HIV Prevention, Treatment, Care And Support For People Who .
HIV PREVENTION,TREATMENT, CARE ANDSUPPORT FOR PEOPLE WHOUSE STIMULANT DRUGSTECHNICAL GUIDE
UNITED NATIONS OFFICE ON DRUGS AND CRIMEViennaHIV Prevention, Treatment, Careand Support for People Who UseStimulant DrugsTECHNICAL GUIDEUNITED NATIONSVienna, 2019
United Nations Office on Drugs and Crime, 2019The content of this document does not necessarily reflect the views of the United Nations Office on Drugs and Crime(UNODC) as well as of the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS(UNAIDS), or their Member States. The description and classification of countries and territories in this publication andthe arrangement of the material do not imply the expression of any opinion whatsoever on the part of the Secretariat of theUnited Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning thedelimitation of its frontiers or boundaries, or regarding its economic system or degree of development.Publishing production: English, Publishing and Library Section, United Nations Office at Vienna.
AcknowledgementsThis guide was developed by the United Nations Office on Drugs and Crime (UNODC) in collaboration with representatives from the community of people who use drugs and international experts inthe field.Marcus Day and Mat Southwell coordinated the development of the guide under the supervision ofFabienne Hariga, Senior Expert, HIV/AIDS Section, UNODC. Other UNODC staff who made significant contributions include Gilberto Gerra, Chief, Drug Prevention and Health Branch; MonicaBeg, Chief, HIV/AIDS Section and Global Coordinator for HIV/AIDS; and Monica Ciupagea, Experton Drug Use and HIV and Civil Society Focal Point.The guide builds on a discussion paper developed by Steve Shoptaw of the Departments of FamilyMedicine and Psychiatry and Biobehavioral Sciences, University of California Los Angeles, updatedand enriched with the inclusion of scientific data from a comprehensive literature review prepared forUNODC by Anna Williams, and by the outcomes of the UNODC 2016 scientific consultation onHIV and stimulant drugs. The meaningful involvement of people who use drugs has been critical in thedevelopment and writing of this guide.We give special thanks to the contributing writers: Luciano Colonna, Marcus Day, Brun González,Jean-Paul Grund, Alastair Hudson, Laura LeMoon, Russell Newcombe, Cheryl Overs, Les Papas,Shaun Shelly, Valentin Simionov, Mat Southwell and Pascal Tanguay. We also thank our reviewers:Ruth Birgin, Peter Blanken, Lee Hertel, Mark Kinzly and Jay Levy, as well as reviewers from otherUnited Nations organizations, including Virginia MacDonald, Fabio Mesquita and Annette Verster(World Health Organization) and Boyan Konstantinov (United Nations Development Programme).We thank the other experts who provided comments via an electronic consultation:George Ayala, MPact Global Action for Gay Men’s Health and Rights; Gavin Bart, Director, Divisionof Addiction Medicine, Hennepin Healthcare and Associate Professor of Medicine, University ofMinnesota (United States); Adam Bourne, La Trobe University (Australia); Jamie Bridge,International Drug Policy Consortium (United Kingdom); Daniel Deimel, German Institute onAddiction and Prevention Research, Catholic University of Applied Science North-Rhine Westphalia(Germany); Don Des Jarlais, Icahn School of Medicine at Mount Sinai, New York City (UnitedStates); Andrew Doupe, HIV and legal consultant (Australia); Evanno Jerome, Paroles Autour de laSanté, Guadeloupe (Burkina Faso); Andrej Kastelic, Centre for Treatment for Drug Addiction,Ljubljana University Psychiatric Hospital and South Eastern European Adriatic Addiction TreatmentNetwork (Slovenia); Igor Koutsenok, Department of Psychiatry, University of California San Diego(United States); Sherry Larkins, Integrated Substance Abuse Program, University of California LosAngeles (United States); Nicole Lee, Curtin University and 360Edge (Australia); Howie Lim,University of Malaysia (Malaysia); Helena Maria Medeiros Lima, Pontifícia Universidade Católicade São Paulo (Brazil); Ruth Morgan Thomas, Global Network of Sex Work Projects; Kevin Mulvey,Substance Abuse and Mental Health Services Administration (United States); Chris Obermeyer,Fulbright Public Policy Fellow, Ministry of Health of Ukraine (Ukraine); Emily Rowe, HarmReduction International; Katie Stone, Harm Reduction International; Lucas Wiessing, EuropeanMonitoring Centre for Drugs and Drug Addiction.iii
HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGSWe are also grateful to the experts who participated in three country consultations:Ho Chi Minh City, Viet Nam, 5-6 December 2017:Bình Dương; Dr Bùi Mình Kha, Provincial AIDS Centre Bà Rịa – Vũng Tàu; Dr Bùi Thị Minh Hiền,FHI 360; Prof. Bùi Tôn Hiến, University of Labor and Social Affairs; Dr Cao Kim Thoa, Viet NamAuthority of AIDS Control (VAAC); Cao Tan Thanh, VNPUD; Đặng Quốc Phong, VNMSM; Prof.Dr Đỗ Văn Dũng, Ho Chi Minh City University of Medicine and Pharmacy; Dr Hoàng Đình Cảnh,Viet Nam Authority of AIDS Control (VAAC); Dr Huỳnh Thanh Hiển, Mental Health Hospital, HoChi Minh City; La Thị Hồng Lan, Đại học Y Dược Ho Chi Minh City; Lại Phước Thanh Huy,Provincial AIDS Centre Hồ Chí Minh; Lê Huỳnh Thị Cẩm Hồng, Ho Chi Minh City University ofMedicine and Pharmacy; Lê Thành, G-link; Lê Thị Bích Huyền, VNSW; Mai Như Sơn, CBO XuânHợp – Đồng Nai; Mai Thị Hoài Sơn, Provincial AIDS Centre Ho Chi Minh; Nguyễn Anh Ngọc,G-link (MSM); Nguyễn Công Hậu Centre for Life Quality Promotion (LIFE); Dr Nguyễn HồngHải, Viet Nam Authority of AIDS Control (VAAC); Nguyễn Hồng Phúc, Centre for SupportingCommunity Development Initiatives (SCDI); Nguyễn Ly Lai, Đại học Mở Ho Chi Minh City;Nguyễn Ngọc Phương, CBO MARS HCM City; Dr Nguyễn Quang Thông, Provincial AIDS CentreCần Thơ; Dr Nguyễn Thu Trang, Hanoi Medical University; Nguyễn Thụy An My, VNSW; DrNguyễn Thùy Anh, Hanoi Medical University; Nguyễn Thùy Linh, Centre for Supporting CommunityDevelopment Initiatives (SCDI); Nguyễn Viết Hùng, CBO Muối Trắng BR; Phạm Hồng Sơn,G3VN; Dr Phạm Thanh Thành, Provincial AIDS Centre Bình Thuận; Trần Mạnh Thắng, VNPUD;Trần Ngọc Du, Department of Labour, Invalids and Social Affairs HCM; Dr Trần Trung Tá, ProvincialAIDS Centre Đồng Nai; Vincent Trias, ESTHER; Trương Ngọc Phương Bình, Provincial AIDSCentre Bình Thuận; Trương Thị Nhung, Centre for Life Quality Promotion (LIFE); Võ Hoàng Nam,CBO Trăng Khuyết; Võ Hoàng Sơn, FHI 360; Dr Võ Thị Năm, Provincial AIDS Centre Cần Thơ;Vũ Thị Hiền, Centre for Supporting Community Development Initiatives (SCDI); Vũ Thị Tường Vi,Ho Chi Minh City University of Medicine and Pharmacy; Vũng Tàu.Brasília, 14-15 December 2017:Nara Araújo, UNAIDS; Irina Bacci, LGBTI National Alliance; Cláudio Barreiros, GeneralCoordination of Mental Health, Alcohol and other Drugs, Ministry of Health; Francisco Bastos,Oswaldo Cruz Foundation (Fiocruz); Sandra Fergutz