UNODC regional conference "Harm reduction in the Baltic states - the way forward"
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05.11.2010

(posted 04/11/2010 http://www.unodc.org/balticstates/en/news/2010/IVq/HR_BS_25-26Oct/article.html)

A regional conference "Harm reduction in the Baltic States - the way forward" took place in Riga on 25-26 October 2010. The aim of the conference was to discuss the current situation and future challenges of needle and syringe programmes (NSP) and other harm reduction services in Estonia, Latvia and Lithuania. The meeting was attended by policy makers, harm reduction service providers, doctors, academics and civil society organizations.

The first session of the conference was dedicated to peer-driven interventions (PDI) for HIV education and prevention among injecting drug users (IDU). Oksana Matiyash from International HIV/AIDS Alliance in Ukraine presented the aims and methodology of PDI as well as lessons learned from PDI implementation in Ukraine. The PDI is a "chain-referral" outreach model developed for accessing and educating IDUs in the community to prevent HIV and related diseases. With special recruiting coupons and existing peer networks PDI model provides access to hidden IDU populations in closed drug scenes. In contrast to traditional HIV prevention models that rely on staff of NSPs, the PDI relies on drug users themselves. IDUs receive rewards for educating their peers and recruiting them to the harm reduction agency, where they are offered risk assessment interviews, HIV prevention education, free HIV test and referral to other services. UNODC project officers Evija Dompalma and Loreta Stoniene analyzed the results of PDI pilot projects in Latvia and Lithuania. In both countries the projects were implemented by NSPs for six months in 2010. During this period, 1152 drug users were reached in Latvia and 367 - in Lithuania. The number of new clients had increased more than 3 times comparing with the same period in 2009. The pilot projects demonstrated that drug users are effective source for prevention education among their peers. Risk assessment interviews showed that about half of respondents have shared injecting equipment and many IDUs also have high sexual risk behaviour: in Lithuania, only 30% of IDUs use condoms with casual sexual partners. The pilot projects also revealed low coverage of HIV testing among IDUs.

During the next session, participants analyzed the current situation and future challenges for NSPs in the Baltic States region. Aljona Kurbatova from Estonian National Institute for Health Development informed how coverage of NSPs has been increased to 52% of the estimated size of IDU population in Estonia. 48% of injecting drug users in Tallinn and 65% in Kohtla-Jarve has reported NSP as the main source for syringes. Research shows that majority of drug users did not share their injecting equipment during the last month: 65% in Tallinn, and 79% in Kohtla-Jarve. One of the future challenges is inclusion of harm reduction service providers in the classification of professions as well as development of service delivery standards and training. It is also planned to expand services offered by NSPs by including TB control, broader use of rapid HIV tests, and gynaecological services for women. Preparations are underway for a pilot project on distribution of naloxone for overdose prevention. Inga Upmace from Infectology Centre of Latvia demonstrated that coverage of NSPs has increased from 7% in 2006 to 27% in 2009. She pointed to the increasing proportion of HIV transmission through heterosexual contacts and to sexual partners of IDUs as a new risk group. It was also suggested to use new HIV testing algorithms and to increase testing coverage.  Rimatas Šagždavičius from Drug Control Department in Lithuania provided an overview about indicators used for monitoring NSPs as well as results of recent studies of IDU risk behaviour.

Signe Rotberga, UNODC Regional Coordinator for the Baltic States analyzed the current situation of NSPs in Latvia and Lithuania using information gathered with EMCDDA Data Collection Protocol for Specialist Harm Reduction Agencies. In 2009-2010, in both countries funding for NSPs has decreased and this has resulted in reduced operating hours, decreased staffing levels and shortfalls in supply of syringes and HIV tests. Several NSPs face the risks of being closed, if funding problems are not solved urgently. Data analysis revealed that in many harm reduction agencies staff safety issues are not addressed sufficiently, e.g. Hepatitis B vaccination, code of practice on needle stick injuries and safe disposal of used injecting equipment. Only a few NSPs provide condoms, and harm reduction service providers lack skills on assessing sexual risk behaviour and providing risk reduction education. Information from EMCDDA Data Collection Protocol, as well as PDI findings indicates increasing use of amphetamine-type stimulants.

To address this new phenomenon, the second day of the conference was dedicated to the amphetamine type stimulant use. Liudmila Shulga from the International HIV/AIDS Alliance in Ukraine provided information on amphetamine use, methods of consumption and production, as well as described the impact of long-term use on human body. She also spoke about harm reduction strategies for amphetamine users and stressed importance of specific services for stimulant and poly-drug users. The participants shared information about services available in their countries and discussed possibilities to adjust those services for amphetamine users' needs.