people who inject drugs Fabienne Hariga MD MPH Senior HIV Adviser UNODC Vienna Cosponsor HIV among People who Use Drugs HIV in Prison Settings CONVENING AGENCY Prevalence of HIV among people ID: 318321
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Slide1
HIV Prevention, treatment and care amongpeople who inject drugs
Fabienne Hariga, MD, MPH
Senior HIV Adviser, UNODC ViennaSlide2
Co-sponsor
HIV among People who Use Drugs
HIV in
Prison Settings
CONVENING AGENCYSlide3
Prevalence of HIV among people who
inject
drugs
12.7 million PWID (0.27 % )
1.7 million PWID living with HIV (13.1% of PWID)52% with hepatitis C
Source: World Drug report 2014Slide4
HIV AND PEOPLE WHO INJECT DRUGS IN PRISONSSlide5
JOINT UN RECOMMENDED INTERVENTIONSComprehensive Package
of interventions for HIV prevention, treatment and care among people who inject drugs
Needle and syringe programmes
(NSPs)
Opioid substitution therapy (OST) and other evidence-based drug dependence treatmentHIV testing and counselling (HTC)
Antiretroviral therapy (ART)Prevention and treatment of sexually transmitted infections (STIs)Condom programmes for people who inject drugs and their sexual partnersTargeted information, education and communication (IEC) for people who inject drugs and their sexual partnersPrevention, vaccination, diagnosis and treatment for viral hepatitisPrevention, diagnosis and treatment of tuberculosis (TB).Slide6
Effectiveness of NSP
Reduction in the rate of HIV transmission (and HCV)
Frequency of
unsafe injection (risk HIV and HCV
)No initiation of injecting among people who have not injected previouslyNo increase in the duration or frequency of illicit drug use or drug injectionAllow for IECAllow for referral to OST, HTC or ARV and TB
Reduce number of used syringes discarded in public areasBleach is not an effective alternative especially for Hepatitis CHIV (and hepatitis C or B) is transmitted among people who inject drugs through sharing injection equipmentSlide7
O
pioid use
Frequency of injection & unsafe injection (risk HIV and HCV)
Risk of overdoses
Risk of abortion/miscarriage of pregnant opiate dependent women
Increase retention in drug dependence treatmentAdherence to treatment (ARV , TB, Hepatitis C) Improve health status and wellbeingSocial functioningWork and productivity and economic statusCriminal behaviourRecidivismViolence, drug seeking in prisonReduction in the rate of HIV transmission (and HCV)
Effectiveness of OSTSlide8
Why a comprehensive approach?
Source: Sarkar et al, 2008Slide9
Universal Access
Physically accessible
geographically
distributed Hard to reach locationAffordable patients should not have to pay for their treatment
Equitable and non-discriminatory no exclusion criteria except medical ones, e.g. OST should not be limited to only those IDUs who are HIV infected or who have failed on other drug dependence treatmentNo compulsory treatmentNon-rationed supply should be determined by need: e.g. needle and syringe programmes with strict limits on the number of syringes provided to each client are less successful than those that do not impose such restrictionsSlide10
HIV incidence
I
ncidence
du VIH à Maurice (2000-oct 2013
)
NSPSlide11
PRINCIPLES
Prison health is public health
Linkages with public health and community
programmes
Human rights based and gender sensitive
Principle of equivalence
Medical ethicsNo segregation of PLWH;
Criminal justice reforms to reduce the prison population
Alternatives to imprisonmentReduce pre-trial incarceration End compulsory detention of drug users and sex workers for “rehabilitation”Prison reforms
Ensure safe prison conditionsPrevent violence Proper classification Conjugal visiting roomsSlide12
12
Harm reduction in prisonsSlide13
Stigma
BottlenecksSlide14
Critical enablers
Supportive legal and policy framework
Supportive law enforcement practices
Empowerment of people who use drugs
Alternatives to imprisonment including decriminalisation of drug use
Appropriate fundingSlide15
New publications:
Police, HIV and PWID: a
training manual
Policy
brief on HIV and women who inject drugs
Handbook on needle and syringe programmes in prisonsSlide16
…Unfortunately, many national drug control systems rely on sanctions and imprisonment, rather than evidence-based health care in full compliance with human rights
standards
…
… These are major barriers to HIV and to harm reduction services, including in prisons and other closed settings
…UNAIDS Programme Coordinating Board,1 July 2014Slide17
Thank you!
Fabienne.Hariga@unodc.org
www.unodc.org