ISSN 1472-4863. Published by i-Base.
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November 24-25 2007
On November 24-25 2007, the European AIDS Treatment Group (EATG) in partnership with the Eurasian Harm Reduction Network (EHRN - formerly CEEHRN) held a seminar in Vilnius, Lithuania, entitled Access to HIV treatment drugs for injecting drug users (IDUs) in Central and Eastern Europe. The seminar was organised within the framework of the ““AIDS Action & Integration”, led by AIDES and funded by the European Commission (DG SANCO).
The Action and Integration project is designed to promote the development of local, community based actions on HIV/AIDS in Central and Eastern Europe.
The November seminar targeted primarily people directly involved in the provision of HIV treatment and care to injecting drug users (IDUs) such as NGOs, activists, representatives of the drug users’community, and people living with HIV/AIDS from the new Member States and accession countries of the European Union. The purpose was to share experience and learn more about delivering treatment to IDUs. Targeting IDUs in Central and Eastern Europe is based on evidence that injecting drug use represents one of the major transmission routes of HIV in the region.
Today, the question of HIV care for IDUs in the Region is less a matter of financial resources than one of delivery.
Scientific evidence demonstrates that treatment outcomes for IDUs can be as good as the outcomes for other patients if appropriate services are provided.
The seminar gave East and Central European participants the opportunity to exchange best practices in the region and neighbouring Europe in order to overcome barriers faced by IDUs with HIV.
Other relevant issues were pointed out to raise awareness on the importance of integrating adequate TB and Hepatitis care as well as the provision of substitution therapy services with antiretroviral therapy (ART) services.
Eastern Europe is the home of 1.6 million people living with HIV (PLWH) and up to 2.8 million injecting drug users (IDUs). The region suffers from a heterogeneous dynamic. In the Czech Republic, Hungary, Slovakia and Slovenia, the predominant mode of transmission is sexual (heterosexual) intercourse even though there have been increases in the number of new cases reported among men who have sex with men. In Romania, most HIV infections took place among children who are now adolescents and young adults and recently HIV cases are reported to be acquired through heterosexual intercourse.
In Eastern Europe and Central Asia, the predominant transmission route for HIV infection is the sharing of injecting equipment. However, there is evidence of increasing heterosexual transmission. 64-85% of cumulative registered HIV cases with known transmission routes in Azerbaijan, Belarus, Estonia, Latvia, Lithuania, Moldova, Russia and Ukraine occurred among IDUs.
These figures suffice to demonstrate that harm reduction measures targeting IDUs need to be scaled-up in the region. There is also a need to improve both access to and the quality of health and social services (based on a non-discriminatory approach).
A number of studies were carried out to monitor current access to services including antiretroviral therapy (ART). The European and Central Asian governments signed the Dublin Declaration and thus committed themselves to eliminate inequality in treatment provision and to ensure equal universal access to ART for all people in need by 2005. It is worrying to observe that the region is far behind schedule.
Central European countries, like Western European countries, report good access to ART (defined as 75% and higher treatment coverage of the estimated number of people in need of ART) in 2004.
Eastern Europe and Central Asia have the second lowest coverage of antiretroviral therapy in the world. However, the region has seen significant increases in funding available for access to ART and significant expansion of access to ART within the last few years.
Despite this progress, access to ART for IDUs remains disproportionately low in the region overall.
Russia and Ukraine, where most of HIV-positive IDUs live, show low coverage and are rolling out antiretroviral therapy programmes, with ambitious plans to provide therapy to 60% (inRussia) and 55% (in Ukraine) of people in need by 2008.
The Baltic countries with fast developing upper-middle income economies, relatively small populations and with injecting drug use-driven HIV epidemics continue to experience problems with delivery of ART to IDUs.
A number of social and physical barriers are still in place. The impact of stigma cannot be underestimated. IDUs living with HIV face dual stigma associated with both injecting drug use and positive HIV status.
Low levels of knowledge about ART and misconceptions about treatment for IDUs is also one of the key barriers to treatment. In particular, the knowledge of ART needs to be improved in low prevalence countries. Myths or incomplete information about side effects, interactions with illicit drugs and interactions with opioid substitution treatment (OST) often discourage treatment uptake.
Patient’s education is thus recognized as a key facilitator of treatment adherence. Some interesting programmes for patient’s education have been piloted such as “patient schools” but are often challenged to find sustainable funding. Adequate education of health care staff is essential in order to improve access to treatment and care for IDUs.
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