A global perspective on scaling up harm reduction 2 nd National Harm Reduction Conference, Ukraine, March 2007 Dr Jos Perriens, Director Prevention Department of HIV/AIDS, WHO Headquarters, Geneva

% 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 S. & S-E Asia: 3.33m E. Europe & C. Asia: 3.2m E. Asia & Pacific 2.35m MENA:0.44m S. Saharan- Africa 0.009m L. America: 0.97m Caribbean: 0.028m N. America 1.43m W. Europe: 1.24m Australia & N. Zealand: 0.19m 13,200,000 IDUs worldwide – 4 million of them living with HIV

1,8% 5.9% IDU as % of all HIV/AIDS reported cases (end 2003) NOTE: % of AIDS cases in countries not reporting HIV Sources: 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 increase in 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):

Opioid Substitution Therapy (OST) Demonstrated effectiveness: Reduced illicit drug use and associated HIV risk Improved health Improved social functioning Reduced criminal activity

Current provision of Opioid Substitution Therapy: Methadone and/or Buprenorphine in 59 Countries Methadone 49 countries Buprenorphine 33 countries

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 Lithuania Croatia Russian Federation 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).

Quality How well are we providing our services? Coverage How much services do we need to provide?