Harm reduction evidence: Eastern Europe and Central Asia Raminta Stuikyte Central and Eastern European Harm Reduction Network

Eastern Europe and Central Asia Fast epidemics among injecting drug users; up to 75% of all registered HIV cases Drug policies could be indicated as harsh: –attached to incarceration for possession of drugs for personal use; drug users often fair to have needles with them because of police Drug services are scarce –No country has national scale of harm reduction interventions (needle exchange, outreach work, substitution treatment neither in community, nor in prisons) –Coverage estimates varies 0-15% Research is limited; mainly RAR studies and project data analysis

Needle syringe exchange (NSE) efficacy Russia: –Behavioral 5-city research showed that level of needle sharing in one month from participating at NSE from 38% to 11% in 2002 (n=1076) Des Jarlais D et. al (2002): HIV risk behavior among participants of syringe exchange programs in central/eastern Europe and Russia; International Journal of Drug Policy: 13: Ukraine: –24% of IDUs reached by NSE do not share compared to 16% of those never attending NSE sites Yaremenko, Balakirieva (2004) Effectiveness of Harm Reduction Projects in Ukraine. Ukrainian Institute for Social Research. Kyrgyzstan: –Percent of clients reusing needles drops from 98% to <30% after start of NSP –Needle sharing drops from 68% to 14%; Estebesova. The Role of NGOs in the Implementation of Harm Reduction Programs for Drug Dependency in the Kyrgyz Republic. In Decreasing Vulnerability of Injection Drug Users of the Kyrgyz Republic: Conference Proceedings (May 2003), edited by TK Asanov. Osh, 2003.

NSE efficacy II: changes in condom use and AIDS knowledge Russia –Condom use in last sexual intercourse ranges from 28% among non clients of NSE to 58% among NSE clients RAR in Russia; Open Health Institute 2003 Kyrgyzstan –Condom use increased from 14% to 46%; –Knowledge about AIDS increased from 35% to 73% Estebesova. The Role of NGOs in the Implementation of Harm Reduction Programs for Drug Dependency in the Kyrgyz Republic. In Decreasing Vulnerability of Injection Drug Users of the Kyrgyz Republic: Conference Proceedings (May 2003), edited by TK Asanov. Osh, 2003.

NSE Effectiveness III: Cost analysis Belarus –Economic evaluation of a harm reduction program in Svetlogorsk: one HIV infection could be averted for not more than US$68 Kumaranayake L et al. The cost-effectiveness of HIV preventive measures among injecting drug users in Svetlogorsk, Belarus: Draft. Geneva, UNAIDS, Russia –US$23,4 – costs per client served and $0,36 costs per syringe exchanged Bobrik A. et al. HIV prevention among drug users in Russian cities: cost-effectiveness analysis: Russian Family Doctor, 4(6)30-36

Substitution treatment Evidence even more limited as limited and mainly delayed application of substitution treatment in the region –Baltics – since ; Kyrgyzstan – since 2002; Moldova – since 2004; Ukraine, Georgia – 2005, Uzbekistan 2006 Positive preliminary results about methadone program in Lithuania: –In conclusion, there is documented evidence on the efficacy, feasibility, safety and acceptability of methadone programs in Indonesia, Lithuania and Thailand. WHO (2005) The WHO Collaborative Study on Substitution Therapy of Opioid Dependence and HIV/AIDS. Preliminary results of study implementation in Indonesia, Lithuania, and Thailand

Substitution treatment Kyrgyzstan –In Bishkek, percent of patients using opiates in addition to methadone decreases from 44% in June 2002 to 15% in April 2003 –In Osh, decrease from 25% to <5% –Only one HIV infection reported among program clients and the person was not tested on opiates by 2003 Asanov, TK. “Methadone Maintenance Treatment Programs in the Kyrgyz Republic.” In Decreasing Vulnerability of Injection Drug Users in the Kyrgyz Republic: Conference Proceedings (May 2003), edited by TK Asanov. Osh, 2003.

Summary NSE showed being effective in reducing sharing needles in different sites of Eastern Europe Some studies showed increased condom use and HIV knowledge among NSE clients NSE is cost-effective and relatively low cost Substitution treatment studies are limited and not completed, however their preliminary results indicate positive results in its efficacy in decreasing illegal opioids, decreasing injecting and needle sharing