HIV and Drugs: The Challenge and The Open Door

1. HIV and Drugs: The Challenge and The Open Door Dr Ehab El Kharrat

2. Global summary of the HIV/AIDS epidemic,December 2005 Number of people living with HIV in 2005 Total 40.3 million (36.7 – 45.3 million)Adults 38.0 million (34.5 – 42.6 million) Women 17.5 million (16.2 – 19.3 million) Children under 15 years 2.3 million (2.1 – 2.8 million) People newly infected with HIV in 2005 Total 4.9 million (4.3 – 6.6 million)Adults 4.2 million (3.6 – 5.8 million)Children under 15 years 700 000 (630 000 – 820 000) AIDS deaths in 2005 Total 3.1 million (2.8 – 3.6 million)Adults 2.6 million (2.3 – 2.9 million)Children under 15 years 570 000 (510 000 – 670 000) The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information.

3. Adults and children estimated to be living with HIV as of end 2005 Eastern Europe & Central Asia 1.6 million [990 000 – 2.3 million] Western & Central Europe 720 000 [570 000 – 890 000] North America 1.2 million [650 000 – 1.8 million] East Asia 870 000 [440 000 – 1.4 million] North Africa & Middle East 510 000 [230 000 – 1.4 million] Caribbean 300 000 [200 000 – 510 000] South & South-East Asia 7.4 million [4.5 – 11.0 million] Sub-Saharan Africa 25.8 million [23.8 – 28.9 million] Latin America 1.8 million [1.4 – 2.4 million] Oceania 74 000 [45 000 – 120 000] Total: 40.3 (36.7 – 45.3) million

4. Estimated number of adults and childrennewly infected with HIV during 2005 Eastern Europe & Central Asia 270 000 [140 000 – 610 000] Western & Central Europe 22 000 [15 000 – 39 000] North America 43 000 [15 000 – 120 000] East Asia 140 000 [42 000 – 390 000] North Africa & Middle East 67 000 [35 000 – 200 000] Caribbean 30 000 [17 000 – 71 000] South & South-East Asia 990 000 [480 000 – 2.4 million] Sub-Saharan Africa 3.2 million [2.8 – 3.9 million] Latin America 200 000 [130 000 – 360 000] Oceania 8200 [2400 – 25 000] Total: 4.9 (4.3 – 6.6) million

5. UNDCP – Global Illicit Drug Trends 2002 Afghanistan the Region’s Major Opium Producer

6. Concentrated Epidemics • Epidemics where HIV prevalence is below 1% in the “general adult population” and over 5% in at least one group at higher risk • Typical groups at higher risk: • FSW and MSW • MSM • IDU • Others: Inmates, migrant workers, etc • May or may not imply a transition towards generalized epidemics

7. 1993 <5% High Risk Group > 5% High Risk Group >1%Antenatal Women

8. Behind the earlier map the trend is hidden and so is the potential. Asia has shown the highest proportional growth rate of HIV in recent times. • Colour of map should change to better identify the “hot spots”

9. 2004 <5% High Risk Group > 5% High Risk Group >1%Antenatal Women 8 M HIV+ I M new Infections 0.5 M deaths

10. Colour of map should change to better identify the “hot spots”

11. Concentrated Epidemics in the World • Asia: HIV epidemics in part generalized, in part low-level, in part concentrated on IDU and MSM • Latin America (not Caribbean): Mostly concentrated on MSM; also in IDU in Southern Cone. • North Africa/Middle East: In some countries concentrated in IDU, MSM • Eastern Europe/Central Asia: Mostly IDU

12. HIV rise among IDUs in Indonesia Indonesia • before 2000: HIV + were less then 1% • In the year 2000: it became 19% (in Bali up to 50%) China: 70% of PLWHA are IDUs Myanmar 65% Iran 75% (2002)

13. Russia:1997 20 000 2001 1 500 000 • Ukraine: 1 600

14. HIV Prevalence in 2015 (Projections) Under policy intervention If policy intervention is postponed for 5 years If status quo

15. IDUs Driven Epidemic

16. HIV prevalence among injecting drug users in Kathmandu, Nepal: 1991-1999 60 50 40 30 % HIV-positive 20 10 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 Sources: Peak A et al. (1995); AIDS. Gurubacharya RL et al. (1998); 12th World AIDS Conference, Abstract 23246. Oelrichs RB et al. (2000) J. Virol.

17. Poor coverage 5.4% 19% 1% 8% Source: WHO (2004). Coverage of Selected Services for HIV/AIDS Prevention, Care and Support in Low and Middle Income Countries in 2003

18. Behind the earlier map the trend is hidden and so is the potential. Asia has shown the highest proportional growth rate of HIV in recent times.

19. What is “comprehensive HIV prevention” for IDU? • Prevention of drug use • Treatment • Drug substitution • Therapeutic communities • Outpatient drug free programs • Harm reduction: • Behavior change programs to promote condom use, reduction in numbers of partners and other safer behaviors • Outreach • Needle exchange • HIV counseling and testing • Care settings • Prevention programs for PLHA WHO advocacy guide for IDU, 2004

20. Is it our calling? • Comparative advantage/ Anointing and calling

21. Can we afford not to work on HIV? • If you do not get tested, you are not HIV negative you are only HIV ignorant • There is life after addiction • There is life after HIV • There is life after HIV and Addiction • You and Those whom you serve may well be HIV positive

22. HIV Prevention: Involvement of Faith Based Drug Projects • Assets: 1.History of doing outreach, but the goal was abstinence only. 2.Strong peer education/involvement, but only as a start to a rehabilitation process 3.Professional and former addicts team 4. Understand stigma, understand denial

23. HIV Prevention: Involvement of Faith Based Drug Projects Challenges: 1.HIV/AIDS denial 2.Double stigmatization 3.Fear 4.Christian and 12-Step resistance 5.The safe sex issue