1. “Humanitarian Action” The Saint-Petersburg Charitable Foundation for Medical and Social Programs HAF

2. June 2001 – date of official registration of the Foundation June 2001 – date of official registration of the Foundation HAF was created on the basis of projects of “Medecins du Monde – France” in Saint Petersburg

3. All HAF programs include activities related to HIV WHY?

4. Epidemic situation in Russia in 2004 305 242 registered HIV cases since starting the epidemic process 305 242 registered HIV cases since starting the epidemic process Number of deaths caused by AIDS 6 350, including 302 children Number of deaths caused by AIDS 6 350, including 302 children 11 530 children born from HIV+ mothers 11 530 children born from HIV+ mothers

5. HIV in Russia Negative tendencies during 2 last years Increasing on 87% of mortality among HIV+ people Increasing on 87% of mortality among HIV+ people 2,7 times increasing of number of children born from HIV+ mothers 2,7 times increasing of number of children born from HIV+ mothers Increasing on 189% of HIV infected children and adolescents Increasing on 189% of HIV infected children and adolescents

6. HIV in St Petersburg in 2004 Numbers of cases

7. HIV Epidemics in St Petersburg in 2004 During 2004 the number of new cases was 4 576 During 2004 the number of new cases was 4 576 165 new cases among young people aged 15 -18 years 165 new cases among young people aged 15 -18 years Since 1987 to 2004 number of deaths due to HIV was of 1004, including 122 people in the stage of AIDS Since 1987 to 2004 number of deaths due to HIV was of 1004, including 122 people in the stage of AIDS

8. HIV in St Petersburg in 2004 A decrease of 10% of new HIV cases is observed among all groups of population. Young people 15 – 29 years old are 74,9% of all number of HIV +

9. HIV in St Petersburg in 2004 Ways of transmission

10. HIV in St Petersburg in 2004 The parenteral way is still very important (65,1%) But less important than 1n 2003 (87%)

11. HIV in St Petersburg in 2004 Sex ratio

12. HIV in St Petersburg in 2004 Dinamics of sexual and parenteral ways of transmission

13. HIV in St Petersburg in 2004 Age groups

14. HIV in St Petersburg in 2004 Number of HIV+ pregnant women

15. HAF programs in Saint Petersbourg Program of medical, social, psychological help to street children – since 1995 Program of medical, social, psychological help to street children – since 1995 Harm reduction program for drug users – since 1997 Harm reduction program for drug users – since 1997 HIV prevention program among street commercial female sex workers – since 2000 HIV prevention program among street commercial female sex workers – since 2000 Out-patient center run in partnership with the Botkin hospital Out-patient center run in partnership with the Botkin hospital TB prevention among HIV+ people TB prevention among HIV+ people Working out adherance in treatment among IDU (case management) Working out adherance in treatment among IDU (case management) Lobbying of HR and of access to treatment for IDU Lobbying of HR and of access to treatment for IDU

16. Medical, social and psychological help to street kids Main services: - Outreach work - Day drop-in centre for consultations - Short term night centre - VСT (HIV, hepatitis, syphilis) Prevention information provided in all moduls.

17. A constant contact with the street is provided by the intensified street and outreach work

18. Medical consultations

19. Since 7 years more than 4000 children were provided with help within the framework of the program activities

20. Risks related to the street life Engaging in criminal structures or activities Engaging in criminal structures or activities Absence of social protection Absence of social protection Sanitary risks Sanitary risks

21. Sanitary risks Promiscuity Promiscuity Drug use Drug use Absence of information Absence of information

23. Street children and drugs 1998 2004 Tobacco 329 (55,6%) 726 (74,5%) Heavy drugs 50 (8,5%) 324 (33,3%) Sniffing 88 (14,9%) 223 (22,9%) Alcohol 169 (28,6%) 597 (61,3%)

24. Comparative evaluation of the HIV-rate (for 1000 population, 2002)

25. Testing results

26. Average age of HIV-positive street children 15,9 years old

27. What next?

28. Harm Reduction program Bus – an outreach unit Provided services: - Needle exchange - Distribution of condoms - Information - Medical and psychological consultations - VCT (HIV, hepatitis B and C, syphilis)

32. Harm reduction bus activities in 2004 Number of clients - 1906 Number of visits - 8 200 Number of exchanged syringes - 232 000 Number of tested people - 563 20.7% - positive results Average age of clients: - women -23,3 - men 25,5 Main drug – heroine (85%)

33. HIV prevention program for street commercial sex workers Van – an outreach unit Provided services: - Condoms’ distribution - Needle exchange - Information - Medical and psychological consultations - VCT (HIV, hepatitis B and C, syphilis)

37. Data for 2004 Number of street female commercial sex- workers (CSW) - 8000–10000 95% of them are intravenous drug users (UDVI) Number of contacts - 8764 Number of contacts - 8764 Number of women contacted - 2169 Number of women contacted - 2169 Number of condoms distributed - 56621 Number of condoms distributed - 56621 Number of syringes distributed – 63000 Number of syringes distributed – 63000 Average age – 23,9 Average age – 23,9

38. Infections among female CSW Study of the end of 2003 HIV – 48% HIV – 48% Syphilis – 44% Syphilis – 44%

39. Lobbying of HR and access to treatment. Why? - HR is still rather tolerated but not really accepted by the authorities - Drug use is criminalized - Access to health structures is very difficult - No political will of government to change situation

40. Photo: Hans Jürgen Burkard

41. Access to treatment About 150 people receive ARV in St Petersburg About 150 people receive ARV in St Petersburg About 300 need ARV and are on the waiting list, but real need unknown About 300 need ARV and are on the waiting list, but real need unknown IDU are practically excluded of this number IDU are practically excluded of this number

42. What is being done by HAF? - Creation of a network of specialists of concerned medical structures and trainings for them - Trainings for police officers - Creation of an out-patient structure in the Botkin hospital for infectious diseases - Institutional development of the community of PLWHA

44. IDUs as percent of registered HIV/AIDS cases; IDUs as recipients of any form ARV Source: Central and Eastern European Harm Reduction Network, 2002

45. Causes of Discrimination against IDU’s in Health Care Settings

46. Three necessary components for an effective response to HIV in our region Scaled up prevention efforts for vulnerable populations – drug users, sex workers, street kids Scaled up prevention efforts for vulnerable populations – drug users, sex workers, street kids HIV care for everyone that needs it with special attention paid to marginalized groups HIV care for everyone that needs it with special attention paid to marginalized groups Reassessment of drug policies and bringing them in line with European discourse Reassessment of drug policies and bringing them in line with European discourse

47. Alexander Tsekhanovich Humanitarian Action Foundation 197 110, Russia, Saint-Petersburg Ofitsersky pereulok 6-2 +7 812 237 14 95 +7 812 237 18 21 www.humanitarianaction.org office@humanitarianaction.org