1. 30 June – 03 July 2013 – Kuala Lumpur, Malaysia
Social science of HIV and hepatitis C in Russia and southeastern Europe
Sergii Dvoriak M.D., Ph.D Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
Symposium “Social and Structural Determinants of the HIV Epidemic in Eastern Europe and Central Asia”
IAS th IAS Conference on HIV Pathogenesis, treatment and
Prevention
30 June – 03 July 2013 – Kuala Lumpur, Malaysia

2. Eastern Semi-globe

4. 4-th place after China, India and USA

5. UNAIDS, Global Report, 2011
FACT SHEET
Eastern Europe and Central Asia A steep regional increase in new HIV infections and AIDS-related deaths
In EE&CA, the number of people living with HIV almost tripled between 2000 and An estimated 1.4 million [1.3 million–1.6 million] people were living with HIV in compared to [ – ] in 2000.
AIDS-related deaths continue to rise in the region: an estimated [60 000– ] people died from AIDS-related causes in 2009 compared to [14 000– ] in 2001, a four-fold increase.
The Russian Federation and Ukraine together account for nearly 90% of newly reported HIV infections.
Ukraine has the highest adult HIV prevalence in all of Europe and Central Asia, at 1.1% [1.0%–1.3%]. Annual HIV diagnoses in Ukraine have more than doubled since
Between 2000 and 2009, the HIV incidence rate increased by more than 25% in five countries in the region: Armenia, Georgia, Kazakhstan, Kyrgyzstan and Tajikistan.

6. Social Determinants of Health
Complex and overlapping community, social, economic, and environmental factors that influence an individual’s and a collective community’s risk for health inequities.

7. Structural factors on HIV-Epidemic
Health care and
Social welfare systems
Disease-specific public health response
Treating of vulnerable groups (PWID, Sex workers, prison populations etc.)
Evidence-based drug policy

8. Barriers Unequal distribution of wealth and power; Classism Racism
Sexism
Homophobia
Transphobia
Narcophobia

9. HIV, HCV, Mental Health problems
Predisposition to DA
Poverty
Addiction + Risky Bhv
Unemployment
Incarceration
HIV, HCV, Mental Health problems

10. The HIV Epidemic in Ukraine
In 1995, the WHO characterized Ukraine as a low prevalence country. By 1996, all 25 regional capitals in Ukraine reported HIV, primarily among drug injectors. In some cities, rates of HIV among IDUs rose from nearly zero in 1994 to more than 50% two years later. Today, Ukraine is the most HIV-affected country in Europe and Central Asia, with an estimated 260,000 infected between the ages of , or 1.13% of the population in this age range. Prevalence among PWID – 21.5%. (Bio-behavioral Survey, 2011)

11. Social reasons: The social and economic disintegration that followed the collapse of the Soviet Union in 1991.
With the withdrawal of the Soviet Union in December 1991:
Police controls became ineffective, drugs more readily available, and corruption uncontrolled.
In the first 5 years following the demise of the Soviet Union, the magnitude of the illicit economy was estimated to have tripled, reaching more than 40% of the gross national product from 1994 through 1995.
Locally produced opiates and amphetamines proliferated. Registered drug users increased from 30,000 to 63,000 between 1990 and 1996.
State-supported services, including health care, were reduced or eliminated.
Robert Booth at all AIDS Behav

12. Registered drug users in Central Asia (UNODC World Drug Report, 2010)

13. Russia 547,000 – registered addicts 102.5 mln of age 15-64
Estimated Prevalence 1.64% Total ~1.68 mln drug users

14. HIV Incidence by Mode of Transmission in Russia, 1987-2008

15. HIV transmission in Ukraine
Injection of drugs
From mother to child
Data of the Ukrainian AIDS Center
Sexual
Undetermined

16. Mode of Transmission Attributed to HIV Cases by Gender in Ukraine, 2005-2011

17. Monitoring of Epidemic Trends
The main indicator– HIV prevalence among high- risk groups
Example – HIV prevalence among IDUs using drugs at least 2 years
2005г. – 23,8%
2006г. – 20,2%
2007г. – 18,9%

18. HIV prevalence among recent IDUs and IDU coverage by prevention programs, 2004-2011
HIV Prevalence among recent IDUs (injecting for less than 3 years) was used as proxy incidence.
Median value for 8 cities: Donetsk, Lutsk, Odessa, Poltava, Simferopol, Summy, Kharkov, Kherson.
Prevention program coverage at last 12 month
With increasing coverage over the last 6 years, HIV incidence has been declining significantly: from 29.9% percent in 2004 to 5.5% in 2011
Coverage

19. Prevalence of Hepatitis C among People who Inject Drugs*
*Cumulative information on infections over the last decades. Incidence of hepatitis C infections is unavailable in most countries.

21. STOP HARM REDUCTION!
Needle / syringes exchange programs stimulate a tolerance toward patients with drug abuse and violators of Russian federation’ legislation Russian Minister of Health (2010)

23. About methadone
“In honor of Hitler it was named Adolphine and later Dolophine”.
“In the majority of nations methadone was completely prohibited. Any supply of this compound is stored and safely put away completely in the West”.
“Methadone was used as a detonator in conducting so called ‘colored’ revolutions. It was established with the breakup of Yugoslavia: there was a factory made for the production of methadone and it was distributed for free, until civil unrest. Then the factory was closed and thousands of drug users began to vandalize and destroy everything in their way”.
“Rossiyskaya Gazeta”

24. Russian Authorities are categorically against OST
“EC countries make a pressure to us for implementation of OST. They want we do treat drug addicts by other drugs”.
FDCS will not allow to stick Russia methadone therapy.
“The USA and some European countries support us”.

27. Study of Structural Barriers to HIV Prevention and Treatment Among Drug Injectors in Odessa, Ukraine (2010).
Legal and economy collapse leaded to increasing risky behavior.
The epidemic is largely sustained by the lack of government resources devoted to the problem, the continued risky drug using practices of injection and,
perhaps most importantly
by the risk environment
surrounding drug users.
Collaboration and especially financial support of government to NGOs is very poor.

28. Opinions of Most Effective Strategies for Treating Addiction (N=239)
It would be interesting how it looks among medical staff, particularly MDs

29. CONCLUSIONS
Many social barriers in FSU countries continue to support the epidemics (HIV & HCV).
Joint efforts needed to change drug policy, drug treatment with HIV.HCV prevention; and eliminate stigma from PWID.
Drug policy and treatment/prevention approaches have to be based on scientific evidence.
Public health issues must be the priority

30. Thank you for your attention. Contacts: dvoryak@uiphp.org.ua