Presentation on theme: "HIV and drug prevention in Estonia Harm reduction services"— Presentation transcript:
1 HIV and drug prevention in Estonia Harm reduction services Aljona KurbatovaNational Institute for Health DevelopmentTallinn, Estonia
2 Republic of Estonia: Population – 1.29 million people 276 newly diagnosed HIV cases per million population in 2011 (n=370)Decrease in the number of new HIV cases (2012; n=315)A total of HIV-cases in 1988–2012Main risk group – people who inject drugsHighest rate of overdose deaths in EUAll possible comorbidities – HIV/IDU, HIV/TB, TB/IDU, IDU/HIV/TB, IDU/HIV/MDR-TB.
3 People who inject drugs Old estimate: IDUs in Estonia in 2004, which translated into a prevalence of 2,4% (95% CI 1,4-5.9) among people years.New estimate: IDUs in Estonia in 2009, which translated into a prevalence of 0,9% (95% CI 0,7–1,7%) among people years.Experts’ estimate: around – 9 000IDU prevalence is mostly confined to two (out of 15) counties – Harjumaa including Tallinn and Ida-Virumaa (North-East).According to the available data the age and injecting period of IDUs is increasing - the population seems to have stabilized.Main drug – fentanyl, 3-methylfentanylThere is evidence that injecting of amphetamines has increased.
4 BackgroundFirst NSP project was launched in May 1997 – needle and syringe exchange was provided from a vehicle (car) in Tallinn (NGO AIDS Support and Information Centre).In 1998 HIV voluntary testing and counselling centre in Narva started second needle and syringe exchange project.In June 2000 NSP services were extended to other cities in North-East of Estonia - Narva (4 sites in total), Kohtla-Järve (2 sites in total), Jõhvi, Sillamäe and Kiviõli.First opioid substitution programms in 1997, however officially OST started in 2002.
5 BackgroundIn the beginning of 2000-s national government and Tallinn City Government started to support harm reduction programmes, however resources allocated were very modest.In 2003 Global Fund Programme is launched and more systematic development of the harm reduction becomes possible on national level.In 2004 European Commission PHARE project in collaboration with Netherlands is launched which allows to establish three new low threshold centres in cooperation with local municipalities – Tallinn, Kohtla-Järve ja Paide.From the end of 2007 harm reduction programmes are fiannced from the state budget.additional funding for counselling services from European Social Fund
6 National HIV Policy Main action areas: Harm reduction programs for people who inject drugsSyringe exchange programsOpioid substitution treatmentCounsellingOverdose preventionHIV testing and counselling (based on risk behaviors and indicator conditions) and STI testingVoluntary HIV testing and counsellingPiloting of the Internet-facilitated STI testing for MSMPiloting of the partner notification and testing (STI services for IDUs and their sexual partnersSTI testing, treatment and counselling services for CSWSTI testing, treatment and counselling services for IDUSTI testing, treatment and counselling services for uninsured young peopleHIV-related health care services including ARV treatment (free of charge for all)
7 National drug policyMain action areas relevant to the injecting drug use:Drug treatment and rehabilitationDetoxificationLong-term medical rehabilitation (psychotherapy etc)Counselling
8 Basic structure of services for drug users Low thresholdEstablishment of the first contact, provision of motivation for treatment – family physicians, harm reduction sevices, counselling etc.Addiction treatment, rehabilitationHealth care organisations, rehabilitation centres.Aftercare, reintegrationCounselling services - social, psychological, peer counselling.Support services and possibilities for the reintegration of former drug addicts in the labour market (limited).
9 Work process NATIONAL STRATEGY: Long term objectives (united effort of different sectors and organisations)ACTIVITY PLAN OF THE STRATEGYyearly plan – the amount of services targeted at people who inject drugs is planned for the whole countryACTIVITY PLANS OF SERVICE PROVIDERS IN THE REGIONYearly plan – the amount of service planned for each organisation (in cooperation of service providers and NIHD).SERVICE DESCRIPTION –the types of services provided, required conditions, safety requirements, etc (in cooperation of service providers and NIHD).
10 The roles of different partners NIHD in national level:coordinating the general development of the service,planning the budget and the service need for the country,conducting public procurements (syringes, needles, condoms etc)financing the service,organising staff trainings,conducting studies,analysing the results of the service.Service providers in regional level:planning the service and the budget in their organisation,delivering service to the target group,participating in preparing service descriptions/standardsParticipating in research and development.
11 Some of the latest developments National HIV policy has been integrated into Health Action PlanMinistry of Interior has taken over coordination of the national drug policyNew national HIV testing guidanceRapid testing in community settings in collaboration of NIHD, health care and community based organisations (although legally restricted to health care settings)Regional expansion of OSTPiloting of the take-home naloxone programme in 2013, preparations underway