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Drug Use Accelerating HIV Epidemic in Eastern Europe

VIENNA, Austria | Europe now has the fastest growing HIV epidemic in the world, due in large part to intravenous drug use, the World Health Organization told the International AIDS Conference in Vienna Wednesday.

The epidemic is disproportionately affecting Eastern Europe, which accounts for about 80 percent of the more than 100,000 new HIV infections reported in Europe in 2008.

“The situation in Eastern Europe is very volatile,” said Martin Donoghoe, program manager for WHO’s Europe HIV/AIDS office. “The dominant HIV transmission route in the East is injection drug use.”

In some countries in the region an estimated 50 percent of all HIV infected individuals are injecting drug users, or IDUs, a population that is particularly hard to reach and serve with prevention and treatment efforts. HIV treatment levels in Eastern Europe are also some of the lowest in the world, Donoghoe said, because drug users are “highly marginalized.”

“We have to face up to the fact that the epidemic in Europe is concentrated in these groups that as a society we have a problem with — drug users, sex workers,” he said. “It’s very hard to attract sympathy, and funding, when treating these groups.”

The WHO is calling for more harm reduction measures in these countries to combat the rise, including opiate substitution like methadone and needle exchange programs.

In Ukraine, which has the highest HIV prevalence in all of Europe, the government has been trying to scale up free needle programs and is serving more than 5,000 drug users with opiate substitution, a small but significant portion of drug users in the country.

Natalia Nizova, director of the Ukrainian AIDS Center, said it is a challenge to attract IDUs to services.

“There is still some stigma with drug users,” Nizova said. “We use new information practices, target teenagers and young people, recruit from AIDS clinics and do peer consultations.”

An estimated 87 percent of IDUs in Ukraine have now utilized a free needle exchange program. But that number is calculated from known drug users so is likely inflated, and for HIV prevention purposes needle exchange has to be used regularly by the patients.

Ukraine’s efforts are being held up as a model for the region even though they still have much progress to make. Other countries in Eastern Europe have actually seen a drop in HIV prevention services for IDUs in the past two years, reported UNAIDS.

“We need to make sure [IDUs] have a way to access services, to have access to evidence-based therapy” like needle exchange and heroine substitutes, said Michel Sidibe, executive director of UNAIDS.

A study presented at the conference Tuesday found this is a problem worldwide, and that only a small percentage of IDUs get help to prevent them from spreading HIV to others.

Five percent of IDUs have access to needle exchange programs, and 8 percent can access opiate substitutes, said the study out of the National Drug and Alcohol Research Center at the University of New South Wales, Australia.

A critical momentum has been building around the issue of drug users at the conference, led by the Vienna Declaration, issued at the end of June and published again yesterday in the Lancet Journal.

The declaration calls on governments to support opiate substitution therapy and needle and syringe programs that have been shown to reduce HIV rates and criticizes the criminalization of drug users.

“There is a huge discordance between scientific evidence and policy as it relates to drug addiction,” said Evan Wood, founder of the International Centre for Science in Drug Policy and one of the authors.

“A key concern is that by making addiction a crime you drive people into hidden environments where it’s difficult to offer them prevention, care and treatment.”

The declaration was endorsed by more than 10,000 people, including Julio Montaner, chairman of the AIDS 2010 conference, several former presidents of Latin American countries, as well as the head of the Global Fund to Fight AIDS, Malaria and Tuberculosis.

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