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Implementing hiv and sti programmes with keypopulation alexandr kossukhin

  1. IMPLEMENTING HIV AND STI PROGRAMMES WITH KEY POPULATIONS Dr. Alexandr Kossukhin, HIV Programme Specialist United Nations Population Fund, Regional Office for Eastern Europe and Central Asia Delivering a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled.
  2. UNAIDS 90-90-90 STRATEGY HIV treatment is a critical tool towards ending the epidemic. HIV treatment prevents illness, death and averting new infections Treatment targets by 2020 90% diagnozed 90% on treatment 90% virally suppress ed
  3. PROPORTION OF CD4 CELL COUNTS <350 REPORTED FOR HIV CASES OLDER THAN 14 YEARS, DIAGNOSED IN 2012 (DATA OF ECDC AND WHO EURO) 75 53 0 10 20 30 40 50 60 70 80 Albania Armenia Azerbaijan Belarus Bosnia and Herzegovina Georgia Kazakhstan Kosovo Kyrgyzstan FYRMacedonia Moldova Montenegro Serbia Tajikistan Turkey Turkmenistan Ukraine Uzbekistan PEOPLE ARE NOT MUCH MOTIVATED TO KNOW THEIR HIV STATUS
  4. PROPORTION OF CD4 CELL COUNTS <350 REPORTED FOR HIV CASES AMONG MSM, DIAGNOSED IN 2012 (DATA OF ECDC AND WHO EURO) 78 46 0 10 20 30 40 50 60 70 80 90 Albania Armenia Azerbaijan Belarus Bosnia and… Georgia Kazakhstan Kosovo Kyrgyzstan FYRMacedonia Moldova Montenegro Serbia Tajikistan Turkey Turkmenistan Ukraine Uzbekistan
  5. ESTIMATED NUMBER OF ADULTS AND CHILDREN NEWLY INFECTED WITH HIV2013 Middle East & North Africa 25 000 [14 000 – 41 000] Sub-Saharan Africa 1.5 million [1.3 million – 1.6 million] Eastern Europe & Central Asia 110 000 [86 000 – 130 000] Latin America 94 000 [71 000 – 170 000] Caribbean 12 000 [9400 – 14 000] Total: 2.1 million Sub-Saharan Africa: 1.5 million Eastern and Southern Africa (ESA) Region: 1.1 million Asia and the Pacific 350 000 [250 000 – 510 000] North America and Western and Central Europe 88 000 [44 000 – 160 000] 5
  6. NEWLY DIAGNOZED HIV INFECTIONS BY COUNTRY (DATA OF ECDC, WHO EURO, 2012) 0 20 40 60 80 100 120 140 160 2006 2007 2008 2009 2010 2011 2012 Serbia Albania Bosnia and Herzegovina Montenegro FYR Macedonia Linear (Serbia) Linear (Albania) Linear (Bosnia and Herzegovina) HIV spread in Balkan countries is low, but trend to its increase is there
  7. Between 40% and 50% of all new HIV infections among adults worldwide occur among people from key populations and their immediate partners 0 50 100 150 200 Albania Armenia Azerbaijan Belarus Bosnia Georgia Kazakhstan Kosovo Kyrgyzstan Makedonia Moldova Serbia Tajikistan Turkey Turkmenistan Ukraine Uzbekistan 0 100 200 0 100 200 300 HIV PREVALENCE AMONG KEY POPULATIONS PER 1000 IN COUNTRIES OF EECA REGION (DATA OF NATIONAL REPORTS OF IMPLEMENTATION OF UNGASS DECLARATION (2012-2013) Sex workers MSM PID
  8. KEY POPULATIONS GUIDANCE • WHO Consolidated Guidelines on HIV, Prevention, Diagnosis, Treatment and Care for Key Populations • SWIT, MSMIT, DUIT, TRANSIT (by WHO, UNFPA, WB and others) • Global Commission on HIV and the Law (by UNDP and others) • World Bank/JHSPH/UNFPA/UNDP/UNODC Global HIV Epidemics series • UNAIDS Guidance Note on HIV and Sex Work Focusing on populations with higher risk of exposure to HIV: sex workers, MSM, transgenders, prisoners and PID is a key to tackle the epidemic
  9. The guidelines addresses: • comprehensive package of • clinical interventions critical enablers • service delivery • decision-making, • planning and monitoring and evaluation WHO CONSOLIDATED GUIDELINES ON HIV, PREVENTION, DIAGNOSIS, TREATMENT AND CARE FOR KEY POPULATIONS
  10. Summary of recommendations ALL KEY POPULATIONS • Condoms and condom-compatible lubricants • Post Exposure Prophylaxis (PEP) • Interventions to fix problems with alcohol and substance abuse MEN WHO HAVE SEX WITH MEN • Pre-Exposure Prophylaxis (PrEP ) PEOPLE WHO INJECT DRUGS • Sterile injecting equipment • Opiate substitution treatment • Naloxone PREVENTION OF HETEROSEXUALLY ACQUIRED HIV IN MEN • Voluntary medical male circumcision (VMMC) HIV PREVENTION
