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HIV Prevention, treatment and care among HIV Prevention, treatment and care among

HIV Prevention, treatment and care among - PowerPoint Presentation

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HIV Prevention, treatment and care among - PPT Presentation

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

drug hiv treatment people hiv drug people treatment inject drugs programmes health injection prison pwid hepatitis hcv ost prisons

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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