Druguse,policyandHIV

AndrewScheibeRUN2016DrugPolicyWeek

CapeTown,SouthAfrica2February2016

Overview

•  HIVtransmissionrisks•  OverviewofHIVepidemiologyamongpeoplewhoinjectdrugs(PWID)inSouthernAfrica

•  Policy,processandhealth•  EvidencebasedHIVprevenFonintervenFonsforPWIDandrecommendedpracFce

•  Casestudies•  FuturedirecFons

Source:PaqueKeetal,2013

RelaFveHIVtransmissionrisks(peract)

SouthernAfricanPWID:SizeEsFmatesLoca%on,sample,methods Findings Source

2013

SouthAfrica.Modeleddatafrom2008householdsurvey.

67000(0.2%peopleaged15–64)

Petersenetal.2013

2014

Mozambique.SizeesFmaFonaspartofbiobehaviouralsurvey.

Maputo:1684;Nampula:520 Teodoroetal.2015

SouthAfrica.SouthAfricanEpidemiologyNetworkonDrugUse.Substanceusedisordertreatmentcentres.Admissiondata(2010–2013)

16–18%admissionsreportedheroininjecFng;18–22%reportmethamphetamineinjecFng70270admissionsoverperiod.

HarkerBurnhams2014

2015

SouthAfrica.NaFonal.ProgrammaFcmapping.Secondarykeyinformant.

75701(42755males;32946females).Mostinmetroareas.44%PWIDvisitbar/clubs

Setsweetal.2015

SouthAfrica.FormaFveassessmentinCapeTown,Durban,Pretoria

Dataanalysisunderway TB/HIVCareAssociaFonetal.2015

SouthAfrica.PWIDaccessingHIVprevenFonandharmreducFonservicesinCapeTown,Durban,Pretoria.

994PWIDaccessedservicesbetweenJune–December2015(363CapeTown;139Durban,492Pretoria)

THCA,OUT,CDC,UNODC,Mainline2015

SouthernAfricanPWID:HIVPrevalence&RiskLoca%on,sample,methods Findings Source

2004

SouthAfrica.CapeTown,239heroinusers(57PWID).CrosssecFonal(CS)survey

HighriskdrugusingpracFces.RightsviolaFons

Plüddemannetal.2008

2005

SouthAfrica.CapeTown,Pretoria,Durban.189peoplewhousedrugs(50females)(55PWID–sexnotprovided).QualitaFvestudy

HighriskdrugusingandsexualpracFces.RightsviolaFons

Parryetal.2007

2013

SouthAfrica.CapeTown,Durban,Pretoria,Centurion,Johannesburg.450PWID(363males,87females).CSsurvey

HighriskinjecFngandsexualpracFces.Highlevelsofarrestandoverdose.

UNODC2015

2014

Mozambique.Maputo(n=351)andNampula(139).Integratedbiobehaviouralsurvey.

HighHIVburden:50.3%inMaputoand36.9%inNampula.HighriskpracFces:26.1%inMaputoand28.6%inNampulasharedneedlesinlast30days.

Teodoroetal.2015

Thepolicycycle

Source:WellcomeTrust.2016

Thepolicyreality

Source:WellcomeTrust.2016

Drugpolicyandhealthoutcomes

Source:Burrisetal.2004

•  AccesstoHIVtesFng•  LinkagetoHIVcare•  RetenFonincare&viral

suppression

Evidence-basedHIVprevenFon,treatment,careandsupportintervenFonsforPWID

1.  HIVcounsellingandtesFng2.  AnFretroviraltherapy3.  Needleandsyringeprogrammes4.  OpioidsubsFtuFontherapy5.  Condom&lubricantdistribuFon6.  PrevenFonandtreatmentofSTIs7.  TargetedinformaFon,educaFon

andcommunicaFonmaterial8.  PrevenFon,diagnosis&treatment

ofTB9.  PrevenFon,diagnosis&treatment

ofviralhepaFFs

WHOgoodpracFcerecommendaFons

Worktowards:•  ThedecriminalisaFonofdruguse

•  TheunjustapplicaFonofcivillawandregulaFonsagainstpeoplewhousedrugs

•  ImplemenFngandenforcinganFdiscriminaFonandprotecFvelawstoeliminatesFgma,discriminaFonandviolenceaffecFngkeypopulaFons

Casestudies:Impactoflawenforcementonhealth

Australia

Ukraine

DropinaKendanceatneedlesyringeprogrammesakerpolice“crackdown”

HIVrisklinkedtorushedinjecFngduetofearof/experiencedarrest

Casestudy:Delayingevidence-basedintervenFons

Russia

Source:WorldDrugReport,2014

HIVincidenceamongPWIDinEasternEurope,1993-2011

ManynewinfecFonsinRussiawithasupplyreducFonfocus

Casestudies:Scale-upofharmreducFon

intervenFons

China

Source:UNAIDS,2014

HIVincidenceamongPWIDbeforeandakerharmreducFonintervenFons,XichangCity,China,2002-2008

75%reducFoninnewHIVinfecFonsakerharm

reducFonintervenFonsintroduced

MauriFus

Large-scaleharmreducFonintervenFonsimplemented

Source:UNAIDS,2013

HIVprevalenceamongPWIDandotherpopulaFons,MauriFus,2000-2012

WhatwillhappeninSouthAfrica?

