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Martin C. Donoghoe on behalf of the XIX International AIDS Conference Regional Working Group for Eastern Europe and Central Asia Why is the HIV epidemic.

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Presentation on theme: "Martin C. Donoghoe on behalf of the XIX International AIDS Conference Regional Working Group for Eastern Europe and Central Asia Why is the HIV epidemic."— Presentation transcript:

1 Martin C. Donoghoe on behalf of the XIX International AIDS Conference Regional Working Group for Eastern Europe and Central Asia Why is the HIV epidemic in Eastern Europe and Central Asia the fastest growing in the world and what do we need to do to halt it? XIX International AIDS Conference Regional Session on Eastern Europe and Central Asia

2 HIV epidemic in Europe still not under control Cumulative number of diagnosed cases (in thousands), WHO European Region, 1986–2010 Sources: ECDC/WHO. HIV/AIDS surveillance in Europe Stockholm: ECDC; UNGASS country progress reports for the Russian Federation and Ukraine.

3 Low access to HIV testing and counselling among populations most at risk in eastern Europe and central Asia Source: UNAIDS/WHO. HIV/AIDS in Europe and central Asia. Progress Report respondents who reported receiving an HIV test and learning the results in the preceding 12 months, selected countries 2005, 2007 and 2009

4 People living with HIV: fast growing numbers in eastern Europe and central Asia Estimated number of people living with HIV in Europe, Source: UNAIDS. Together we will end AIDS Europe (total estimated) 2.4 million [2.1 million – 2.7 million] Eastern Europe and central Asia 1.5 million [1.3 million – 1.8 million] Western and central Europe [ – ]

5 Estimated ART coverage in eastern Europe and central Asia among the worst globally (2011) ART also reduces risk of HIV transmission – Donnell D et al. Lancet, 2010, 375(9731):2092–2098 ART also reduces risk of HIV transmission – Donnell D et al. Lancet, 2010, 375(9731):2092–2098 Source: UNAIDS. Together we will end AIDS. 2012

6 Proportion of people who inject drugs receiving ART in low- and middle-income countries in the WHO European Region Sources: ECDC/WHO. HIV/AIDS Surveillance in Europe, ECDC, Stockholm, 2011 EuroHIV. HIV/AIDS Surveillance in Europe. End-year report Saint-Maurice, Institut de veille sanitaire, 2006 WHO/Europe. Annual surveys on HIV/AIDS and HAART and WHO/UNAIDS/UNICEF monitoring and reporting on the Health Sector Response to HIV/AIDS, * Preliminary ART data and 2010 HIV surveillance (case reporting) data * Number of reporting countries among 26 low- and middle income countries Diagnosed people infected with HIV through injecting drug use (% among cumulative diagnosed HIV infections with a known transmission mode) (71%) (77%) (77%) (59%) (59%) People infected with HIV through injecting drug use receiving ART (% among all people receiving ART with a known transmission mode) 130 (20%) 4700 (26%) 5300 (26%) 7700 (21%) 9000 (21%)

7 Infection increasing faster than treatment Cumulative number of reported cases and deaths (in thousands), WHO European Region, 1986–2010 Sources: ECDC/WHO. HIV/AIDS surveillance in Europe UNGASS country progress reports for the Russian Federation and Ukraine. WHO/UNAIDS/UNICEF monitoring and reporting on the Health Sector response to HIV/AIDS.

8 8 HIV infection 1984–2010: WHO European Region Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

9 WHO European Region: geographical areas 9 West Centre East Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

10 HIV infections diagnosed 2010 in WHO European Region: geographic area 10 Characteristics of cases WHO European Region* West*Centre*East Number of HIV cases Rate per population Percentage of cases Age 15–24 years** 11.6%10.0%17%13% Female 38%27%19%42% Transmission mode** Heterosexual 43%24%***24%48% Men who have sex with men 20%39%29%0.7% Injecting drug use 23%4% 43% Unknown 13%16%41%7% Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010 *No data from the following countries: Austria, Liechtenstein, Monaco. ** Countries with no data on age or transmission mode excluded. *** Excludes individuals originating from countries with generalised epidemics.

11 HIV infections diagnosed 2010: WHO European Region cases per pop 11 Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010

12 HIV infection 2004–10:WHO European Region three geographical areas 12 Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010 Data not consistently reported or not available from: Austria, Monaco, Russian Federation.

13 HIV infections diagnosed 2010 WHO European Region: transmission mode and geographical area Sources: ECDC/WHO. HIV/AIDS surveillance in Europe Russian Federation Ministry of Health and Social Development

14 HIV infections 2004–10: transmission groups in WHO European Region - East 14 Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010 Data not consistently reported or not available from: Estonia, Russian Federation.

15 AIDS diagnoses 2004–10: WHO European Region three geographic areas and EU/EEA 15 Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010 Data not consistently reported or not available from: West: Andorra, Denmark, Monaco, Sweden; Centre: Turkey; East: Russian Federation, Ukraine.

