1. 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

2. Background

3. 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

4. Program coverage

5. 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

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

7. 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

8. Distribution of syringes by type of venue

9. Results: HIV among PWID is decreasing

10. Risky behavior patterns related to drug use

11. HIV incidence proxy: case registration
Young IDUs in 2013?

12. HIV incidence proxy: HIV prevalence among young and recent PWID
Source: IBBS study reports

13. Growing role of heterosexual transmission

14. 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.

15. Newly registered HIV cases in Ukraine

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

17. 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

18. 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

19. 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

20. Thank you for your attention!