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How do PWID prevention activities impact the HIV epidemic? Case of Ukraine .

How do PWID prevention activities impact the HIV epidemic? Case of Ukraine. Olga Varetska International HIV/AIDS Alliance in Ukraine. Background. HIV epidemic among PWID in Ukraine. PLH: 238,000 or 0.9% of estimated adult prevalence (2013) Estimated # of PWID in Ukraine is 310,000

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How do PWID prevention activities impact the HIV epidemic? Case of Ukraine .

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  1. How do PWID prevention activities impact the HIV epidemic? CaseofUkraine. Olga Varetska International HIV/AIDS Alliance in Ukraine

  2. Background

  3. HIV epidemic among PWID in Ukraine • PLH: 238,000 or 0.9% of estimated adult prevalence (2013) • Estimated # of PWID in Ukraine is 310,000 • Main injectable drug of abuse – home-made acetylated poppy straw extract (opioid) • Home-made methamphetamine-type drugs are also prevalent • HIV epidemic started in 1995 among PWID in southern and eastern regions • Mean HIV prevalence among PWID is 18% (up to 40% in some regions) Kyiv Dnipropetrovsk Donetsk Lviv Odesa Mykolaiv AR Crimea

  4. Program coverage

  5. SAMPLE SLIDE 2 • Speaking at AIDS 2014 • What to think about? • Keep it simple • Larger text is easier to read • Single words rather than sentences • Bullet points are there to remind you, not to tell the whole story

  6. Program coverage Minimal package for PWID includes clean syringe, condom, information material, consultation, access to HIV testing

  7. 27% of clients screened for TB 42.2% of clients tested for HIV in community settings 25.9% of clients tested for Syphilis, and up to 7% for other STIs 13.8% tested for Hep C and 16.3% for HepB 4.1% of clients on OST

  8. Distribution of syringes by type of venue

  9. Results: HIV among PWID is decreasing

  10. Risky behavior patterns related to drug use

  11. HIV incidence proxy: case registration

  12. HIV incidence proxy: HIV prevalence among young and recent PWID Source: IBBS study reports 2007-2013

  13. Growing role of heterosexual transmission

  14. Modes of HIV-transmission: heterosexual share is increasing Source: L.V. Gromashevsky Institute for Epidemiology and Infectious Diseases of the National Academy of Medical Sciences of Ukraine, HIV infection in Ukraine, Newsletter No. 41, Ukrainian Centre for AIDS Prevention and Control, Ministry of Health, Kiev, 2014, p17.

  15. Newly registered HIV cases in Ukraine

  16. Changes in modes of transmission – Spectrum model results • Spectrum model confirms increasing role of heterosexual transmission • Who is the “remaining population”?

  17. Reported HIV cases in PWID and young women infected heterosexually by HIV incidence tercileamong PWID Reported HIV cases in PWID by PWID incidence tercile Reported HIV cases in young women by PWID incidence tercile Similar trends are evident among young women infected heterosexually as among PWID in the regions most affected by PWID epidemic This suggests that heterosexual transmission is linked to existing HIV cases among PWID, i.e. is happening among sexual partners of PWID

  18. Behavioral data: condom use during last sexual intercourse among PWID • In 50% of cases PWID do not use condoms • Behavioral data confirms risky sexual practices among PWID

  19. Conclusions: prevention proves effective, but more focus on sexual mode of transmission among PWID needed • inverse correlation between coverage of prevention programs and number of HIV cases • decreasing coverage or limited service package for PWID (inevitable in case of anticipated decline in funding of services for PWID in Ukraine)would undermine the success • need to focus on sexual mode of HIV transmission among PWID and partners to achieve significant results in suppressing HIV rates among general population

  20. Thank you for your attention!

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