1. UNODC response to HIVAIDS Baltic Forum "Drug Control in the Baltic Region: New Challenges" 27-28 September 2005 Vilnius Zhannat Kosmukhamedova, HIV/AIDS Unit, UNODC

2. HIV/AIDS is more than a health issue. It is also a socio-economic issue, an issue of human rights and gender-based discrimination

3. In 2004, of the 39,4 million people living with HIV/AIDS, 17.6 million (48 per cent) were women and 2.2 million were children (< 15) ~13 million people with HIVAIDS are between 15-24 years old The HIVAIDS situation worldwide (estimated number of PLWHA) E-Europe & Central Asia 1.4 million E. Asia & Pacific 1.1 million South & S-E. Asia 7.1 million Australia & N. Zealand 35,000 Sub-Saharan Africa 25.4 million MENA 540,000 Western Europe 610,000 North America 1 million Caribbean 440,000 Latin America 1.7 million Worldwide, 5-10 per cent of all HIV infections are attributably to injecting drug use, mostly from the use of contaminated injection equipment by injecting drug users

4. Non-injecting drug use Unsafe sex between sex workers and clients Unsafe injecting drug use HIV-infected mother to child transmission Commercial sex work Unsafe sex with partners HIV transmission routes related to drug abuse

5. Epidemiology of HIVAIDS and injecting drug use 13.2 million people inject these drugs 10.3 million (78%) in developing countries Worldwide, more than 58 million people abuse opiates, cocaine and amphetamine-type stimulants

6. Estimated number of injecting drug users (IDUs) East. Europe & Central Asia 3.2m E. Asia & Pacific 2.3m Western Europe 1.2m North Africa & Middle East 400,000 Sub-Saharan Africa 900,000 Australia & New Zealand 200,000 Latin America 1m North America 1.5 m South & S.East Asia 3.3 m Caribbean 13,800 Up to 73.7 Up to 84.0 Up to 1.23 Up to 2.0 Up to 59.4 Up to 90.1 Up to 80.0 Up to 55.2 Up to 42.0 Up to 66.5 and HIV prevalence among IDUs (mid-point estimates)

7. EASTERN EUROPE & CENTRAL ASIA. IDU population & HIV prevalence among IDUs (1998/2004) IDU pop. over 100,000 people (mid point) Russian Federation: 2,500,000 Ukraine: 495,682 Kazakhstan: 250, 000 Romania: 101,000 IDU pop. 20,000 – 100,000 people (mid point) Moldova: 97,000 Uzbekistan: 109,431 Tajikistan: 53, 000 Belarus: 46,000 Poland: 96,514 Czech Rep: 26,164 Hungary: 25,007 Croatia and Kyrgyzstan: 21,146 Estonia: 22,500 IDU pop. under 20,000 people (mid point) Armenia, Azerbaijan, Bosnia & H., Bulgaria, Georgia, Latvia, Lithuania, Slovakia and Turkmenistan HIV prevalence among IDUs ArmeniaUp to19%LatviaUp to 19% AzerbaijanUp to 2.3%LithuaniaUp to 3% BelarusUp to 67%MoldovaUp to 4.9% EstoniaUp to 41%RussiaUp to 70% GeorgiaUp to 4.7%UkraineUp to 73.6%

8. HIV/AIDS IN PRISON SETTINGS: GLOBAL EFFECT there are annually about 30 million prisoners going through the prison system worldwide At any given time there are approximately 10 million people imprisoned worldwide New prisoners Released prisoners Epidemiological data in prisons on HIV/AIDS, tuberculosis, hepatitis and sexually transmitted infections need to be interpreted against a background of high turnover among the persons incarcerated infected outside prison system infected while incarcerated

9. Estimated number of IDUs in prisons and HIV/AIDS prevalence among prison inmates in selected countries Number of IDUs in prisons (%): European Union countries – 15-55 Estonia – 25 Latvia – 27 Kazakhstan – 70 Ukraine – 30 Russian Federation – 50 Bangkok – 30 Vietnam – 61 Brazil – 30 Mexico – 37 South Africa – 41 HIV among prison populations (%) Estonia – 17 Latvia – 6.2 Lithuania – 15 Romania – 13 Russian Federation – 5 Ukraine – 6 Belarus – 2.2 Portuguese – 20 Spain – 16.6 Switzerland – 12 Italy – 7 Vietnam – 28.4 Iran – 36.5 India – 14 (women), 7(men) Prevalence of Hepatitis C among injecting drug using inmates is 50-90% ; globally, rates of HIV-infection among prison population are generally much higher than in the general population.

