Injecting Drug Users, HIVAIDS Treatment and Primary Care in CEEFSU Results of a Regionwide Survey

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Injecting Drug Users, HIV/AIDS Treatment and
Primary Care in CEE/FSU Results of a Region-wide
Survey

• Emilis Subata, MD
• CEEHRN
• Health Security in Central Asia
• Drug Use, HIV and AIDS,
• October 14-16, Dushanbe, Tajikistan

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Survey respondents

• 132 programs in CEE/FSU (April-May 2002)
• Harm reduction programs primarily low-threshold
  programs for IDUs (65)
• Government HIV/AIDS programs national AIDS
  commissions and centers, regional AIDS centers,
  etc. (34)

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Respondents by sub-region
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Three areas surveyed

• HIV/AIDS treatment ARV, PCP prophylaxis, immune
  system monitoring (e.g., CD4 counts)
• Basic (primary) health care, such as treatment of
  bacterial infections or STIs
• Substitution treatment (gt 3 months of methadone,
  buprenorphine)

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Access to Antiretroviral therapy (ARV)

• Access to ARV, particularly triple combination
  therapy, highly limited
• 9 999 in region receive some form of ARV,
  including monotherapy
• 6 892 people2 of registered HIV/AIDS
  casesreceive triple, with more than 75 in
  Romania and Poland
• In the European NIS only 733 people0.3 of
  HIV/AIDS cases registeredreceive triple
  combination therapy
• No ARV of any kind is available in Albania,
  Armenia, Azerbaijan, Kyrgyzstan, Macedonia,
  Tajikistan, or Turkmenistan

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IDUs access to ARV

• Access to ARV greatest where percentage of IDUs
  is the smallest among registered HIV/AIDS cases
• Eight countries in central and southeastern
  Europe provide ARV to more than 20 of registered
  HIV/AIDS cases. In all but one, Yugoslavia, IDUs
  are less than 15 of cases
• Countries where IDUs are two-thirds or more of
  total HIV/AIDS cases provide almost no ARV of any
  kind, or exclude IDUs from the little treatment
  available
• From the eleven countries where two-thirds or
  more of HIV cases are among IDUs, none provides
  ARV of any kind to more than 5 of those infected

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Disparities in access to triple therapy for IDUs

• IDUs do not respect life and so do not deserve
  treatment
• In Estonia and Lithuania, where IDUs are 85 and
  72 of total HIV cases respectively, no IDUs
  receive ARV of any kind
• IDUs are 93 of HIV/AIDS cases in Russia, but
  only 13 of those who receive triple combination
  therapy
• In Moscow, respondents report IDUs restricted
  from triple therapy
• In St. Petersburg, none of 100 on triple therapy
  are IDUs

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IDUs as percent of registered HIV/AIDS cases in
CEE/FSU IDUs as recipients of any form ARV in
CEE/FSU
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Primary health care and IDUs

• Half of programs cannot say how many IDUs have
  access to care
• HR programs report 73 of IDUS on average have no
  access to primary care from any source

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Sources of discrimination
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Substitution treatment

• 6 565 receiving substitution treatment in CEE/FSU
  (97 methadone and 3 buprenorphine)
• Substitution treatment least available where IDUs
  largest share of HIV/AIDS cases (Slovenia and
  Croatia alone account of 52 - 3400)

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Substitution treatment

• Nine countriesAlbania, Armenia, Azerbaijan,
  Belarus, Kazakhstan, Russia, Tajikistan,
  Turkmenistan, and Uzbekistanoffer neither
  Buprenorphine or Methadone
• More than 80 of all HIV IDUs in CEE/FSU live in
  these nine countries

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Conclusions

• Sharp differences in care (ARV, substitution)
  between CEE and FSU resulting from proportion of
  IDUs among HIV/AIDS cases
• IDU exclusion true in varied economic
  circumstances
• Neither Estonia (per capita GDP 6 670 USD) nor
  Moldova (2 100 USD) offer ARV to any IDUs

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Conclusions - 2

• Need further studies of models where IDUs receive
  triple therapy (e.g., Poland)
• Need for further research on the ways about how
  to improve adherence to treatment and increase
  support for drug users

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• For copies of the report in Russian
  www.ceehrn.org

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Special Thanks to

• International Harm Reduction Development Program
  (IHRD)
• UNDCP
• WHO Regional Office for Europe