Olga Varetska International HIV/AIDS Alliance in Ukraine How do PWID prevention activities impact the HIV epidemic? Case of Ukraine. Olga Varetska International HIV/AIDS Alliance in Ukraine

Background

HIV epidemic among PWID in Ukraine PLH: 238,000 or 0.9% of estimated adult prevalence (2013) Estimated # of PWID in Ukraine is 310,000 Main injectable drug of abuse – home-made acetylated poppy straw extract (opioid) Home-made methamphetamine-type drugs are also prevalent HIV epidemic started in 1995 among PWID in southern and eastern regions Mean HIV prevalence among PWID is 18% (up to 40% in some regions) Kyiv Dnipropetrovsk Donetsk The main message – the HIV epidemic in Ukraine was fuelled by PWID since the beginning. Now there is a decline in PWID. Lviv Odesa Mykolaiv AR Crimea

Program coverage

SAMPLE SLIDE 2 Speaking at AIDS 2014 What to think about? Keep it simple Larger text is easier to read Single words rather than sentences Bullet points are there to remind you, not to tell the whole story

Program coverage Minimal package for PWID includes clean syringe, condom, information material, consultation, access to HIV testing

27% of clients screened for TB 42.2% of clients tested for HIV in community settings 25.9% of clients tested for Syphilis, and up to 7% for other STIs 13.8% tested for Hep C and 16.3% for Hep B 4.1% of clients on OST

Distribution of syringes by type of venue

Results: HIV among PWID is decreasing

Risky behavior patterns related to drug use

HIV incidence proxy: case registration Young IDUs in 2013?

HIV incidence proxy: HIV prevalence among young and recent PWID Source: IBBS study reports 2007-2013

Growing role of heterosexual transmission

Modes of HIV-transmission: heterosexual share is increasing Slide on share of transmission and on growth of new cases. Something from triangulation on associations? Condom use during last intercourse/ Source: L.V. Gromashevsky Institute for Epidemiology and Infectious Diseases of the National Academy of Medical Sciences of Ukraine, HIV infection in Ukraine, Newsletter No. 41, Ukrainian Centre for AIDS Prevention and Control, Ministry of Health, Kiev, 2014, p17.

Newly registered HIV cases in Ukraine

Changes in modes of transmission – Spectrum model results Spectrum model confirms increasing role of heterosexual transmission Who is the “remaining population”?

Reported HIV cases in PWID and young women infected heterosexually by HIV incidence tercile among PWID Reported HIV cases in PWID by PWID incidence tercile Reported HIV cases in young women by PWID incidence tercile Similar trends are evident among young women infected heterosexually as among PWID in the regions most affected by PWID epidemic This suggests that heterosexual transmission is linked to existing HIV cases among PWID, i.e. is happening among sexual partners of PWID

Behavioral data: condom use during last sexual intercourse among PWID In 50% of cases PWID do not use condoms Behavioral data confirms risky sexual practices among PWID

Conclusions: prevention proves effective, but more focus on sexual mode of transmission among PWID needed inverse correlation between coverage of prevention programs and number of HIV cases decreasing coverage or limited service package for PWID (inevitable in case of anticipated decline in funding of services for PWID in Ukraine)would undermine the success need to focus on sexual mode of HIV transmission among PWID and partners to achieve significant results in suppressing HIV rates among general population

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