (%):European Union countries – 15-55Estonia – 25Latvia – 27Kazakhstan – 70Ukraine – 30Russian Federation – 50Bangkok – 30Vietnam – 61Brazil – 30Mexico – 37South Africa – 41

HIV among prison populations (%)Estonia – 17Latvia – 6.2Lithuania – 15Romania – 13Russian Federation – 5Ukraine – 6Belarus – 2.2Portuguese – 20Spain – 16.6Switzerland – 12Italy – 7Vietnam – 28.4Iran – 36.5India – 14 (women), 7(men)

Prevalence of Hepatitis C among injecting drug using inmates is 50-90% ;globally, rates of HIV-infection among prison population are generally much higher than in the general population.

Comprehensiveness and up to scale

Prevention and care interventions need to be comprehensive and multi-sectoral to address the needs of often very diverse vulnerable populations.

Prevention and care have to go hand-in-hand: Large-scale treatment initiatives, such as the “Three by Five” initiative, provide excellent opportunities for prevention, as do prevention initiatives for treatment.

To reverse the trends of existing HIV/AIDS epidemics and to prevent a new wave of epidemics, it is essential that interventions go to scale immediately. There is no time and no need for pilot projects.

Only if the majority of vulnerable people are reached with services, an epidemic can be prevented, halted and reversed.

UNODC advocates, therefore, that comprehensive and large-scale interventions be integral part of the national HIV/AIDS framework.

http://www.who.int/3by5/en/

HIV/AIDS: Three Key areas of interventions

Injecting Drug Use

Prison Settings

Trafficking in persons


Injecting Drug UseResearch indicates that an HIV/AIDS epidemic among injecting drug users can be prevented, halted and even reversed, if responses are based on a sound assessment of the specific drug use situation and the socio-cultural and political context.

UNODC footnote in IDU key result

HIV/AIDS prevention and care programmes for injecting drug users typically include a wide variety of measures (the “package” approach),

ranging from drug dependence treatment, including drug substitution treatment, outreach providing injecting drug users with information on risk reduction and referral to services, prevention commodities, voluntary counselling and testing, treatment of sexually transmitted infections, antiretroviral therapy, and interventions for especially at-risk populations such as prisoners and sex workers who inject drugs. Such a comprehensive package of measures also usually includes treatment instead of punishment for persons convicted of minor offences, since drug treatment not only constitutes a humane, cost-effective alternative, but also incarceration usually increases the risk of HIV transmission.


HIV/AIDS prevention and care programmes for injecting drug users typically include a wide variety of measures (the “package” approach), ranging from drug dependence treatment, including drug

substitution treatment, outreach providing injecting drug users with information on risk reduction and referral to services, prevention commodities, voluntary counselling and testing, treatment of sexually transmitted infections, antiretroviral therapy, and interventions for especially at-risk populations such as prisoners and sex workers who inject drugs. Such a comprehensive package of measures also usually includes treatment instead of punishment for persons convicted of minor offences, since drug treatment not only constitutes a humane, cost-effective alternative, but also incarceration usually increases the risk of HIV transmission.


HIV/AIDS prevention and care programmes for injecting drug users typically include a wide variety of measures (the “package” approach), ranging from drug dependence treatment, including drug substitution treatment, outreach providing injecting drug users with information on risk reduction and referral to services, prevention commodities,

voluntary counselling and testing, treatment of sexually transmitted infections, antiretroviral therapy, and interventions for especially at-risk populations such as prisoners and sex workers who inject drugs. Such a comprehensive package of measures also usually includes treatment instead of punishment for persons convicted of minor offences, since drug treatment not only constitutes a humane, cost-effective alternative, but also incarceration usually increases the risk of HIV transmission.


HIV/AIDS prevention and care programmes for injecting drug users typically include a wide variety of measures (the “package” approach), ranging from drug dependence treatment, including drug substitution treatment, outreach providing injecting drug users with information on risk reduction and referral to services, prevention commodities, voluntary counselling and testing, treatment of sexually transmitted infections,

antiretroviral therapy, and interventions for especially at-risk populations such as prisoners and sex workers who inject drugs. Such a comprehensive package of measures also usually includes treatment instead of punishment for persons convicted of minor offences, since drug treatment not only constitutes a humane, cost-effective alternative, but also incarceration usually increases the risk of HIV transmission.


HIV/AIDS prevention and care programmes for injecting drug users typically include a wide variety of measures (the “package” approach), ranging from drug dependence treatment, including drug substitution treatment, outreach providing injecting drug users with information on risk reduction and referral to services, prevention commodities, voluntary counselling and testing, treatment of sexually transmitted infections, antiretroviral

therapy, and interventions for especially at-risk populations such as prisoners and sex workers who inject drugs. Such a comprehensive package of measures also usually includes treatment instead of punishment for persons convicted of minor offences, since drug treatment not only constitutes a humane, cost-effective alternative, but also incarceration usually increases the risk of HIV transmission.


