1. HIV/AIDS prevention and care among injecting drug users and in prison settings in Estonia, Latvia and Lithuania Signe ROTBERGA UNODC, Baltic States 5 November 2009 9/12/2015

2. Comprehensive strategy: Preventing drug abuse Facilitating entry into drug dependence treatment Establishing effective harm reduction measures to reduce adverse health and social consequences of drug abuse

3. Project objectives: Develop strategies and action plans to address HIV/AIDS among IDUs and in prison settings Improve professional capacity to address HIV/AIDS Increase coverage of comprehensive HIV/AIDS prevention and care services Generate and share strategic information to respond appropriately to evolving HIV/AIDS epidemics

4. Indicators to measure access to services Availability (Y/N? number of sites per 1000 IDUs ) Coverage (% IDU using services) Quality (Adhering to WHO/UNODC guidelines) Quality combined with scale-up will make a difference on the intervention ’ s impact on the epidemic. Source: WHO/UNODC/UNAIDS TECHNICAL GUIDE for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users

5. Comprehensive package of HIV prevention services for IDUs Needle and syringe programmes (NSP) Pharmacotherapy (methadone, buprenorphine) and other drug dependence treatment Voluntary HIV Counselling and Testing (VCT) Anti-Retroviral Therapy (ART) Sexually Transmitted Infections (STI) prevention and treatment Condom programming for IDUs and partners Targeted Information, Education and Communication (IEC) Hepatitis diagnosis, treatment (Hepatitis A, B and C) and vaccination of A&B Tuberculosis (TB) prevention, diagnosis and treatment WHO/UNODC/UNAIDS TECHNICAL GUIDE for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users

6. Small grants programme for HIV prevention among IDUs and in prisons Needle and syringe programmes 8 projects Pharmacotherapy with methadone 4 projects HIV education and care in prisons 2 projects Total budget: 673 600 LTL

7. Grants for harm reduction services in 2009

8. Capacity building in 2009 20 training seminars, 449 participants 2 study tours, 8 participants 11 conferences/meetings, 413 participants Professional networking and training: participation in 4 international events, 67 persons

9. Capacity building Training needs assessment Training topics: pharmacotherapy, peer driven interventions for IDUs, estimation of IDU prevalence, HIV and drug education Target groups: physicians, nurses, social workers, prison staff, policy makers, NGOs, police, pharmacists All training events evaluated, positive feedback received

10. Information and education materials FHI material “HIV voluntary counselling and testing: a Reference Guide for Counsellors and Trainers“ in cooperation with Lithuanian AIDS centre. Educational material "Diagnostic, Treatment and Social Support of Opioid Dependent People” in cooperation with Vilnius Centre for Addiction Disorders. Manual “Risk reduction for IDUs in prison” in cooperation with Prison department under MoJ. Information leaflet “Frequently asked questions about methadone or/and buprenorphine” in cooperation with Vilnius Centre for Addiction Disorders.

11. Training modules, guidelines Clinical protocol for psychiatrists “Pharmacotherapy of opioid dependence with methadone” Training module for social workers “HIV prevention and services for drug users”, Siauliai Medical College

12. Mid-term evaluation: conclusions Project is extremely useful and well-run Highly relevant to national responses to HIV in the Baltic states Evidence of progress towards objectives and results

13. Mid-term evaluation: concerns Sustainability of activities and systems established Strategic information is not always being used to shape the national response Access to HIV tests for IDUs Discontinuation of pharmacotherapy with methadone in prison settings

14. Mid-term evaluation: recommendations for Lithuania Revise National AIDS programme ensuring focus on IDUs and prison settings Piloting provision of methadone maintenance therapy in prisons Explore ways in which ARV therapy can be financed in prisons

15. Why prisons? National averagePrisons HIV prevalence0,04%3,7% Prevalence of drug use 1 %>20 % Overcrowding High turnover Interaction between prison and society

16. International norms and standards guiding prison health care Prison health is part of public health The principle of equivalence A human rights approach to prison health

17. Health is a fundamental human right indispensible from the exercise of other human rights UN Committee on Economic, Social and Cultural Rights Loss of liberty alone is the punishment, not the deprivation of fundamental human rights. Like all persons, therefore, prisoners have a right to enjoy the highest attainable standard of health.

18. Every country’s response to HIV...... is influenced by economic and social conditions, as well as by cultural, social, and religious traditions, but these national conditions do not reduce or negate government obligations to meet recognized international prison, health and human right standards. International law is clear that a lack of resourses does not excuse a state from its obligations to provide proper and humane prison conditions

19. Achievements in 2009 Regulation on provision of methadone in arrest houses Preparations for introduction of methadone therapy in remand prisons

20. Costs of drug dependence treatment per person per year (in US$)

21. www.unodc.org/balticstates