References•  Aitken,C.,Moore,D.,Higgs,P.,Kelsall,J.,&Kerger,M.(2002).Theimpactofapolicecrackdownonastreetdrugscene:

Evidencefromthestreet.InternaFonalJournalofDrugPolicy,13,189–198.doi:10.1016/S0955-3959(02)00075-0•  Booth,R.E.,Dvoryak,S.,Sung-Joon,M.,Brewster,J.T.,Wendt,W.W.,Corsi,K.F.,…Strathdee,S.A.(2013).Law

EnforcementPracFcesAssociatedwithHIVInfecFonAmongInjecFonDrugUsersinOdessa,Ukraine.AIDSandBehavior,17(8),2604–2614.doi:10.1007/s10461-013-0500-6

•  Best,D.,Strang,J.,Beswick,T.,&Gossop,M.(2001).AssessmentofaConcentrated,High-ProfilePoliceOperaFon.NoDiscernibleImpactonDrugAvailability,PriceorPurity.BriFshJournalofCriminology,41(4),738–745.doi:10.1093/bjc/41.4.738

•  Burris,S.,Blankenship,K.M.,Donoghoe,M.,Sherman,S.,Vernick,J.S.,Case,P.,…Koester,S.(2004).Addressingthe“riskenvironment”forinjecFondrugusers:themysteriouscaseofthemissingcop.TheMilbankQuarterly,82(1),125–56.doi:10.1007/s10461-013-0500-6.

•  HarkerBurnhams,N.(2014).PaKernsandtrendsofheroinuseandinjecFonbehaviourinSouthAfrica.InRapidAssessmentofHIVamongpeoplewhoinjectdrugsstudyresultsdisseminaFonworkshop.CapeTown.

•  PaqueKeD,DemersA,WongT.AsynopsisofthecurrentevidenceontheriskofHIVtransmissionStructuredabstract:CanadaCommunDisRep.2013;39(1).

•  Parry,C.,Carney,T.,Petersen,P.,&Dewing,S.(2007).TechnicalReport:DruguseandsexualHIVriskpaKernsamongnon-injecFngandinjecFngdrugusersinCapeTown,PretoriaandDurban,SouthAfrica.CapeTown:MedicalResearchCouncil.

•  Plüddemann,A.,Parry,C.D.H.,Flisher,A.J.,&Jordaan,E.(2008).HeroinusersinCapeTown,SouthAfrica:InjecFngPracFces,HIV-RelatedRiskBehaviors,andOtherHealthConsequences.JournalofPsychoacFveDrugs,40(3),273–9.RetrievedfromhKp://www.ncbi.nlm.nih.gov/pubmed/19004419

•  Petersen,Z.,Myers,B.,vanHout,M.-C.,Plüddemann,A.,&Parry,C.(2013).AvailabilityofHIVprevenFonandtreatmentservicesforpeoplewhoinjectdrugs:findingsfrom21countries.HarmReducFonJournal,10(1),13.doi:10.1186/1477-7517-10-13

References(cont.)

•  Setswe,G.,Cloete,A.,Mabaso,M.,Jooste,S.,Ntsepe,Y.,Mswelli,S.,…Molobeli,R.(2015).ProgrammaFcMappingandSizeEsFmaFonStudyofKeyPopulaFonsinSouthAfrica:SexWorkers(maleandfemale),MenwhohaveSexwithMen,PersonsWhoInjectDrugsandTransgenderPeople.CapeTown:NACOSA.

•  Strathdee,S.a,HalleK,T.B.,Bobrova,N.,Rhodes,T.,Booth,R.,Abdool,R.,&Hankins,C.a.(2010).HIVandriskenvironmentforinjecFngdrugusers:thepast,present,andfuture.Lancet,376(9737),268–84.doi:10.1016/S0140-6736(10)60743-X

•  Teodoro,E.,Boothe,M.,Baltazar,C.,Young,P.,Frank,H.,Sathane,I.,…Horth,R.(2015).UrgentNeedforHarm-ReducFonIntervenFonsinMozambique:ResultsfromtheIntegratedBio-BehavioralSurveyamongPeopleWhoInjectDrugs.InIAS2015(p.PresentaFon).Vancouver.

•  UNAIDS.(2013).GlobalReport.UNAIDSreportontheglobalAIDSepidemic.Geneva:UNAIDS.•  UNAIDS.(2014).TheGapReport.UNAIDSreportontheglobalAIDSepidemic.Geneva:UNAIDS.•  UnitedNaFonsOfficeonDrugsandCrime(2014).WorldDrugReport2015.Vienna:UnitedNaFonsOfficeonDrugsand

Crime..•  UnitedNaFonsOfficeonDrugsandCrime(2015).WorldDrugReport2015.Vienna:UnitedNaFonsOfficeonDrugsand

Crime..•  UnitedNaFonsOfficeonDrugsandCrime(2015).RapidassessmentofHIVandrelatedriskfactorsamongpeoplewhoinject

drugsfromfiveSouthAfricanciFes.Finalreport.Pretoria:UNODC.•  WorldHealthOrganizaFon,UnitedNaFonsOfficeonDrugsandCrime,UNAIDS(2012).TechnicalGuideforcountriestoset

targetsforuniversalaccesstoHIVprevenFon,treatmentandcareforinjecFngdrugusers.2012revision.Geneva:WorldHealthOrganizaFon.

•  WellcomeTrust.Whatispolicy.AccessedfromhKp://www.wellcome.ac.uk/Funding/Public-engagement/Engagement-with-your-research/Support-and-resources/Government-and-science-policy/WTS040421.htmon25January2016

•  WorldHealthOrganizaFon.(2014).ConsolidatedGuidelinesonHIVPrevenFon,Diagnosis,TreatmentandCareforKeyPopulaFons.Geneva:WHO.