HIV/AIDS prevention and care programmes for injecting drug users typically include a wide variety of measures (the “package” approach), ranging from drug dependence treatment, including drug substitution treatment, outreach providing injecting drug users with information on risk reduction and referral to services, prevention commodities, voluntary counselling and testing, treatment of sexually transmitted infections, antiretroviral therapy, and interventions for especially at-risk populations such as prisoners and sex workers who inject drugs. Such a comprehensive package of measures also usually includes

treatment instead of punishment for persons convicted of minor offences, since drug treatment not only constitutes a humane, cost-effective alternative, but also incarceration usually increases the risk of HIV transmission.


Prison Settings

Effective policies to prevent HIV/AIDS inside prison and other correctional settings is often hampered by the denial of the existence of the factors that contribute to the spread of HIV (e.g., unsafe sex and drug use, gangs, violence) inside these institutions. In order to address the overall situation, a comprehensive strategy must focus at three broad levels:


Prison Settings

- Policy and environmental level

- Health care services level

- Individual level


Prison SettingsSpecial attention needs to be given to the

needs of especially at-risk inmates including juveniles, females, foreigners and inmates belonging to ethnic and other minorities.



There are worldwide practically no initiatives focusing on HIV/AIDS prevention and care as it relates to the trafficking in persons. As a rule, governments are not aware of either the extent of human trafficking in their countries or of the connection between human trafficking and HIV/AIDS. General responses addressing HIV/AIDS have little impact on trafficked persons due to the clandestine nature of human trafficking and because they are not reached with services. More focused action specifically addressing potential or actual victims of human trafficking need to be urgently developed and implemented.

Plans for 2006-2007

HIV/AIDS: Principal resultCountries able to establish, implement

& scale-up HIV/AIDS prevention responses

Injecting Drug Use

Prison Settings


HIV/AIDS: Key results

Plans for 2006-2007

Key result description: Increase and improve service

coverage of HIV/AIDS prevention and care for injecting drug users in

countries where the use of contaminated injection

equipment among them is a major or potentially a major

route of transmission.



Injecting Drug Use


Plans for 2006-2007

Key result description: Develop a globally agreed strategy on HIV/AIDS prevention, care and support in prison settings, and establish national HIV/AIDS prevention and care programmes in prison settings, of selected countries.



Injecting Drug Use


Prison Settings

Plans for 2006-2007

Key result description: Provide actual and potential trafficking victims, particularly women and girls, with comprehensive, gender-sensitive, HIV/AIDS prevention and care in selected countries of origin and destination.



Injecting Drug Use


Prison Settings


Plans for 2006-2007Injecting Drug Use

Type of initiatives Support to countries (legislation, policies and standards); Encourage the proactive involvement of law enforcement agencies in HIV prevention and care (more cooperation/collaboration between health, criminal justice sectors and community based and civil society organizations). Establishment of outreach interventions, covering at least 35 per cent of all IDUs, to provide them with HIV/AIDS information, education and the means of reducing their HIV infection risk; Diversification and expansion of drug dependence treatment services, including special treatment programmes for young injectors and for women, and, if appropriate, establishment of large-scale drug substitution maintenance treatment; Awareness raising among drug dependence treatment services with respect to the need to address HIV/AIDS prevention and care issues; Interventions to prevent the transition from non-injecting drug use to injecting drug use, particularly for young people

Plans for 2006-2007Prison Settings

Type of initiatives Promoting the right to health care and HIV/AIDS prevention, care and treatment for inmates, equivalent to that available in the general community;· Providing HIV/AIDS information and education to inmates, wardens and other staff in prison settings;· Confidential and voluntary counselling, testing and psycho-social support, HIV/AIDS education and provision of the means of HIV prevention;· Monitoring internally and externally general prison conditions and operating secure, safe and orderly prisons in order to reduce violence and the spread of HIV;· Minimizing overcrowding;· Classification and separation of juveniles from adult prisoners, and use of maternity wards;· Organization of meaningful rehabilitation activities in prisons, including pre-release reintegration programmes;· Training of prison staff on prison management and on the needs of HIV- infected inmates;· Provision of antiretroviral therapy and improved hygiene, sanitation and diets for HIV-infected prisoners;· Promoting the active involvement of civil society organizations in prisons and for after-care services.· Promoting drug dependence treatment as an alternative to punishment.

Thank you

Documents

UNODC response to HIVAIDS Baltic Forum "Drug Control in the Baltic Region: New Challenges" 27-28 September 2005 Vilnius Zhannat Kosmukhamedova, HIV/AIDS