10. Comprehensiveness and up to scale Prevention and care interventions need to be comprehensive and multi-sectoral to address the needs of often very diverse vulnerable populations. Prevention and care have to go hand-in-hand: Large-scale treatment initiatives, such as the “Three by Five” initiative, provide excellent opportunities for prevention, as do prevention initiatives for treatment. To reverse the trends of existing HIV/AIDS epidemics and to prevent a new wave of epidemics, it is essential that interventions go to scale immediately. There is no time and no need for pilot projects. Only if the majority of vulnerable people are reached with services, an epidemic can be prevented, halted and reversed. UNODC advocates, therefore, that comprehensive and large- scale interventions be integral part of the national HIV/AIDS framework.

11. HIV/AIDS: Three Key areas of interventions Injecting Drug Use Prison Settings Trafficking in persons

12. HIV/AIDS: Three Key areas of interventions Injecting Drug Use Research indicates that an HIV/AIDS epidemic among injecting drug users can be prevented, halted and even reversed, if responses are based on a sound assessment of the specific drug use situation and the socio-cultural and political context.

13. UNODC footnote in IDU key result HIV/AIDS prevention and care programmes for injecting drug users typically include a wide variety of measures (the “package” approach), ranging from drug dependence treatment, including drug substitution treatment, outreach providing injecting drug users with information on risk reduction and referral to services, prevention commodities, voluntary counselling and testing, treatment of sexually transmitted infections, antiretroviral therapy, and interventions for especially at-risk populations such as prisoners and sex workers who inject drugs. Such a comprehensive package of measures also usually includes treatment instead of punishment for persons convicted of minor offences, since drug treatment not only constitutes a humane, cost- effective alternative, but also incarceration usually increases the risk of HIV transmission.

14. UNODC footnote in IDU key result HIV/AIDS prevention and care programmes for injecting drug users typically include a wide variety of measures (the “package” approach), ranging from drug dependence treatment, including drug substitution treatment, outreach providing injecting drug users with information on risk reduction and referral to services, prevention commodities, voluntary counselling and testing, treatment of sexually transmitted infections, antiretroviral therapy, and interventions for especially at-risk populations such as prisoners and sex workers who inject drugs. Such a comprehensive package of measures also usually includes treatment instead of punishment for persons convicted of minor offences, since drug treatment not only constitutes a humane, cost-effective alternative, but also incarceration usually increases the risk of HIV transmission.

15. UNODC footnote in IDU key result HIV/AIDS prevention and care programmes for injecting drug users typically include a wide variety of measures (the “package” approach), ranging from drug dependence treatment, including drug substitution treatment, outreach providing injecting drug users with information on risk reduction and referral to services, prevention commodities, voluntary counselling and testing, treatment of sexually transmitted infections, antiretroviral therapy, and interventions for especially at-risk populations such as prisoners and sex workers who inject drugs. Such a comprehensive package of measures also usually includes treatment instead of punishment for persons convicted of minor offences, since drug treatment not only constitutes a humane, cost-effective alternative, but also incarceration usually increases the risk of HIV transmission.

16. UNODC footnote in IDU key result HIV/AIDS prevention and care programmes for injecting drug users typically include a wide variety of measures (the “package” approach), ranging from drug dependence treatment, including drug substitution treatment, outreach providing injecting drug users with information on risk reduction and referral to services, prevention commodities, voluntary counselling and testing, treatment of sexually transmitted infections, antiretroviral therapy, and interventions for especially at-risk populations such as prisoners and sex workers who inject drugs. Such a comprehensive package of measures also usually includes treatment instead of punishment for persons convicted of minor offences, since drug treatment not only constitutes a humane, cost- effective alternative, but also incarceration usually increases the risk of HIV transmission.

17. UNODC footnote in IDU key result HIV/AIDS prevention and care programmes for injecting drug users typically include a wide variety of measures (the “package” approach), ranging from drug dependence treatment, including drug substitution treatment, outreach providing injecting drug users with information on risk reduction and referral to services, prevention commodities, voluntary counselling and testing, treatment of sexually transmitted infections, antiretroviral therapy, and interventions for especially at-risk populations such as prisoners and sex workers who inject drugs. Such a comprehensive package of measures also usually includes treatment instead of punishment for persons convicted of minor offences, since drug treatment not only constitutes a humane, cost- effective alternative, but also incarceration usually increases the risk of HIV transmission.

18. UNODC footnote in IDU key result HIV/AIDS prevention and care programmes for injecting drug users typically include a wide variety of measures (the “package” approach), ranging from drug dependence treatment, including drug substitution treatment, outreach providing injecting drug users with information on risk reduction and referral to services, prevention commodities, voluntary counselling and testing, treatment of sexually transmitted infections, antiretroviral therapy, and interventions for especially at-risk populations such as prisoners and sex workers who inject drugs. Such a comprehensive package of measures also usually includes treatment instead of punishment for persons convicted of minor offences, since drug treatment not only constitutes a humane, cost-effective alternative, but also incarceration usually increases the risk of HIV transmission.

