HIV/AIDS prevention and care among injecting

drug users and in prison settings in Estonia,

Latvia and Lithuania

Main achievements in 2007 – 2008

Signe ROTBERGA, UNODC, Baltic States

29 January 2009

Information about the project

• Duration: 2006 – 2010

• Government Focal Agencies: MOH, MOSA, MOJ

• Budget: 5 000 000 USD

• Overall goal: to halt and reverse the HIV/AIDS epidemics among IDUs and in prisons, and to avoid generalised epidemic

Project objectives:

• Build national and regional consensus on effective implementation strategies to address HIV/AIDS among IDUs and in prison settings

• Increase coverage of comprehensive HIV/AIDS prevention and care services

• Generate and share strategic information to respond appropriately to evolving HIV/AIDS epidemics

Obj.1: Build national and regional consensus on effective

implementation strategies to address HIV/AIDS among

IDUs and in prison settings

• New national HIV programmes for Latvia and Lithuania

• Evaluation of national response to HIV in Estonia (WHO/UNODC)

• Rapid assessment and response on drugs in prisons in Latvia and Lithuania

• Assessment of legal barriers for effective HIV prevention in prisons in Latvia and Lithuania

Obj.1: Build national and regional consensus on effective

implementation strategies to address HIV/AIDS among

IDUs and in prison settings

• Evaluation of pharmacotherapy in Latvia and Estonia

• Assessment of availability of syringes in Lithuania

• Estimation of IDU population size in Lithuania

Obj.1: Build national and regional consensus on effective

implementation strategies to address HIV/AIDS among

IDUs and in prison settings (cont.)

• Increased awareness on HIV among decision makers in MOJ and Prison Administration

• Policy dialogue promoted between MOJ and MOH

• Coordination and collaboration between national drugs and HIV programmes

• Involvement of civil society organizations

Objective 2: Increase coverage of comprehensive

HIV/AIDS prevention and care services among IDUs and in

prison settings

Outputs:

2.1. Improved institutional and professional capacity to addressHIV/AIDS among IDUs and in prisons

2.2. Increased access to HIV/AIDS prevention and care services for IDUs and in prison settings

Capacity building in 2007 - 2008

• 39 training seminars, 819 participants

• 8 study tours, 60 participants

• 19 conferences/meetings, 1188 participants

• Professional networking and training: participation in 18 international events, 103 persons

Capacity building

• Training needs assessment

• Training topics: pharmacotherapy, needle and syringe programmes, outreach, ASI, advocacy, monitoring and evaluation, estimating IDU prevalence

• Target groups: physicians, nurses, social workers, prison staff, policy makers, NGOs, police

• All training events evaluated, positive feedback received

Information and education materials

• Training module on pharmacotherapy developed and approved in Lithuania

• Handbook on reduction of health risks for drug users in prisons (in Latvian)

• Information materials in Lithuanian and Russian on HIV and TB, STI, hepatitis and drug overdose

• Directory on health and social services for drug users in Lithuania

Information and education materials

• Handbook on VCT in Lithuania

• Legal aspects on drug use in Latvia and Lithuania

• Information about harm reduction programmes

• NGO Convictus work in prisons

Output 2.2.: Increased access to HIV/AIDS prevention and care

services for IDUs and in prison settings

SERVICES SUPPORTED BY SMALL GRANTS PROGRAMME

• Needle and syringe programmes

• Methadone maintenance therapy

• Information and education in prisons

SMALL GRANTS PROGRAMME 2007 - 2008

Country Number of applications received

Number of projects supported

Total budget in US$

Estonia 4 2 48,000

Latvia 52 36 745,900

Lithuania 41 28 702,700

Scaling-up pharmacological treatment of opioid

dependence in Lithuania

Grants provided for harm reduction services - Latvia

Indicators to measure access to services

• Availability (Y/N? number of sites per 1000 IDUs )

• Coverage (% IDU using services)

• Quality (Adhering to WHO/UNODC guidelines)

Quality combined with scale-up will make a difference on the intervention’s impact on the epidemic.

Source: WHO/UNODC/UNAIDS TECHNICAL GUIDE for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users

Pharmaco-

therapy

(PT)

Estonia Latvia Lithuania WHO/UNODC

recommendation

2006 2008 2006 2008 2006 2008

Number

IDU in PT

Number of

IDU

% IDU in

PT

Number of

PT sites

555

13 800

4.0%

8

670*

13 800

4.8%

8

124

10 000

1.00%

4**

164

10 000

1.6%

8**

402

4 000

(8000)

10.00%

12

512

3 200

16.0%

17

moderate:

10-19%

good: 20-39%

Coverage of long-acting opioid maintenance treatment

* Does not include drop-outs, etc.

** Out of these only one site providing MMT

Needle syringe

programmes

NSP

Estonia Latvia LithuaniaWHO/UNODC

recommendation2006 2008 2006 2008 2006 2008

IDUs in contact

> once per

month in last

year

Number of IDU

% IDU

regularly

reached by

NSP

No. syringes

distributed

Number of IDU

No. of syringes

per IDU per

year

7169

13 800

52%

1 606 989

13 800

116

N/A

13 800

N/A

2 033 243

13 800

147

600-800

10 000

5-8%

117 237

12000

10

690

10 000

7%

182 019

10000

18.2

3400*

4000 (8000)

85%

258 650

4000 (8000)

64.6

3200

187 227

3200

58.5

moderate:

20-39%

good: 40-59%

moderate: 50-99

good: 100-199

NSP coverage indicators

* There is no shared definition on the indicator “regular client”

Objective 3: generate and share strategic

information, lessons learned

• Participation in expert meetings / conferences

– International harm reduction conference in Vilnius

• Project website created

• Mid–term evaluation

UNODC Project Office for the Baltic States website

http://www.unodc.org/unodc/en/baltics/index.html