1. Current state of HIV and associated infections epidemic among adolescents and youth: LATVIA Anda Karnite, MPH, PHD Riga Stradins University and Baltic HIV Association St Petersburg, 27th November 2013

2. Number of newly registered HIV and AIDS cases in Latvia (2000-2013)

3. HIV incidence and prevalence rates in Latvia (registered cases) (1987-2012)

4. Number of HIV tests performed in Latvia

5. Number of newly registered HIV cases by mode of transmission in Latvia (2000-2013)

6. The Latvian HIV-1 outbreak among intravenous drug users (IDUs) in 1997–1998 involved subtype A1.... We estimated that subtype A1 was introduced from Former Soviet Union around 1997 and initially spread explosively among IDUs in Riga. A recent increase of heterosexually infected persons did not form a separate subepidemic, but had multiple interactions with the IDU epidemic. Subtype B was introduced before the collapse of the Soviet Union and primarily has spread among men who have sex with men.

7. Number of newly registered HIV cases according to gender (1987-2013)

8. Total number of cases (1987-2011) according to gender and age at diagnosis

9. Newly registered HIV cases (2000-2010) by gender (within age group 15-25 years)

10. Number of newly registered cases according to mode of transmission, females (1995-2010) 11/27/13

11. Number of newly registered cases according to mode of transmission, males (1995-2010) 11/27/13

12. Newly registered cases in penitentiary istitutions (1997-2012)

13. Subnational differences in HIV prevalence (end of 2012; per 10,000 inhabitants) 13.1 Pierīga 13.5 51.4 2.4 8.0 4.0

14. Studies on HIV prevalence among PWID in Latvia

15. Furthermore, our model shows that social heterogeneity of the susceptible population can explain the shift in HIV-1 incidence in Latvia over the course of the epidemic. Thus, the decrease in IDU incidence may be due to local heterogeneities in transmission, rather than the implementation of control measures. Increases in susceptibles, through social or geographic movement of IDU, could lead to a boost in HIV-1 infections in this risk group.

16. RDS studies among PWID in Latvia HIV (%) Hepatitis C (%) 20072012 20072012 Total22.631.774.482.0 By gender Males21.727.478.984.1 Females24.844.663.675.7

17. RDS studies among PWID in Latvia (2) HIV (%) Hepatitis C (%) 20072012 20072012 Age group 24 years and younger 15.613.859.065.5 25–34 years 26.135.282.683.1 35+ 24.831.878.084.5

18. RDS studies among PWID in Latvia (3) HIV (%) Hepatitis C (%) 20072012 20072012 Injecting career <2 years 7.57.742.546.2 2 - <5 years 7.423.851.552.4 5 - <10 years 27.740.483.880.8 10+ years 29.431.885.287.4

19. RDS studies among PWID in Latvia (4) Sharing needles / syringes (both lending and borrowing; last 4 weeks): - 2007 – 29.6% - 2012 – 36.7% HIV (%) Hepatitis C (%) 20072012 20072012 Main drug injected Opioid 26.138.587.491.1 Other (amphetamine) 19.523.162.074.1

20. Coverage NEP/SEP 17 LTCs in 2013

21. Coverage NEP/SEP (2)

22. Coverage NEP/SEP (3) 23.7 syringes per PDU (n=13,141 according to Trapencieris et al.) per year in 2012 2261 clients PWID in 2012 (around 130 per NEP) 34546 client contacts in 2012 (1920 per NEP, i.e. 160 per month) Least discussed topic in 2012 – TB; most often: addiction problems, psychological support, social support

23. Coverage, OST (9 Methadone cabinets, Buprenorphine in 5 cities in 2012) Despite the increase the coverage is 2-3%, still the lowest in Europe Not all clients are everyday clients...

24. Registered HIV/TB cases in Latvia (1998-2012) 46 cases are among drug users / drug injectors

25. Registered TB cases (2012) according to gender and age (per 100,000 inhab.)

26. Number of notified acute HCV cases in Latvia (2010-2013)

27. Young people (including those at higher risk) in Latvia According to the Youth Law of the Republic of Latvia young people are persons from 13 to 25 years of age 2011 – biobehavioural study among female (outdoor) sex workers (EC project BORDERnetwork) – 23% of females engaged in sex work before the age of 18 years ! 83% of sex workers have experience of drug use

28. Young people (including those at higher risk) in Latvia 2008 – research on drug use among young people in children’s homes, boarding schools, social correction institutions (13-16 years of age)

29. Young people (including those at higher risk) in Latvia (2) ESPAD (2011, 15-16 years of age) – in Riga marihuana / hashish tried more comparing to the rest of the country

30. Young people (including those at higher risk) in Latvia (3) ESPAD (1995-2011) – increasing trends for drug (marihuana) use

31. Young people (including those at higher risk) in Latvia (4) HBSC study (2009/2010; 15-year-olds)

32. Thank you! Autumn in Riga