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HIV/AIDS in Eastern Europe Setting the Stage for Prevention

HIV/AIDS in Eastern Europe Setting the Stage for Prevention. Thomas E. Novotny, MD, MPH April 16, 2004. HIV/AIDS in Eastern Europe Background. Most rapid rate of increase in new HIV infections among all regions of the world;

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HIV/AIDS in Eastern Europe Setting the Stage for Prevention

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  1. HIV/AIDS in Eastern Europe Setting the Stage for Prevention Thomas E. Novotny, MD, MPH April 16, 2004

  2. HIV/AIDS in Eastern EuropeBackground • Most rapid rate of increase in new HIV infections among all regions of the world; • Transition and economic disruption may lead to increased risk behavior (IDU, trafficking) and reduced prevention and treatment services; • Prevention opportunities based on lessons learned in the region and from outside.

  3. Global HIV: Change in Prevalence Rates 1996–2001 + 1 300% +20% + 20% + 160% + 100% Adult prevalence rate 15.0% – 36.0% 5.0a% – 15.0% 1.0% – 5.0% 0.5% – 1.0% 0.1% – 0.5% 0.0% – 0.1% not available +60% + 40% + 30% + 20%

  4. Causing or Aggravating Poverty CONTRIBUTORS TO POVERTY • Loss of income • Catastrophic cost of care • Increased dependency ratio • Loss of productivity (companies) • Loss of social capital (countries) • Reduced national income? HIV Infection AIDS

  5. Impacts for Generalized Epidemic of HIV/AIDS • 0.5-1.0 percentage point decline in economic growth • 50-100% increase in health expenditures • Impact private sector development • Aggravate informalization of economy • Change in dependency ratio, straining social systems • Change in HH size and composition (single parents, orphans, elderly caring for children • Negative intergenerational effects: Poverty trap

  6. Transmission Groups and Risk • Main mode is heterosexual: IDU (80%) • Little MTCT • Romania: Nosocomial and now heterosexual (n=8,000) • MSM underreported • Structural factors in ECA: social disruption, open borders, economic crisis • Mobility and globalization • Increases in STIs • Youth most at risk (age 20-30 years)

  7. Mobile PopulationsExample: SE Europe • Merchant marines, truckers (37% have unsafe sex while traveling) • Peacekeepers • Roma and other ethnic minorities (8 mil.) • Trafficked women (and children) • Commercial Sex Workers (CSW) • Tourists

  8. Effective Interventions • CSW: 100% condom use, STI treatment, client education, peer education and outreach • IDU: demand reduction, condom social marketing, needle exchange and cleaning education, treatment • Youth: school reproductive health education and peer support • Contacts: tracing, voluntary testing and counseling, referral • STI surveillance, syndromic treatment

  9. Harm Reduction • Needle exchange • CSW outreach, reproductive health services • Drug abuse treatment (Methadone) • Condom distribution • Decriminalization of drugs and prostitution

  10. Challenges in Low Prevalence Countries of ECA • Lack of recognition of future potential • High levels of stigmatization (HIV+, IDU, CSW, ethnic minorities) • Lack of government ownership of harm reduction (HR) approaches • Lack of sentinel surveillance among most vulnerable populations • Most funds go to treatment and not prevention programs • Lack of evaluation on HR and other prevention interventions • Increase in sexual risk behavior

  11. Conclusions: HIV/AIDSin Low Prevalence Countries • Opportunity for prevention is now • Cross-border externalities important in addressing most vulnerable groups • Future burden on health systems and economic productivity may be enormous • Need sentinel surveillance in high risk groups and vulnerable populations • Harm reduction, harm reduction, harm reduction • Public information and professional education are essential

  12. IGH/CAPS Activities • ICOHRTA Supplement with Croatia (NIDA) • Regional training in the Balkans • Eastern Europe/Central Asia Working Group • Research and writing for World Bank publications (Central Asia, Balkan, ECA) • Modeling epidemic and economic impact in the Baltics

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