1. Dr Gilles Raguin, on behalf of ESTHER Senegal, IAS, 2012 HIV Prevention, treatment and care for IDUs in Senegal: An innovative ESTHER partnership

2. Universal access to HIV prevention, treatment and care for IDUs is a priority Package of intervention well defined and efficacy demonstrated Needle exchange programs Opioid substitution treatments (OST) Volontary counseling and testing (VCT) Antiretroviral Treatment (ART) Prevention and treatment of STI Condom distribution programs Information, Education and Communication (IEC) Vaccination, diagnosis and treatment of hepatitis Prevention, diagnosis and treatment of TB Source: WHO/UNODC/UNAIDS TECHNICAL GUIDE for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users

3. HIV and IDU in Africa: a neglected epidemic No data in most countries Kenya: 36 % S Africa: 12 % Nigeria: 5.5 % Tanzania :42 % Zanzibar: 16% Mathers, Lancet 2008

4. An Operationnal Research programme on IDU in Dakar, Sénégal (ANRS/CNLS/ESTHER/IMEA) To provide data on: – IDU prevalence and size of the population – Practices – HIV/HCV prevalence To Build capacities of HCW and CBOs To Advocate and Act for access to HIV prevention, treatment and care for IDUs

5. First step: the survey (Grant ANRS 12243) Population : IDUs, Dakar région Inclusions : héroïn and/or cocaïne users <3 mths (april to july 2011) Location: CRCF, Hospital Fann, Dakar partner of Hospital Saint Antoine, Paris, France Methods: Respondent driven sampling (RDS), 506 inclusions Biology : rapid tests for HIV, HBV, HCV on DBS

6. Results for HIV prevalence (n=506) 22 IDU VIH+ = 4,3 % vs 0,7% in general population Injectors vs non injectors = 9,4 % vs 2,5% (p=0.001) Women vs men = 13% (9/69) vs 3% (13/437) (p= 0,001) Women injecting vs men injecting = 21,1 % vs 7,5% (p= 0,0001)

7. Results for HCV prevalence 120 UDI HCV+ = 24 % vs < 1% in general population Injectors vs non injectors = 38,85 % vs 18% (p=0.000) Women vs men = 29% (20/69) vs 23% (100/437) (p=0,26, NS). Women injecting vs men injecting = 42,1 % vs 38,3% (NS).

8. Second step: capacity building 2010 : Sensibilisation workshop on IDU and HR (30 HCW) 2010 : Study tour in Morocco 2011 : training course and diploma in France for Psychiatrist team leader 2011-2012 : study results at HIV/AIDS conferences 2012 : 3 training sessions (HCW and CHW) May 2012 : study tour in Morocco Oct 2012 : training sessions, tutoring outreach activities, national guidelines on IDU and HR

9. Third step: Advocate and Act Regional workshops UNODC/ESTHER, Grand Bassam (12/09 and 2010) Regional ministerial Dakar Initiative (01/10) Intégration of IDUs among vulnerable groups in the Senegalese National strategic plan against HIVAIDS and allocation of specific funds (GF Round 9) Methadone registered on the list of essential drugs Revision of law in process

10. Third step: Advocate and Act Access to care for recrutees Outreach prevention activities 09/11 Needle exchange program 11/11 Opening of a Care center for Addictions in Fann hospital, Dakar, in partnership with hospital Saint Antoine, APHP, Paris, funded by CLNS/GF, ESTHER, UNODC, City Council of Paris (planned for end of 2012)

11. ESTHER is a partner of the 2010-2014 UNODC regional programme for West africa

12. Acknowledgements CNLS: I Ndoye Ministère de la Santé / DLSI / Bureau Santé Mentale: I Ba and A Wade CRCF et CTA: Pr PS Sow, M Maynart, N F Ngom Gueye CHU Fann, Psychiatry: M Gueye Hôpital Le Dantec (LBV): S Mboup, CT Kane, H Diop, O Ndiaye. UNODC: M Molnar ESTHER: S Perrot, A Toufik, K Diop IRD: A Desclaux, C Desclaux Hôpital Saint Antoine and IMEA: A Leprêtre, PM Girard