Scaling Up HIV Prevention among IDUs in South Asia: the key issues & gaps Dr. M. Suresh Kumar MD DPM MPH Chennai India Inter-country Consultation on Preventing HIV among IDUs Scaling Up: From Evidence to Action April , Kolkata, India

Diffusion of injecting drug use in South Asia Bhutan (N = 200) Bangladesh (N = 1090) India (N = 5800) Nepal (N = 1330) Sri Lanka (N = 1045) Ever injected 37 (18.5%) 300 (28%) 3562 (62.1%) 1060 (80.2%) 39 (3.8%) Ever Injected heroin 3 (1.5%) 46 (4.3%) 1623 (28.3%) 606 (45.8%) 23 (2.3%) Ever Injected Buprenorphine 28 (14%) 295(27.5%)1466(25.6%) 1013 (76.6%) 6 (0.6%) Ever Injected Propoxyphene 32 (16%) 3 (0.3%) 1713(29.9%) 149 (11.3%) 39 (3.8%) UNODC ROSA, 2007

Current pharmaceutical drug use in South Asia UNODC ROSA, 2007

Age at initiation of drug use in South Asia UNODC ROSA, 2007

HIV prevalence among IDUs in certain places, India NACO Sentinel Surveillance

HIV prevalence among IDUs in Bangladesh Ministry of Health and Family Welfare, Bangladesh

HIV prevalence among IDUs in Nepal Source: IBBS Study – NCASC/New Era/SACTS/USAID/FHI, 2003, 04

Injection related risk behaviour of IDUs – South Asia UNODC ROSA, 2007

Sharing injection equipment – new sites in India Project Network, SHARAN India, 2007

Sexual risk behaviour of IDUs – South Asia UNODC ROSA, 2007

Sexual risk behaviour of IDUs – South Asia UNODC ROSA, 2007

IDU related interventions in South Asia InterventionBhutan Banglade sh IndiaNepalPakistan Sri Lanka Community outreach √√√√√√ Needle syringe exchange √√√√ Opioid substitution √√ Convention al drug use treatment √√√√√√

Coverage of IDUs with effective approaches in South Asia CountryCoverage Bangladesh Coverage primarily by NGOs – Care Bangladesh and other NGOs Bhutan No significant implementation of effective approaches India Project Network; Emmanuel Hospital Association and SPYM’s network Targeted interventions of SACS Nepal NGO driven harm reduction projects Pakistan NGO driven harm reduction projects – Nai Zindagi Sri Lanka No significant implementation of harm reduction projects

Scaling-up interventions in one year DFID PMO Harm Reduction Projects Delivery through Networks Engagement of ‘peers’ Liaison with SACS Comprehensive services and continuum of services

Clients referred to different services through Peer Led Interventions – SPYM, India Number of drug users / injecting drug user contacted through PLI

Comprehensive Services through DICs – Project Network

Key issues in coverage Key issue BhutanBangladeshIndiaNepalPakistan Sri Lanka Policyxxxxxx Intervention in place x√√√√x Coverage of IDUs - Good in certain places like Dhaka Example through DfID projects Inadequate Good practice but sustainability threatened - Special populations - Attempts to reach women drug users and partners of IDUs NK Attempts to reach partners of DUs

Key issues in coverage Key issue BhutanBangladeshIndiaNepalPakistan Sri Lanka Human resources -********* Protocols√ NGO involvement ************* IDU engagement *************

Major gaps in coverage of IDUs in South Asia Lack of coordinated response to drug use related problems Lack of coordinated response to drug use related problems NGO supported initiatives only NGO supported initiatives only Lack of continued support to ongoing harm reduction projects Lack of continued support to ongoing harm reduction projects Opioid substitution treatment coverage low in the region Opioid substitution treatment coverage low in the region

Next steps Policy briefs Policy briefs Coordinated efforts between different Ministries Coordinated efforts between different Ministries Government – NGO partnerships Government – NGO partnerships Scaled-up implementation of essential harm reduction components Scaled-up implementation of essential harm reduction components Operational guidelines Operational guidelines Standard protocols Standard protocols Continued support for harm reduction Continued support for harm reduction Expansion of services to women drug users, prisoners and other hidden groups Expansion of services to women drug users, prisoners and other hidden groups

Acknowledgements DFID PMO Projects DFID PMO Projects Emmanuel Hospital Association Emmanuel Hospital Association Project Network – SHARAN India Project Network – SHARAN India SPYM SPYM UNODC ROSA UNODC ROSA H-13 Project RSRA H-13 Project RSRA