Harm reduction among drug users from a conclusive medicine point of view

Speaker: Elvira Demyanenko (Non-governmental organisation “AntiAIDS – Siberia”, Russian Federation). Poster presentation.

Harm reduction (HR) programs have been implemented in the Russian Federation from 1996, in the Altai territory – from 1999. Despite evident results, the government does not consider these programs to be effective and does not provide funding to support them.  Every year 1500 primary clients have been covered by preventive work, in the city of Barnaul; the number of contacts is 13000. Ten clients (0.3%) out of 3000 who visited HR in the years 2006-2009 have tested positively for HIV; out of 15500 injecting drug users (IDU), who are not HR clients 438 IDU (3%) have been tested positively for HIV. During the year each IDU has 15 contacts when injecting drugs. Revealing 1 case of HIV-infection among drug users prevents them from infecting 5-40 partners and 1-5 sex partners. The average cost of the HIV-prevention project among IDU in Barnaul is $35000 per year and the IDU coverage is 1500, so the average expenditure for HR is $23 per 1 client. The cost of 1 contact is about $3. The average treatment course for 1 HIV-infected patient is min $4000 per year without the cost of laboratory examination and treatment of secondary illnesses. During a year each IDU has 15 contacts when injecting drugs. Prevention of 1 case of infection saves 15 contact partners. Prevention of 1 case of infection saves $6400 per year for the budget, which is needed to provide VAART for 15 HIV-infected drug users. HR programs have a high level of effectiveness; The harm reduction programs are needed: to control any changes in the drug scene and to take measures to reduce the risk of HIV-infection among the target group; to reveal new cases of HIV-infection and to prevent the transmission of the virus; to prevent new cases of HIV-infection among the drug users through changing their practices in using drugs; to build a “bridge” between the drug users and governmental institutions including narcological services and rehabilitation centres; It is necessary to implement the most effective harm reduction technologies into existing services (for example, pre- and post-test counselling for the drug users with consideration of high HIV risk behaviour and its change for less risk behaviour).

CV: Elvira Demianenko is Chairperson of the NGO “AntiAIDS-Siberia”, Secretary of the medical headquarters in the struggle against AIDS of the Health Department of the Altai territory Administration, Chairman of National Forum of the NGOs working in the field of HIV/AIDS in Russia, Technical counsellor of the Russian Harm Reduction Network, Coordinator of harm reduction programs in Altai since 2002, Expert for the World Bank and DFID; Ms. Demianenko is responsible for management of HIV/AIDS epidemiological surveillance in Altai, management of social-epidemiological monitoring on HIV/AIDS, advocacy in harm reduction programs on the level of authorities and on the level of institutions supplying help to IDUs; She also coordinated and personally participated in research devoted to needs assessment of injection drug use in Barnaul, behavioural investigations among different groups of population, research “Situational analysis on the spread of HIV-infection and the system of measures aimed to prevent the spread of the HIV epidemic in Altai”.