  11. HEALTH SECTOR INTERVENTIONS: HIV TESTING AND COUNSELLING. TREATMENT AND CARE • Voluntary HTC (including community-based) linked to prevention, treatment and care; • Anti-retroviral treatment (ART); • Prevention of mother to child transmission (PMTCT); • TB prevention, screening and treatment services; • Hepatitis B and C prevention, screening and treatment services ; • Screening and management of mental health Summary of recommendations
  12. SEXUAL AND REPRODUCTIVE HEALTH • Screening, diagnosis and treatment of STIs • Cervical cancer screening • Contraception and pregnancy care • Range of reproductive options and full, pleasurable sex lives • Abortion laws and services should protect the health and human rights of all women (WHO accent) Summary of recommendations
  13. CRITICAL ENABLERS Summary of recommendations • Laws, policies and practices - decriminalization of behaviours / elimination of the unjust application towards: - drug use/injecting, - sex work, - same-sex activity and - non-conforming gender identity • Eliminate stigma, discrimination and violence against key populations; • Health services should be made available, accessible and acceptable; • Package of interventions to enhance key populations; • Communities empowerment; • Preventing and addressing violence against key populations in partnership with key population- led organizations .
  14. KEY POPULATIONS ARE RIGHTS HOLDERS. TO INSURE THAT CRITICAL ENABLERS ARE REALIZED KEY POPULATIONS MUST BE EPOWERED TO CLAIM THEIR RIGHTS • Human rights are fundamental. People are inherently entitled to them; • Human rights are universal, indivisible and interdependent and related; • Human rights are egalitarian they are the same for everyone Standards of human behavior that are regularly protected as legal rights in international law include • Righto highest standards of health care, • Right to decide the timing, number and spacing of one’s children. • Freedom from discrimination, • Fight to fair trial, , • Freedom from tortures • Freedom of speech, • Freedom of thought, conscience and religion, • Freedom of movement and so on.
  15. • Reaching out to key populations • Condom and lubricant programming: forecasting, quality assurance and distribution • Supporting safer behavior (including SRH care seeking behaviors and in particular; • STI health care seeking behavior as a community norm; • Generating demand and implementation of HTC through mobile outreach; • Connecting key populations to health care and supportive services; • Insuring observance of human rights • Feedback on the quality of services from the point of clients’ satisfaction; • Training duty bearers (health care providers, social workers, law enforcement bodies etc.) KEY POPULATIONS ARE PARTNERS EMPOWERING KEY POPULATIONS TO PROTECT THEIR HEALTH: UNIQUE ROLES OF COMMUNITIES
  17. Human rights based approach works Community-empowerment-based responses to HIV in sex workers were consistently associated with significant reductions in HIV and STIs, and increases in condom use. -- Lancet series 2014 • Securing adequate financial resources for sustaining and further improving the national responses through continuity of outreach services and partnership with civil society is crucial; • Some countries made a way to amend the social contracting and NGO funding legislations and ensured sustainability of NGOs engagement in the situation of decreased international support to NGOs; • Local authorities have a particular role to cooperate with NGOs
  18. THANK YOU! • Addressing HIV is integral to UNFPA’s goals of achieving universal access to sexual and reproductive health, and realizing human rights and gender equality • UNFPA promotes integrated HIV and sexual and reproductive health services for young people, key populations, and women and girls, including those living with HIV. • UNFPA supports the empowerment of these populations to claim their human rights and access the services they need • All of UNFPA’s work on HIV is done by engaging and empowering the communities it is mandated to serve.