Transcript Dr. Ernest Bishop (NYC), 1920

The need to scale up HIV
prevention for drug users
Kasia Malinowska-Sempruch
Director
International Harm Reduction Development
Program
Open Society Institute
Krakow, September 26, 2004
Fixing, Astrakhan
Overview
Injecting drug use globally and related HIV
epidemics
Current state of knowledge about addiction
OSI’s experience in supporting harm reduction
Related policy issues
HIV among
injecting drug users
• Primary characteristics -- an explosive
epidemic /easy to contain (UK, Holland,
Canada)
• In 1992 -- 52 countries reporting HIV among
IDUs; in 2002 -- 114.
• Injecting Drug Use accounts for as much as
10% of new HIV infections globally
• An estimated 1 of every 3 new infections
outside of Africa is among IDUs
Drug Use and Global HIV
Epidemic
– Especially in Asia and former Soviet Union,
drug policy holds key to future of HIV
• 52 countries report HIV among IDU’s in 1992, 114
in 2002 (Strathdee and Poundstone, 2002)
• Outside of Africa, estimated 1 of every 3 new
infections comes from contaminated needle (UNAIDS)
HIV IN UKRAINE:
estimated 1%
prevalence
UNAIDS Global Epidemic Update, 2002
Photo: Jacqueline Mia Foster
Explosive nature of HIV infections
among injecting drug users in
Russia
– In Svetlagorsk, Belarus, 1 year after the first
HIV case, 67% of IDUs were estimated to be
infected.
– In St. Petersburg, prevalence among IDUs
was 0.3% in 1998, 19.3% by 2000.
Asia
• China - as many as 1 million HIV cases,
70% among IDUs
• Malaysia—76% of all HIV cases among
IDUs
• Iran—75% HIV cases are among IDUs
• Vietnam—65% HIV cases are among IDUs
• 80% IDUs HIV+ in Manipur (India)
• 90% IDU’s HIV+ in Myitikina (Burma)
• In Chiang Rai, Thailand, HIV prevalence
among IDUs increased from 1% in 1988 to
61% in 1989
Drug Addiction Prevalence
Rate in Kyrgyzstan
National Centre of Addictions of the Ministry of Health of Kyrgyzstan
5591
6000
120000
5000
100000
4000
80000
3000
60000
2000
1290
40000
20
02
20
01
20
00
19
99
19
98
19
97
19
96
19
95
0
19
94
0
19
93
20000
19
92
1000
19
91
80-100 000
5591
HIV prevalence among IDUs
National Centre of Addictions of the Ministry of Health of Kyrgyzstan
1 Jan 2001
1 Jan 2003
<20%
30.2%
69.8%
Injecting Drug
Users
Non-Injection Infection
>80%
Ancient history
Dr. Ernest Bishop (NYC), 1920
•
“We have regarded failure to abstain from
narcotics as evidence of weak will-power.”
•
“We have prayed over our addicts, cajoled them,
exhorted them, imprisoned them, treated them as
insane and made them social outcasts” – and
we’ve consistently failed!
Bishop, The Narcotic Drug Problem. Macmillan; NY 1920
The Baron Edmond de Rothschild
Chemical Dependency Institute
World Health Organization:
Addiction is a brain disease, 1997
•
“Research has shown that substance
dependence is a chronic relapsing disorder
with a biological and genetic basis, and is
not simply due to lack of will. . . “
•
“Substance dependence is as much a
disorder of the brain as any neurological or
psychiatric illness.”
WHO. “Neuroscience of psychoactive substance use and dependence.”
ISBN 92-4-159124-2
The Baron Edmond de Rothschild
Chemical Dependency Institute
National Institute on Drug Abuse
Addiction is a brain disease, 1997
•
“Addiction unequivocally is a disease of
the brain that can be effectively treated”
•
“Strongly recommends expanding access
to methadone treatment”
•
NIDA Notes, 1997 at
http://www.drugabuse.gov/NIDA_Notes/NNVol12/NIPanel.html
The Baron Edmond de Rothschild
Chemical Dependency Institute
Harm reduction
1984
British Home Office publication perhaps
earliest published reference to harm
reduction:
– “An important aspect of prevention is the reduction
of harm associated with misuse –by measures
directed at the user rather than the non-user.”
* British Home Office Prevention – Report of the Advis Counc on misuse of drugs, 1984
The Baron Edmond de Rothschild
Chemical Dependency Institute
OSI-Supported Harm Reduction Programs
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Albania
Azerbaijan
Belarus
Bulgaria
Croatia
Czech Republic
Estonia
Georgia
Kazakhstan
Kyrgyzstan
Latvia
Lithuania
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Macedonia
Moldova
Poland
Romania
Russia
Slovakia
Slovenia
Tajikistan
Turkmenistan
Ukraine
Uzbekistan
Lessons learnt
• Drug users are compliant, if services are
organized in reasonable manner
• HIV treatment must accompany prevention
• Harm reduction is EASY
• Pilots are not enough – programs need to
be taken to scale
• Drug policies need to be re-visited for HIV
prevention to be effective
Drug policies need to be re-visited
Photo: Hans Jürgen Burkard
OTHER CONSIDERATIONS -- Heroin overdose, Volgograd
The need to scale up HIV
prevention for drug users
Kasia Malinowska-Sempruch
Director
International Harm Reduction Development
Program
Open Society Institute
Krakow, September 26, 2004