“Humanitarian Action” The Saint-Petersburg Charitable Foundation for Medical and Social Programs HAF

June 2001 – date of official registration of the Foundation June 2001 – date of official registration of the Foundation HAF was created on the basis of projects of “Medecins du Monde – France” in Saint Petersburg

All HAF programs include activities related to HIV WHY?

Epidemic situation in Russia in registered HIV cases since starting the epidemic process registered HIV cases since starting the epidemic process Number of deaths caused by AIDS 6 350, including 302 children Number of deaths caused by AIDS 6 350, including 302 children children born from HIV+ mothers children born from HIV+ mothers

HIV in Russia Negative tendencies during 2 last years Increasing on 87% of mortality among HIV+ people Increasing on 87% of mortality among HIV+ people 2,7 times increasing of number of children born from HIV+ mothers 2,7 times increasing of number of children born from HIV+ mothers Increasing on 189% of HIV infected children and adolescents Increasing on 189% of HIV infected children and adolescents

HIV in St Petersburg in 2004 Numbers of cases

HIV Epidemics in St Petersburg in 2004 During 2004 the number of new cases was During 2004 the number of new cases was new cases among young people aged years 165 new cases among young people aged years Since 1987 to 2004 number of deaths due to HIV was of 1004, including 122 people in the stage of AIDS Since 1987 to 2004 number of deaths due to HIV was of 1004, including 122 people in the stage of AIDS

HIV in St Petersburg in 2004 A decrease of 10% of new HIV cases is observed among all groups of population. Young people 15 – 29 years old are 74,9% of all number of HIV +

HIV in St Petersburg in 2004 Ways of transmission

HIV in St Petersburg in 2004 The parenteral way is still very important (65,1%) But less important than 1n 2003 (87%)

HIV in St Petersburg in 2004 Sex ratio

HIV in St Petersburg in 2004 Dinamics of sexual and parenteral ways of transmission

HIV in St Petersburg in 2004 Age groups

HIV in St Petersburg in 2004 Number of HIV+ pregnant women

HAF programs in Saint Petersbourg Program of medical, social, psychological help to street children – since 1995 Program of medical, social, psychological help to street children – since 1995 Harm reduction program for drug users – since 1997 Harm reduction program for drug users – since 1997 HIV prevention program among street commercial female sex workers – since 2000 HIV prevention program among street commercial female sex workers – since 2000 Out-patient center run in partnership with the Botkin hospital Out-patient center run in partnership with the Botkin hospital TB prevention among HIV+ people TB prevention among HIV+ people Working out adherance in treatment among IDU (case management) Working out adherance in treatment among IDU (case management) Lobbying of HR and of access to treatment for IDU Lobbying of HR and of access to treatment for IDU

Medical, social and psychological help to street kids Main services: - Outreach work - Day drop-in centre for consultations - Short term night centre - VСT (HIV, hepatitis, syphilis) Prevention information provided in all moduls.

A constant contact with the street is provided by the intensified street and outreach work

Medical consultations

Since 7 years more than 4000 children were provided with help within the framework of the program activities

Risks related to the street life Engaging in criminal structures or activities Engaging in criminal structures or activities Absence of social protection Absence of social protection Sanitary risks Sanitary risks

Sanitary risks Promiscuity Promiscuity Drug use Drug use Absence of information Absence of information

Street children and drugs Tobacco 329 (55,6%) 726 (74,5%) Heavy drugs 50 (8,5%) 324 (33,3%) Sniffing 88 (14,9%) 223 (22,9%) Alcohol 169 (28,6%) 597 (61,3%)

Comparative evaluation of the HIV-rate (for 1000 population, 2002)

Testing results

Average age of HIV-positive street children 15,9 years old

What next?

Harm Reduction program Bus – an outreach unit Provided services: - Needle exchange - Distribution of condoms - Information - Medical and psychological consultations - VCT (HIV, hepatitis B and C, syphilis)

Harm reduction bus activities in 2004 Number of clients Number of visits Number of exchanged syringes Number of tested people % - positive results Average age of clients: - women -23,3 - men 25,5 Main drug – heroine (85%)

HIV prevention program for street commercial sex workers Van – an outreach unit Provided services: - Condoms’ distribution - Needle exchange - Information - Medical and psychological consultations - VCT (HIV, hepatitis B and C, syphilis)

Data for 2004 Number of street female commercial sex- workers (CSW) – % of them are intravenous drug users (UDVI) Number of contacts Number of contacts Number of women contacted Number of women contacted Number of condoms distributed Number of condoms distributed Number of syringes distributed – Number of syringes distributed – Average age – 23,9 Average age – 23,9

Infections among female CSW Study of the end of 2003 HIV – 48% HIV – 48% Syphilis – 44% Syphilis – 44%

Lobbying of HR and access to treatment. Why? - HR is still rather tolerated but not really accepted by the authorities - Drug use is criminalized - Access to health structures is very difficult - No political will of government to change situation

Photo: Hans Jürgen Burkard

Access to treatment About 150 people receive ARV in St Petersburg About 150 people receive ARV in St Petersburg About 300 need ARV and are on the waiting list, but real need unknown About 300 need ARV and are on the waiting list, but real need unknown IDU are practically excluded of this number IDU are practically excluded of this number

What is being done by HAF? - Creation of a network of specialists of concerned medical structures and trainings for them - Trainings for police officers - Creation of an out-patient structure in the Botkin hospital for infectious diseases - Institutional development of the community of PLWHA

IDUs as percent of registered HIV/AIDS cases; IDUs as recipients of any form ARV Source: Central and Eastern European Harm Reduction Network, 2002

Causes of Discrimination against IDU’s in Health Care Settings

Three necessary components for an effective response to HIV in our region Scaled up prevention efforts for vulnerable populations – drug users, sex workers, street kids Scaled up prevention efforts for vulnerable populations – drug users, sex workers, street kids HIV care for everyone that needs it with special attention paid to marginalized groups HIV care for everyone that needs it with special attention paid to marginalized groups Reassessment of drug policies and bringing them in line with European discourse Reassessment of drug policies and bringing them in line with European discourse

Alexander Tsekhanovich Humanitarian Action Foundation , Russia, Saint-Petersburg Ofitsersky pereulok