1. Injecting Drug Use, HIV/AIDS Epidemic and Harm Reduction Strategies Fabio Mesquita, MD, PhD Harm Reduction Adviser IHPCP - Indonesia Pertemuan Nasional HIV & AIDS Ke – 3 Surabaya – 2007

2. TWO MAJOR EPIDEMICS AIDS DRUGS

3. Drug Epidemic AIDS Epidemic

7. Guiyang Kunming Mandalay Yangon Chiang Mai Bangkok Hanoi Vientian e Phnom Penh Ho Chi Minh City Songkhla MYANMAR LAOS CAMBODIA THAILAND VIETNAM CHINA Hong Kong MAJOR HEROIN TRAFFICKING ROUTES IN SE Asia Source: UNODC Regional Centre for East Asia and the Pacific Courtesy BBC World

8. HIV/AIDS Hepatitis B, C and D Overdoses Hepatic chronic diseases Co-Morbidity with Mental Health Addiction Abscesses Endocarditic Syphilis, Malaria, HTLV, etc Tuberculosis/Other Respiratory diseases Car accident Occupational Accidents Violent deaths HEALTH CONSEQUENCES

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

10. Most countries have IDU ignited HIV Non IDU initiated IDU initiated

15. CONDONS AVAILABLE FOR FREE DISTRIBUTION 800 MILLION FOR 2006 1 BILLION FOR 2007 PLUS REGULAR MARKET AND SOCIAL MARKET (DKT)

16. TEST AND COUNSELING FIRST VCT OPEN IN 1989 TOTAL POPULATION EVER TESTED 28,1% - AUGUST 2004

18. 0 20000 40000 60000 80000 100000 120000 140000 160000 180000 jan/97 abr/97 jul/97 out/97 jan/98 abr/98 jul/98 out/98 jan/99 abr/99 jul/99 out/99 jan/00 abr/00 jul/00 out/00 jan/01 abr/01 jul/01 out/01 jan/02 abr/02 jul/02 out/02 jan/03 abr/03 jul/03 out/03 jan/04 abr/04 jul/04 out/04 jan/05 abr/05 jul/05 out/05 170.000 * Dados preliminares Projected Number of patients receiving ARV therapy. Brazil, 1997 – 2005

20. ARV availability in low and middle income countries, according to geographical region. June, 2005* Source: “Progress on Global Access to HIV Antiretroviral Therapy, June 2005 update, World Health Organization Region Number of people receiving ARVs Estimated need Coverage Sub-Saharan Africa 500,000 4,700,000 11% East, South and South-East Asia 155,000 1,100,000 14% North Africa and Middle East 4,000 75,000 5% Eastern Europe and Central Asia Central 20,000 160,000 13% Latin America and the Caribbean 290,000 465,000 62% Total 970,000 6,500,000 15% (Average) *Adults only, average figures

21. AIDS Hospital Admissions in Public Health System in Post HAART Era. Brazil (1996-2001) Source: MOH, 2002

23. AIDS incidence and mortality rates (by 100,000 inhabitants) Brazil, 1985-2003 Sources: Incidence - PN STD-AIDS/SVS/MH. Mortality – SIM/DASIS/SVS/MH 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 0 5 10 15 20 25 Mortality Incidence

24. Distribution of PCP, Toxoplasmosis and Tuberculosis in Reported AIDS Cases to MOH (Brazil, 1981-2001) Source: MOH, 2002 HAART

25. Estimate of HIV Infected Individuals (among 15 a 49 years old) by year 2000 Word Bank Projection (1992) Brazilian MOH Estimate (2000) 0 200 400 600 800 1000 1200 1400 Thousands 1,200,000 600,000 MOH, 2002  50%

26. Dados de Casos de AIDS no Brasil Gráfico 1 – Casos de aids segundo ano de diagnóstico. Brasil, 1980-2003. Fonte: MS/SVS/PN DST e Aids/SINAN.

27. INDONESIAN RESPONSE FOR HIV/AIDS CRISIS AMONG AND FROM IDUS First AIDS case in Indonesia: 1987 First case in IDU: 1995 First Harm Reduction Project: 1999 Ongoing: NEP. Methadone, CST for IDUs

28. Grafik 1: Jumlah Kasus AIDS di Indonesia 10 Tahun Terakhir Berdasarkan Tahun Pelaporan sd 31 Maret 2006 ----------------------------------------------------------------------------------------------------------- Figure 1 : Number of AIDS Cases in Indonesia in Last 10 Years up to March 31, 2006

29. Risk Factors Indonesian Epidemic

31. HIV PREVENTION AND CARE FOR IDUs After 25 years of the HIV/AIDS we’ve learned how to confront the epidemic among and from injecting drug users

34. Evolution of Indonesian Response - NSP