Opioid Substitution Therapy in Eurasia: Increasing Access, Improving Quality

1. Improving health and protecting human rights  for individuals, communities, and society Opioid Substitution Therapy in Eurasia: Increasing Access, Improving Quality AlisherLatypov, Eurasian Harm Reduction Network, Vilnius AsyaBidordinova, Independent Consultant, Toronto AvetKhachatrian, Independent Consultant, Toronto XIX International AIDS Conference Washington D.C., 23 July 2012

2. Background and Methodology 29 countries, 6 sub-regions: The Baltics, Central Europe, South-Eastern Europe, European countries of CIS, South Caucasus and Central AsiaData collection: Interviews and literature review between August – November 2011Updated data: Initial findings updated based on UNGASS 2012 country reports, data collected by EHRN for HRI GSHR 2012; feedback from EHRN members and national OST experts XIX International AIDS Conference Washington D.C., 23 July 2012

3. Countries with OST and Year of OST Introduction XIX International AIDS Conference Washington D.C., 23 July 2012

4. OST in Prisons and Authorization of Take-home Dosages XIX International AIDS Conference Washington D.C., 23 July 2012

5. Number of Individuals Receiving OST XIX International AIDS Conference Washington D.C., 23 July 2012

6. Percentage of People Who Inject Drugs Receiving OST XIX International AIDS Conference Washington D.C., 23 July 2012

7. OST Coverage and Prevalence of HIV among PWID, % XIX International AIDS Conference Washington D.C., 23 July 2012

8. Recent OST Assessments in the Region Subata, Karymbaeva, Moller, WHO Europe, 2011, Penitentiary Institution No. 47 in Bishkek (Kyrgyzstan): “Results of the study indicate the consistent improvement of health and quality of life among opioid substitution therapy patients, as well as the significant reduction of injecting risk behaviour in relation to transmission of HIV and other bloodborneviruses” (p. 2). Boltaev, Deryabina, Howard, ICAP, Columbia University, 2012, OST Pilot Program in Kazakhstan: Results include reductions in use of illicit opiates, criminality, HIV risk behavior, and self-assessed improvements in health functioning (p. 5). XIX International AIDS Conference Washington D.C., 23 July 2012

9. Kyrgyz National Funding & The War on Drug Users State Drug Control Service: 358,500 USD per year for 962 cases of possession of ≥ 10g Ministry of Internal Affairs: 474,500 USD per year for 1,800 cases of possession of ≥ 10g State Service for Correctional Affairs: 402,200 USD per year on inmates sentenced for possession of ≥ 10g TOTAL direct costs of prosecution of possession of “small” (≥ 10g) amounts of drugs without intent to sell = 1,250,000 USD per year or almost as much as Kyrgyz HIV domestic public spending in 2008 XIX International AIDS Conference Washington D.C., 23 July 2012

10. ‘Self-induced’ Challenges Political ambivalence, poor financial commitment and strong opposition Containing OST within the remits of narcology Police harassment of OST clients & service providers Keeping OST out of prisons XIX International AIDS Conference Washington D.C., 23 July 2012

11. Increasing Access and Improving Quality National ownership of OST through strong political commitment and sustained national funding Policy reform and adopting supportive legislation Investing in building local capacities for OST advocacy Strengthening human resource capacities and ensuring that patients’ perspective is present XIX International AIDS Conference Washington D.C., 23 July 2012

12. Thank you! XIX International AIDS Conference Washington D.C., 23 July 2012