19. HIV/AIDS: Three Key areas of interventions Prison Settings Effective policies to prevent HIV/AIDS inside prison and other correctional settings is often hampered by the denial of the existence of the factors that contribute to the spread of HIV (e.g., unsafe sex and drug use, gangs, violence) inside these institutions. In order to address the overall situation, a comprehensive strategy must focus at three broad levels:

20. HIV/AIDS: Three Key areas of interventions Prison Settings - Policy and environmental level - Health care services level - Individual level

21. HIV/AIDS: Three Key areas of interventions Prison Settings Special attention needs to be given to the needs of especially at-risk inmates including juveniles, females, foreigners and inmates belonging to ethnic and other minorities.

22. HIV/AIDS: Three Key areas of interventions Trafficking in persons There are worldwide practically no initiatives focusing on HIV/AIDS prevention and care as it relates to the trafficking in persons. As a rule, governments are not aware of either the extent of human trafficking in their countries or of the connection between human trafficking and HIV/AIDS. General responses addressing HIV/AIDS have little impact on trafficked persons due to the clandestine nature of human trafficking and because they are not reached with services. More focused action specifically addressing potential or actual victims of human trafficking need to be urgently developed and implemented.

23. Plans for 2006-2007 HIV/AIDS: Principal result Countries able to establish, implement & scale-up HIV/AIDS prevention responses Injecting Drug Use Prison Settings Trafficking in persons HIV/AIDS: Key results

24. Plans for 2006-2007 Key result description: Increase and improve service coverage of HIV/AIDS prevention and care for injecting drug users in countries where the use of contaminated injection equipment among them is a major or potentially a major route of transmission. HIV/AIDS: Principal result Countries able to establish, implement & scale-up HIV/AIDS prevention responses Injecting Drug Use HIV/AIDS: Key results

25. Plans for 2006-2007 Key result description: Develop a globally agreed strategy on HIV/AIDS prevention, care and support in prison settings, and establish national HIV/AIDS prevention and care programmes in prison settings, of selected countries. HIV/AIDS: Principal result Countries able to establish, implement & scale-up HIV/AIDS prevention responses Injecting Drug Use HIV/AIDS: Key results Prison Settings

26. Plans for 2006-2007 Key result description: Provide actual and potential trafficking victims, particularly women and girls, with comprehensive, gender-sensitive, HIV/AIDS prevention and care in selected countries of origin and destination. HIV/AIDS: Principal result Countries able to establish, implement & scale-up HIV/AIDS prevention responses Injecting Drug Use HIV/AIDS: Key results Prison Settings Trafficking in persons

27. Plans for 2006-2007 Injecting Drug Use Type of initiatives  Support to countries (legislation, policies and standards);  Encourage the proactive involvement of law enforcement agencies in HIV prevention and care (more cooperation/collaboration between health, criminal justice sectors and community based and civil society organizations).  Establishment of outreach interventions, covering at least 35 per cent of all IDUs, to provide them with HIV/AIDS information, education and the means of reducing their HIV infection risk;  Diversification and expansion of drug dependence treatment services, including special treatment programmes for young injectors and for women, and, if appropriate, establishment of large-scale drug substitution maintenance treatment;  Awareness raising among drug dependence treatment services with respect to the need to address HIV/AIDS prevention and care issues;  Interventions to prevent the transition from non-injecting drug use to injecting drug use, particularly for young people

28. Plans for 2006-2007 Prison Settings Type of initiatives  Promoting the right to health care and HIV/AIDS prevention, care and treatment for inmates, equivalent to that available in the general community; · Providing HIV/AIDS information and education to inmates, wardens and other staff in prison settings; · Confidential and voluntary counselling, testing and psycho-social support, HIV/AIDS education and provision of the means of HIV prevention; · Monitoring internally and externally general prison conditions and operating secure, safe and orderly prisons in order to reduce violence and the spread of HIV; · Minimizing overcrowding; · Classification and separation of juveniles from adult prisoners, and use of maternity wards; · Organization of meaningful rehabilitation activities in prisons, including pre-release reintegration programmes; · Training of prison staff on prison management and on the needs of HIV- infected inmates; · Provision of antiretroviral therapy and improved hygiene, sanitation and diets for HIV-infected prisoners; · Promoting the active involvement of civil society organizations in prisons and for after-care services. · Promoting drug dependence treatment as an alternative to punishment.

29. Thank you