Track E report by Colby Donn
The first part of the session was a review of the HIV epidemic in the region by M. Donoghoe of Denmark. Although the HIV prevalence rate in the region is lower than in Africa, it is rising rapidly and is now the fasting growing HIV epidemic in the world. The numbers of known infected persons has doubled since 2001 and is now higher in Eastern Europe than in Western Europe. Only 23% of PLWH are on ART, less than half the global average of 54% for low and middle-income countries. 43% of infections are due to IDU, 45% of infections are due to heterosexual sex, many of whom are sexual partners of IDU. MSM are a small % of infections, but probably is underreported because of stigma and discrimination. Mother to children transmission is very low.
Access to services for IDU is poor. Few countries provide needles and syringes at the numbers needed for HIV prevention. IDU have less access to ART than other groups. Co-infection with hepatitis B, hepatitis C, and TB is common. 91% of funding for HIV/AIDS programs comes from international donors, threatening stability of programs as donor support decreases.
The second half of the session was a panel discussion with representatives of governments, NGOs, civil society, PLWH, and the media. Panelists and audience members made a number of suggestions for improving access to HIV prevention and treatment services:
- Improve referral and coordination between services.
- Provide health care services through primary care offices rather than in specialist centers.
- Increase HIV testing through use of rapid testing, testing in the community, testing in the private sector, and universal testing.
- Increased access to opiate substitution treatment (OST) such as methadone.
- Address the severe stigma and discrimination against IDU in the former Soviet block countries.
At the session a copy of the WHO report European Action Plan for HIV/AIDS 2012-2015 was distributed. The report is available at www.euro.who.int
CPC report by Terje Anderson
This regional session explored the question of why, at a time when most parts of the world are experiencing stable or slowing epidemics, the Eastern European/Central Asian region is seeing the most rapidly accelerating epidemic in the world - one driven primarily by sharing of injection equipment and heterosexual transmission to the partners of drugs users.
An opening video presentation gave voice to people from across the region who were unable to attend the conference in person - drugs users, HIV+ people, and others. They personalized a number of key issues in the region - including lack of access to substitution therapy, police and social harassment of IDUs and sex workers, women losing custody of children, access issues in prison, travel restrictions, uneven access to medications/health care for HIV and other infections.
An overview of the epidemiology (Martin Donoghoe, WHO) detailed the growth in new infections. Only 23% of those in need of ARV treatment in the region are currently receiving it, a number less than half of the estimates for sub-Saharan Africa. While IDUs constitute 59% of the estimated 1.3-1.8 infected people in the region, they represent only 21% of those currently receiving treatment, a gross disparity.
A panel of diverse experts and activists from the region engaged in lively discussion of the challenges, with focus on several key issues, including:
- the central nature of injection drug use in the epidemic, in an environment of public and political hostility to drugs users, punitive laws, lack of access to substitution therapy.
- lack of national government support in many countries, with 91% of the HIV funding in the region coming from international sources. Only 11% of funding across the region is currently going to key populations.
- co-morbidities of TB, HCV and addiction - with poor integration of systems of care.
- the need to instill a greater sense of urgency and political will through community mobilisation, lobbying, political leadership and media outreach.