A global perspective on scaling up harm reduction

2nd National Harm Reduction Conference, Ukraine, 21-23 March 2007Dr Jos Perriens, Director PreventionDepartment of HIV/AIDS, WHO Headquarters, Geneva

1998-2004. 91% of the world adult population (4 billion) covered by the data.UN Reference Group on HIV/AIDS prevention and care among IDUs in developing and transitional countries www.idurefgroup.org.

S. & S-E Asia: 3.33m

S. & S-E Asia: 3.33m

E. Europe & C. Asia: 3.2mE. Europe &

C. Asia: 3.2m

E. Asia & Pacific 2.35m

E. Asia & Pacific 2.35mMENA:0.44mMENA:0.44m

S. Saharan-Africa

0.009m

S. Saharan-Africa

0.009mL. America:

0.97mL. America:

0.97m

Caribbean: 0.028m

Caribbean: 0.028m

N. America 1.43m

N. America 1.43m

W. Europe: 1.24m

W. Europe: 1.24m

Australia & N. Zealand:

0.19m

Australia & N. Zealand:

0.19m

13,200,000 IDUs worldwide – 4 million of them living with HIV

60%

71.1%

15%

4%

11%

5%

90%

68%

1%

84%

80%

81.2%

82.9%

73.6%

82%

0.12%

87%

1.3%

7.4% 86%

71%

81.6%

51%

<20%

20-40%

40-60%

60-80%

64%

50% 29.2%

6.03%

12.9%

33.7%10%

14.5%

17% 19.3%

11%

3.8%

16%

32%

16%

16%

>80%

23.5%

60%

25%

56.5%14%3%

10%

1,8%

5.9%

IDU as % of all HIV/AIDSreported cases (end 2003)NOTE: % of AIDS cases in countries not reporting HIVSources: EuroHIV; national reports;

6%

0%

N/A

25%

Comprehensive harm reduction programmes Needle and syringe programmes (NSP)

Outreach programmes

HIV testing and counselling

Prevention and treatment of STI, access to condoms

_______________________________

Opioid Substitution Therapy (OST) other drug dependence treatment

_______________________________

HIV treatment and care, including ART

Hepatitis B vaccination and treatment of viral hepatitis

_______________________________

in the community and in prison settings

Needles Syringe Programming (NSP)

Annual Change in HIV prevalence among IDU at city level

5,9 % annual increasein 52 cities without NSP

5,8 % annual decrease in 29 cities with NSP

Hurley SF, Jolley DJ, Kaldor JM. Effectiveness of needle-exchange programme for prevention of HIV infection. Lancet 1997, 359 (9068): 1797-800

0

10

20

30

40

50

60

70

80

90

100

Belar

us

Croat

ia

Czech

Rep

Eston

ia

Russi

a

Ukrai

ne

Needle & syringe exchange coverage (% IDUs reached)

IDU as % of all reported HIV cases

Opioid Substitution Therapy (OST)

Demonstrated effectiveness:

Reduced illicit drug use and associated HIV riskImproved healthImproved social functioningReduced criminal activity

Current provision of Opioid Substitution Therapy:Methadone and/or Buprenorphine in 59 Countries

Methadone 49 countriesBuprenorphine 33 countries

0

10

20

30

40

50

60

70

80

90

100

Belar

us

Russia

Estonia

Latvi

a

Ukrai

ne

Lithuan

ia

Poland

Finla

nd

Swed

en

Norway

United

Kingdom

Ger

man

y

Irela

nd

Substitution treatment coverage (% IDUs treated)

IDU as % of HIV cases

Misconceptions about OST

Does not breach UN conventions Is supported by the UN System (including WHO,

UNODC and UNAIDS) Does not “trap” people into dependency Does not reduce demand for drug-free treatment Does not lead to an increase in drug use in the

community

HIV/AIDS Treatment for IDU

Injecting Drug Users are

Often excluded from HIV/AIDS treatment

Least likely to receive ART

Initiate ART later

Clinicians reluctant to prescribe ART

Concerns regarding low adherence leading to resistance

HIV treatment access among IDU in Eastern Europe

Serbia and

Montenegro Czech

Republic Moldova Estonia Ukraine

100

90

80

70

60

50

40

30

20

10

Lithuania Croatia

RussianFederation

IDU as % of people living with HIV

IDU as % of people on ART

HIV Treatment and Care for IDUs

HIV care for IDUs often successful

ART resistance levels similar in IDUs and non IDUs

IDUs can adhere to ART as well as non IDUs

OST improves retention and adherence to ART

Harm Reduction in Prisons

Prisoners and detainees have a rights to the protection of their physical and mental health of the same quality and standard as is afforded to those who are not imprisoned or detained.

Adopted by United Nations General Assembly resolution 37/194 of 18 (December 1982).

QualityHow well are we providing our services?

CoverageHow much services do we need to provide?