Transcript epidemio
Focusing Injecting Drug Users as The Main Root of HIV/AIDS Transmission Shelly,dr.,Msi Picture from Bahtera Foundation, Bandung Background Indonesia faces Three HIV epidemics: General population in Papua through sexual risk behaviour Concentrated epidemic in IDU through shared needles Concentrated epidemic in CSW through unprotected sex * Source : Directorate General CDC & EH, Ministry of Health, Republic of Indonesia, 2007 Illustration of HIV prevalence among Injecting Drug Users (IDUs) and Comercial Sex Workers (CSWs) HIV (+) percentage IDUs CSWs Source : Sentinel Surveilance, Indonesia Health Department Prediction of HIV Infection Source : MAP, 2005 (http://www.unaids.org/epi/2005/doc/EPIupdate2005_html_en/epi05_06_en.htm) Estimation of IDUs population in each province in 2006 IDUs population West Java (population : 40.000.000) Estimation of adult person vulnerable to be infected with HIV in 2006 National report, Health Department & National AIDS commission HIV Risk factors in West Java • • • • West Java is in the third highest (Jakarta, Papua) 22,000 IDU’s in Province West Java* 21% of IDU’s are in prison in West Java; 71,9% of AIDS patients are IDUs Source UNAIDS 2006* Source chart: UNAIDS 2006 according to the risk factors form 1989-december 2004 Characteristics of IDUs in Bandung Compare with other countries : The age are younger (19 y.o) Higher education background (85% senior high school or ) Type of drug used : alcohol, marijuana, heroin, tranquilizer (> 75%) The most common drug used for injecting is heroin (close to 100%) Increasing use of buprenorphine (Subutex ® = opioid agonist) Wrong knowledge about cleaning needle (sterile water > 75%) Source : Bahtera questionnaires, 2006 (345 respondents), FGD 2007 Characteristics of IDUs in Bandung Needle sharing is 34-39% and sharing injecting equipments Still able to use drug in control environment (14,8% in prison, 3,5% in rehabilitation center) High sexual risk behavior (no condom use 52%) Sexual partner : partner (88%), CSW (42%), IDUs (25%), casual (19%), spouse (15%) Low number of HIV test (11%) Low number of Hepatitis B or C test (10%) Source : Bahtera questionnaires, 2006 (345 respondents), FGD 2007 Transmission HIV/AIDS in Bandung CSW Clients Low risk man IDUs MSM (34-39%) Low risk woman CSW : commercial sex worker; MSM : men sex with men; IDUs : injecting drug users Interventions to Control HIV Increased HIV-testing for risk groups Harm reduction for IDUs HIV-treatment community Target group IDUs AIDS HIV + Education Outreach Case Finding VCT Prevention and care Harm Reduction : Methadone Program Treatment & Care for HIV/AIDS ( including ART) Treatment and care Framework for comprehensive measures to control the HIV epidemic in West Java. Harm Reduction Strategies To Control HIV Transmission Safe Injection (Needle & Syringe Exchange Programs) Heroin substitution Programs (methadone, buprenorphine) Education and Outreach Programs Condoms to reduce risk of sexual transmission Best programs provide combination of preventive and therapeutic services (“comprehensive care”) Heroin Substitution Program • Methadone is a ‘synthetic opioid agonist’ prevents withdrawal symptoms • Long acting (15 to 32 hours) • Taken orally so reducing the injection of heroin • Reduces criminality* • Increases health status* • Reduces depression* • Decreases HIV transmission by reducing injecting risk behavior and other skin penetrating risk behavior* • Reduces the number of sexual partner* * Source : Study of methadone effectivity in Hasan Sadikin Hospital, September, 2006 CONCLUSION Indonesia has an explosive HIV-problem driven by IDU Need a comprehensive approach Sustainability of effective interventions needs local capacity building Academic partnerships work This document has been produced with the financial assistance of the European Union. The contents of this document are the sole responsibility of IMPACT Bandung and can under no circumstances be regarded as reflecting the position of the European Union Acknowledgement Reinout van Crevel, Lucas Pinxten, Diba Basar (IMPACT Program (Integrated Management for Prevention And Control and Treatment of HIV/AIDS Bandung, West Java, Indonesia)) Teddy Hidayat, Bachti Alisjahbana (Medical Faculty, Universitas Padjadjaran & Hasan Sadikin Hospital, Bandung West Java Indonesia) Jose Boom (Radboud University Nijmegen Department NUSI/ Internal Health) Tamami A Zain (Yayasan Bahtera Community HIV Prevention Program) Octavey Kamil (Family Health International / ASA, Jakarta) Cor de Jong (Radboud University Nijmegen, Scientist Practioners in Addiction) Universitas Padjadjaran Bandung - Indonesia Hasan Sadikin Hospital Bandung - Indonesia CORDAID The Haque The Netherlands Radboud University Nijmegen The Netherlands Antwerp University Belgium Maastricht University The Netherlands Working Groups for 5 Activity Areas: • • • • • IEC / Health Promotion about HIV-related risk behavior in adolescents Scaling-up HIV-testing & VCT Harm reduction (including methadone), for IDU’s in community, prison & hospital Scaling-up treatment & care for HIV/AIDS, incl. antiretroviral treatment Building Capacity, transfer of knowledge to local professionals to conduct and up-scale the above activities Harm Reduction focuses on reducing the harms related to drug use rather than eliminating drug use itself. Harm Reduction aims to: prevent the spread of infections including HIV/AIDS, Hepatitis and other blood-borne infections; reduce the risk of overdose and other drugrelated fatalities; and lessen the negative effects drug use may have on individuals and communities including poverty and crime. Proportion of HIV new infection among subpopulation in Indonesia in 2020 Estimation of adult person vulnerable to be infected with HIV in 2006 National report, Health Department & National AIDS commission CONCLUSION Indonesia faces an explosive HIV-problem which is mostly driven by Intravenous Drug Use. The nature of the epidemic requires a comprehensive approach: integrating prevention, harm reduction, addiction medicine and HIV/AIDS treatment and care and building on both behavioural and medical sciences Use of local capacity and technical expertise will enable the establishment of effective and sustainable interventions in HIV/AIDS. Academic partnerships and technical assistance from Europe will help local professional capacity in a pragmatic and effective response to the Indonesian HIV epidemic.