The HIV outbreak - . L...number of PWID and of HIV prevalence in this population, and monitoring of co-infection and pattern of drug use. 2 3 HVB, HVC & HIV prevalence among PWID,

The HIV outbreakamong IDUs

- evolutions and updates

LISBON16 October 2014

Lavinus Sava- National Focal Point of Romania

� risk assessment in November 2011 (EMCDDA &ECDC) -significant increase in newly detected HIV CASES among PWID in Romania and Greece.

� expert meeting &roundtable in Bucharest in November 2013: -the need to:

◦ scale up HIV prevention interventions for PWID in Romania(HIV testing, NSP & OST);

◦ identify additional funding to maintain and scale up HIV prevention interventions;

◦ strenghten collaboration between government institutions and NGOs;

◦ improve data, including developing more accurate estimates of the number of PWID and of HIV prevalence in this population, and monitoring of co-infection and pattern of drug use.

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HVB, HVC & HIV prevalence among PWID, 2004-2013 (%) – TD I data

3.4 6.9 8.8 10 11.7 10.3 13.1 14.924.5

27.7

47.6 45.8 46.2

65.672.6 71.3

63.968.5

82.474.2

0 1.1 1.44 1.6 1.09 3.3 4.111.6

24.9

49.2

0

10

20

30

40

50

60

70

80

90

100

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

HVB+ HVC+ HIV+

� 49,2 % prevalence - almost double compared to 2012 (809 PWID self reported as previously been in HIV screening- 398 cases HIV +);

� high rates of HVC co-infection (slight decrease compared to previous year);

� heroin is the first drug injected in 2013 but there are high levels of injecting NSP use as well (as first drug or combined with heroin or methadone)- 52,2% use heroin/27,1% NPS;

� higher prevalence of HIV+ for those not for the first time in treatment (51,1%);

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HIV – 2013:

� highest prevalence of HIV+ among IDUs from >34 years old group (58,2%) and little higher prevalence in women (54,3%);

� higher rates of HIV+ in the long term injecting users group - 5 to 10 years and more

� significant increase of HIV+ prevalence among the <2 years injecting drug use ( from 0% in 2012 to 46,2% in 2013).

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Source: Compartment for Monitoring and Evaluation of HIV/AIDS in Romania -INBI “Prof.Dr.M.Balş”

Stable trend - indicates the maintaining HIV+ outbreak

previously detected among PWID .

� heroin is the first drug injected by the IDUs in 2013 but there are high levels of injecting NSP use as well (as first drug or combined with heroin or methadone).This maintains an intensive injecting pattern among IDUs from Bucharest.

� low rates of harm-reductions programmes provision for IDUs caused by the lack of founding;

� high level of syringes sharing (from 24% in 2012 to 41% in 2013) was recorded.

� most of the IDUs infected with HIV comes from the long term users population group (from 5 to 10 years and more) but there is also an obvious increasing trend among short term users group (<2 years). We may then expect in the near future a significant “dispersion” of the HIV infection to the new injectors population.

� limited access of the public medical &social services for the IDUs, caused bytheir social vulnerability(economic, education, ethnic discrimination, deviantand antisocial behaviours) and lack of IDs.

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RISK FACTORS

� The main public actors both government and NGOs involved in prevention of drug related infectious diseases risk remained almost the same (Health Ministry, National Antidrug Agency, National Authority for Penitentiaries, few specialised NGOs) .The General Council of Bucharest (local authority) joined in 2013 as a sponsor for the most extensive NSP implemented by the Romanian Asociation Against AIDS (ARAS) among IDUs population from the capital city.

� In 2013, in Romania were available all 7 key-interventions recommended by the ECDC&EMCDDA guideline for prevention and control of infectious diseases among PWID. Most of the harm-reduction interventions were focused in Bucharest.

� Health Ministry provided public funding for specific Harm-reduction and HIV infection prevention interventions through a National Health Program for HIV prevention. New funding is available from the EEA and Norway grants in 2014 (e.g. RO19 Public Health Initiatives).

� An informal consultation group of experts in harm reduction was created (GIRRAD) in february 2014.

� Starting with 2012, the NAA set up a pilot monitoring system of the Needle& Syringes Programmes available in Romania.

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11087621730776

946820 895160 10743942051770

7284 9417 8966 9000

4460 5148

152 183105 100

240399

1

10

100

1000

10000

100000

1000000

10000000

2008 2009 2010 2011 2012 2013Număr de seringi distribuite Număr CDI deserviţi Număr de seringi/client/an

Source: NAA’s pilot monitoring system of NSP

◦ the number of distributed syringes almost doubled compared to 2012 and is similar to 2008-2009 peak period;

◦ the number of assisted clients increased by 13% (5148 IDUs);

◦ an average of about 400 syringes/client /year was registered (an historical maximum).

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� After an increasing trend started in 2011, HIV prevalence among IDUs from Bucharest has been stabilised in 2013-2014 on high rates confirming the existence of the previously identified HIV infection outbreak (most of the newly detected cases are 25-34 years old males, opioid or poly-drug users from Bucharest).

� NAA, Health Ministry and NGOs partners have set up an working framework for cooperation (expert counselling, monitoring, common and co-financed prevention intervention projects, etc.) which needs to be expanded and constantly improved.

� The changes detected could be explained both by: 1. the low provision rate of interventions aiming to reduce the drug

infectious diseases risk, caused by insufficient funding;2. the increasing efforts of the authorities and NGOs for screening and

monitoring IDUs populations compared to previous 2 years. That made more "visible" the whole scene and enhanced the characteristics of the phenomenon in Romania.

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