2. HIV/AIDS in the Northern Dimension Area. Challenges and prospects Pauli Leinikki and Outi Karvonen PAC side event Oslo 24.11 2009 16/10/09 1

3. HIV/AIDS Expert Group of NDPHS2 Features: 1. Very high prevalence in some areas and populations – potentially significant impact on health policy! (Data from T. Smolskaya 2009)

4. 16/10/09 HIV/AIDS Expert Group of NDPHS3 Features: 2. The epidemic is closely linked with socially and politically problematic subpopulations such as IDU:s, prisoners, MSM, CSW making proper prevention interventions and development of care less attractive.

5. IDUs are vulnerable to harm in many ways Multiple problems Medical Societal Indirect … HIV/AIDS, Hepatitis

6. 16/10/09 HIV/AIDS Expert Group of NDPHS5 Features: 3. Interventions that have been proven to be effective are sometimes regarded as controversial (i.e. harm reduction policies among IDU:s, or, properly implemented ARV) Harm reduction measures among drug users in the Nordic countries (Hans Blystad 2008)

7. Legacy for LTCS Properly implemented non- discriminating LTCS is challenging but could demonstrate the heritage of promoting social well-being and solidarity in the society

8. 16/10/09 HIV/AIDS Expert Group of NDPHS7 Features: 4. The epidemic is linked with undue fear and discrimination which worsens the social survival of those infected Fear and discrimination fuels the spread of the infection

9. 16/10/09 HIV/AIDS Expert Group of NDPHS8 Measures: 1. Adopt and implement interventions that have been proven to be effective 2.Pay special attention to coverage and follow-up 3.Link with academic research to attract intellectual resources and to improve quality of surveillance 4.Link with NGO:s to attract intellectual resources and to improve quality of surveillance

11. 16/10/09 HIV/AIDS Expert Group of NDPHS10 Specific issues: 1.Co-infection with TB, spread of MDR TB and XDR TB 2.Long-term infection and infectivity: ever increasing prevalence and ever increasing burden to the society HIV-TB coinfections in St. Petersburg (Panteleeva):

12. Mortality of coinfected patients, who have died of tuberculosis, in the structure of the mortality of HIV-infected in St. Petersburg (Panteleeva 2008)

13. Challenges for the penitentiary system: 1.Heavy burden due to the high proportion of HIV/IDU-inmates 2.High prevalence of risky behaviour inside the system 3.Secondary prevention inside prisons difficult to organise 4.Tertiary prevention (risk of spread to the civil society). Whose responsibility? 5.Need for independent and confidential health care system 16/10/09

14. Priorities set by the HIV Expert Group Regional collaboration, (learning from each other) Prevention of HIV among drug users Prevention of HIV/TB dual infections Enhancing cross- border activities Prevention of HIV among men who have sex with men Close collaboration with social welfare Promoting harm reduction among IDU:s Prevention of mother-to-child transmissions 16/10/09 13

15. We all agree that our collaboration should soar – but who says to which direction?