16 Vulnerability and marginalisation CountriesProtective lawsPunitive laws A Laws and regulations that protect people living with HIV against discrimination B Non- discrimination laws or regulations that specify protections for vulnerable subpopulations C Laws, regulations or policies that present obstacles to access to prevention, treatment, care and support for vulnerable subpopulations D HIV-specific restrictions on entry, stay or residence E Laws that specifically criminalize HIV transmission or exposure F Laws that criminalize same-sex sexual activities between consenting adults G Laws deeming sex work ("prostitution") to be illegal H Laws that impose compulsory treatment for people who use drugs and/or provide for death penalty for drug offences ArmeniaYes NoYes AzerbaijanYes NoYesNoYes BelarusYes EstoniaYesNo GeorgiaYesNoYesNoYesNoYes KazakhstanYes No YesNo Yes KyrgyzstanYes No YesNo LatviaYesNo LithuaniaYes No Yes Republic of MoldovaYes NoYes NoYes Russian FederationYes NoYes TajikistanYes NoYesNoYes TurkmenistanYes UkraineYes NoYes UzbekistanYes NoYes Key laws supporting or blocking universal access in countries in the east of the region, July 2010 Source: UNAIDS/WHO. HIV/AIDS in Europe and central Asia. Progress Report 2011

17 Poor scale up of services

18 Reported HIV infections acquired through injecting drug use: eastern Europe and central Asia (2010) Data sources: ECDC/WHO. HIV/AIDS surveillance in Europe UNGASS country progress report of the Russian Federation 2010

19 Number of syringes distributed per IDU per year by needle and syringe programmes: eastern Europe and central Asia (2011) Data source: WHO/UNAIDS/UNICEF monitoring and reporting on the Health Sector response to HIV/AIDS

20 Poor integration of services Reduce vulnerability and address structural barriers to accessing services Build strong and sustainable systems Leverage broader health outcomes through HIV response Optimize HIV prevention, diagnosis, treatment and care outcomes Data source: WHO Regional Office for Europe. European Action Plan for HIV/AIDS

21 Percentage of people who inject drugs receiving opioid substitution therapy: eastern Europe and central Asia (2011) Data source: WHO/UNAIDS/UNICEF monitoring and reporting on the Health Sector response to HIV/AIDS * 2010 data

22 TB and hepatitis co infection

23 HIV infection among all TB cases tested for HIV in the WHO European Region ( ) Source: ECDC/WHO. Tuberculosis surveillance and monitoring in Europe, 2012

24 TB/HIV co-infection WHO European Region (2010) Timely detection and appropriate treatment is a challenge. Almost (80%) TB/HIV cases out of an estimated (range – ) were detected in 2010 and only 70% were offered antiretroviral treatment. Source: ECDC/WHO. Tuberculosis surveillance and monitoring in Europe, 2012

25 HIV programme source of funding in Europe and central Asia, 2008 or 2009 Source: UNAIDS/WHO. HIV/AIDS in Europe and central Asia. Progress Report 2011

26 Percentage of HIV programme spending on key populations originating from international funding sources, most recent year West and centre: Belgium, Bulgaria, Croatia, Czech Republic, Hungary, Montenegro, Poland, Romania, Switzerland, United Kingdom. East: Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, Ukraine, Uzbekistan. Source: UNAIDS/WHO. HIV/AIDS in Europe and central Asia. Progress Report 2011

27 Summary: HIV transmission in Eastern Europe and Central Asia Grows at alarming rate Poor access to treatment Vulnerability and marginalisation Poor (integration of and scaling up) services TB (and hepatitis) co infection Funding 27

28 Acknowledgements Andrew Ball Senior Strategy and Operations Adviser, HIV/AIDS Dept WHO, AIDS 2012 Conference Coordinating Committee Fabiano Bertini AIDS 2012 International Conference Secretariat, International AIDS Society Sergii Dvoriak Director of the Ukrainian Institute on Public Health Policy Bernard Kadasia AIDS 2012 International Conference Secretariat, International AIDS Society Anna Koshikova Head of the Analytical Team, All-Ukrainian Network of PLWH Jean-Elie Malkin Senior Adviser to Executive Director/Acting Director of the Regional Support Team for Europe and Central Asia UNAIDS Mara Nakagawa-Harwood AIDS 2012 International Conference Secretariat, International AIDS Society Serge Votyagov Executive Director of the Eurasian Harm Reduction Network (EHRN)

29 Question 1 to the panellists How can we scale up access to ART and increase early HIV diagnosis and treatment?

30 Question 2 to the panellists How can we leverage broader health outcomes through the HIV response and build stronger and more sustainable health systems?

31 Question 3 to the panellists How can we respond to reduce vulnerability and marginalisation?

32 Question 4 to the panellists How can we respond to the funding crisis?


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