UN agencies launch technical guide on HIV prevalence among people who use stimulant drugs

Vienna, 22 August, 2019 - The United Nations Office on Drugs and Crime (UNODC), in partnership with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) have launched a technical guide on HIV prevalence among people who use stimulant drugs. The document provides information on HIV prevention, harm reduction and treatment, care and support for these people, and statistical data.

In 2017, about 1.8 million new HIV infections were estimated worldwide. Of these, 47% were among key populations - men who have sex with men, people who inject drugs, sex workers, transgender women, prisoners and their sexual partners.

Among people who use drugs, the focus since the beginning of the HIV epidemic has been on people who inject them, especially opioids. However, more recent data have shown that the use of other non-injectable drugs is also related to a higher risk of HIV transmission.

In this sense, the guide seeks to guide the implementation of public policies related to people who use stimulant drugs and those who have a higher risk of infection.

Eight success stories are quoted in the technical guide, demonstrating real situations that had positive impacts on the community. Of these, two are Brazilian: the "Live Better Knowing" (VMS, for its acronym in Portuguese) and the "Open Arms" programme. The objective of the first one is to carry out testing, diagnosis and orientation regarding the HIV virus. The second, in turn, focuses on social and health support for people who use crack, aiming at their recovery and social reintegration.

The Brazilian Programmes

Increasing access to HIV testing for key populations in Brazil:

Viva Melhor Sabendo

In 2014, the Department of Surveillance, Prevention and Control of STIs, HIV/AIDS and

Viral Hepatitis of Brazil's Ministry of Health developed the "Viva Melhor Sabendo" (VMS)

strategy. The strategy, implemented nationally in partnership with CSOs, aimed to

increase access to HIV testing for key populations through rapid oral-fluid testing.

Voluntary, confidential and free HIV testing was offered in the locations where key populations live and socialize, including on the street, in the homes of female sex workers and transvestites (travestis), saunas and gay cinemas, sex-work locations, bars,nightclubs, parties and drug-use scenes. Different strategies to establish contact were tested, but most opted for a one-on-one approach, emphasizing the necessary discretion in places such as sex-work points or the drug-use scene.

Community engagement was key to reaching these population groups at alternative times and places and outside health service structures. Trained peer educators conducted all activities and offered information on HIV prevention, diagnosis and treatment. Post-test counselling was offered to all individuals who underwent an HIV test. Those with a positive test result were referred to health services, and the CSOs were responsible for monitoring these individuals until confirmation of diagnosis and initiation of treatment.

Data on 43,000 individuals who participated in the VMS project between 2014 and 2016 showed that 43 per cent were women, 32 per cent heterosexual men, 20 per cent men who have sex with men, and 5 per cent transgender people or travestis. Prevalence of drug use

was 62 per cent, and it was highest among heterosexual men (79 per cent) and among men who have sex with men (72 per cent). Among people who used drugs, 52 per cent received an HIV test for the first time, and 2.4 per cent of these tested positive.

Comprehensive social and health support to homeless people using crack: the De Braços Abertos Programme

Launched in January 2014 by the municipality of São Paulo, Brazil, the De Braços Abertos ("With Open Arms") programme aimed to socially reintegrate people using crack and homeless people living in an area of the city known as Cracolândia ("Crackland"), and to restore their quality of life.

The area was experiencing high rates of violence, and an increasing number of people were using crack in the street. In contrast to the long-standing attempt to restore public security through a repressive approach, the project adopted a health-oriented and human-rights-based approach, focusing on addressing the rights of people to housing, food, income and health. All beneficiaries were offered three meals a day, training and a small weekly allowance of 130 reais (USD 40) in exchange for 20 hours of work such as gardening or street-cleaning.

A mobile unit (tent) was established in the area, offering health care, social assistance, workshops and socio-cultural activities, according to the demands of the community. Health care included low-threshold drug treatment provided by a multidisciplinary team. All women could access gynaecological services. Rapid testing for HIV and syphilis was provided through the mobile clinic, and people who tested positive (4 per cent for HIV and 26 per cent for syphilis) were referred for treatment. Drug-dependence treatment supported participants in increasing their self-care and reducing substance use at their own pace and by their own choice.

The programme had a strong community- and peer-based component that allowed it to develop services tailored to the needs of the community, such as safer spaces for crack/cocaine smoking. The programme rapidly demonstrated a positive impact, delivering more than 10,000 health interventions within two months, and leading to a reduction of 50-70 per cent in crack use among participants.

At the same time, public safety improved significantly in the area, with a 50 per cent reduction in the number of crimes observed during the first six months of the programme. By December 2014, the programme had assisted 500 people, of whom 50 were living with their families again, 20 had a formal employment contract, 42 had been trained and were working in the public park, and 80 were receiving mental health care.

Many beneficiaries reported that stable housing and employment improved their quality of life, minimizing conflict and reducing problematic use of crack. The evaluation also highlighted that community-based interventions with a strong peer-education component were essential to address the cultural specificities and the needs of the communities. 

to access the full report in English, click   aqui .



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