HIV/AIDS prevention and care among injecting drug users and in prison settings in Estonia,

Latvia and Lithuania

Signe ROTBERGA, UNODC, Baltic States

30 April 2009

Information about the project

• Duration: 2006 – 2010• Government Focal Agencies: MOH, MOSA, MOJ• Budget: 5 000 000 USD• Overall goal: to halt and reverse the HIV/AIDS

epidemics among IDUs and in prisons, and to avoid generalised epidemic

Project objectives:

• Build national and regional consensus on effective implementation strategies to address HIV/AIDS among IDUs and in prison settings

• Increase coverage of comprehensive HIV/AIDS prevention and care services

• Generate and share strategic information to respond appropriately to evolving HIV/AIDS epidemics

Obj.1: Build national and regional consensus on effective implementation strategies to address HIV/AIDS among IDUs and in prison settings

• Rapid assessment and response on drugs in prisons inLatvia and Lithuania

• Assessment of legal barriers for effective HIV prevention inprisons in Latvia and Lithuania

• Evaluation of pharmacotherapy in Latvia and Estonia• Assessment of availability of syringes in pharmacies in

Lithuania• Estimation of IDU population size in Lithuania

Incarceration rate(imprisoned people per 100 000 inhabitants)

Estonia 270Latvia 299Lithuania 236EU average 121

HIV prevalence in prisons

Estonia 15.8%Latvia 6.6%Lithuania 3.7%

RAR to drugs in Valmiera prison, Latvia

• 20% of prisoners inject drugs regularly (30-50% according to some inmates)

• 70-80% of prisoners had used drugs before imprisonment

• 10% started to use drugs in prison• Most effective prevention: unwritten laws

“You can place us under a glass dome, but we will find ways how to get the drugs in”

RAR to drugs in Marijampole prison, Lithuania

• 30-60% of prisoners use drugs at least once per month• 5-15% of prisoners inject drugs every day• Up to 10% start to use drugs in prison• Unsafe injecting practices: sharing syringes, using self-

made syringes• Cleaning syringes: tap water, boiling water, lemon juice,

very seldom disinfectants

Obj.1: Build national and regional consensus on effective implementation strategies to address HIV/AIDS among IDUs and in prison settings• Increased awareness on HIV among decision makers in MOJ

and Prison Administration• Policy dialogue promoted between MOJ and MOH• Coordination and collaboration between national drugs and HIV

programmes• Involvement of civil society organizations

Obj.1: Build national and regional consensus on effective implementation strategies to address HIV/AIDS among IDUs and in prison settings

• New national HIV programmes for Latvia and Lithuania• Evaluation of national response to HIV in Estonia

(WHO/UNODC)

Objective 2: Increase coverage of comprehensiveHIV/AIDS prevention and care services among IDUs and inprison settings

Outputs: 2.1. Improved institutional and professional capacity to address

HIV/AIDS among IDUs and in prisons2.2. Increased access to HIV/AIDS prevention and care

services for IDUs and in prison settings

Capacity building in 2007 - 2008

• 39 training seminars, 819 participants• 8 study tours, 60 participants• 19 conferences/meetings, 1188 participants• Professional networking and training: participation in 18

international events, 103 persons

Capacity building

• Training needs assessment • Training topics: pharmacotherapy, needle

and syringe programmes, outreach, ASI, advocacy, monitoring and evaluation, estimating IDU prevalence

• Target groups: physicians, nurses, social workers, prison staff, policy makers, NGOs, police

• All training events evaluated, positive feedback received

Information and education materials• Training module on pharmacotherapy developed and approved in

Lithuania• Handbook on reduction of health risks for drug users in prisons (in

Latvian)• Information materials in Lithuanian and Russian on HIV and TB, STI,

hepatitis and drug overdose• Directory on health and social services for drug users in Lithuania

Information and education materials

• Handbook on VCT in Lithuania• Legal aspects on drug use in Latvia and

Lithuania• Information about harm reduction

programmes• NGO Convictus work in prisons

Output 2.2.: Increased access to HIV/AIDS prevention and careservices for IDUs and in prison settings

SERVICES SUPPORTED BY SMALL GRANTS PROGRAMME

• Needle and syringe programmes• Methadone maintenance therapy• Information and education in prisons

SMALL GRANTS PROGRAMME 2007 - 2008

Country Number ofapplicationsreceived

Number ofprojectssupported

Total budget inUS$

Estonia 4 2 48,000

Latvia 52 36 745,900

Lithuania 41 28 702,700

Scaling-up pharmacological treatment of opioiddependence in Lithuania

Indicators to measure access to services

• Availability (Y/N? number of sites per 1000 IDUs ) • Coverage (% IDU using services)• Quality (Adhering to WHO/UNODC guidelines)

Quality combined with scale-up will make a difference on the intervention’s impact on the epidemic.

Source: WHO/UNODC/UNAIDS TECHNICAL GUIDE for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users

Pharmaco-therapy(PT)

Estonia Latvia Lithuania WHO/UNODC recommendation

2006 2008 2006 2008 2006 2008

Number IDU in PT

Number of IDU

% IDU in PT

Number of PT sites

555

13 800

4.0%

8

670*

13 800

4.8%

8

124

10 000

1.00%

4**

164

10 000

1.6%

8**

402

4 000 (8000)

10.00%

12

512

3 200

16.0%

17

moderate: 10-19%

good: 20-39%

Coverage of long-acting opioid maintenance treatment

* Does not include drop-outs, etc.** Out of these only one site providing MMT

Availability of methadone maintenance therapy inprisons and arrest houses

Estonia: only for detoxification in prisonsLatvia: not available; pilot project planned for 2009Lithuania:

not available in prisons; pilot project planned by the endof 2010; continuation of MMT provided in some arrest houses

Objective 3: generate and share strategic information, lessons learned

• Participation in expert meetings / conferences– International harm reduction conference in Vilnius in 2008

• Project website created• Mid–term evaluation

UNODC Project Office for the Baltic States website

http://www.unodc.org/unodc/en/baltics/index.html