Batista, Brazilian Network of Harm Reductionand Human Rights (REDUC); Gustavo Camilo, Board of Articulation and Projects of the NationalSecretariat on Drug Policies (SENAD-MJSP); Maria Angélica Comis, Brazilian Platform of DrugPolicies, and member of Respire Project of the Community and Cultural Centre É de Lei; Ana CarolinaConceição, General Coordination of Mental Health, Alcohol and other Drugs, Ministry of Health;Paula Dame, Department of Surveillance, Prevention and Control of STIs, HIV/AIDS and ViralHepatitis, Ministry of Health; Marco Duarte, State University of Rio de Janeiro (UERJ); CleitonEuzébio, UNAIDS; Liandro Lindner, Brazilian Harm Reduction Association (ABORDA);Leonardo Moreira, Coordination of Research and Training of the National Secretariat on DrugPolicies (SENAD-MJSP); Dênis Petuco, Department of Surveillance, Prevention and Control ofSTIs, HIV/AIDS and Viral Hepatitis, Ministry of Health; Monique Prata, Central Sex Workers UnionConfederation (CUTS); Marcelo Ryngelblum, Community and Cultural Centre É de Lei; JumaSantos, Latin American Network of People who use Drugs (LANPUD).iv
Kiev, 22-23 January 2018:From Moldova: Svetlana Doltu, AFI Moldova; Lilia Fiodorova, Dispensary Department, RepublicanNarcology Dispensary; Alexander Goncear, AIDS Centre; Ala Latco, Union for HIV Prevention andHarm Reduction; Veaceslav Mulear, GENDERDOC-M; Natalia Nicula, UNODC; Ruslan Poverga,NGO “Positive Initiative”; Roman Sandu, NGO “Zdorovoe Budushee”; Ion Turcanu, National Antidrug Commission.From Belarus: Oleg Aizberg, Department of Psychiatry and Narcology, Belarusian Academy ofPostgraduate Education; Alexei Alexandrov, Minsk Regional Clinical Centre “Psychiatry-Narcology”;Liudmila Buzel, Red Cross Belarus; Aliaksei Kralko, Republican Scientific and Practical Centre forPsychiatry and Addiction, Republican Centre for Narcological Monitoring and Preventology; SergeiKryzhevich, Republican Social Public Association “Your Chance”; Alexandr Nevero, StateCommittee of Forensic Expertise, Republic of Belarus; Andrei Saladounikav, Main Directorate forDrug Control and Countering Trafficking in Human Beings, Ministry of Internal Affairs, Republic ofBelarus; Alena Smirnova, Belarusian Association of UNESCO Clubs; Iryna Statkevich, BelarusianPublic Association “Positive Movement”; Liudmila Truhan, UNODC Belarus.From Ukraine: Olga Belyaeva, EACB; Yuri Bukovski, Antidrug Department, National Police;Andrei Chernyshev, Alliance Global; Olga Dudina, USAID; Sergii Dvoriak, Ukrainian Institute onPublic Health Policy; Anna Garkusha, Users of Ukraine; Sergei Gartsev, Republican Social PublicAssociation “Your Chance”; Natalia Isaeva, Legalife Ukraine; Evgen Krivosheev, Club Enei; AlekseiKurmanaevski, Eurasian Network of People who use Drugs; Vyacheslav Kushakov, Alliance forPublic Health; Igor Kyzin, Public Health Centre; Igor Kyzmenko, DUNews; Anna Martyniuk,VOLNA Convictus Ukraine; Vasili Melnichyuk, Antidrug Department, National Police; EkaterinaMikhina, Club Enei; Natalia Nizova, Vice Premier Minister Adviser; Iryna Pashek, UNAIDS;Gennady Roshchupkin, Eurasian Coalition on Male Health; Sergei Rudoi, Deloitte; NataliaSalabai, UNAIDS; Sergii Shum, Ukrainian Monitoring and Medical Centre for Drugs and Alcohol,Ministry of Health; Vladimir Tymoshenko, EIH; Jacek Tyszko, UNAIDS; Vladimir Yarii, KyivCity Narcological Clinical Hospital “Sociotherapy”; Oleksandr Zeziulin, Ukrainian Institute onPublic Health Policy.This publication was edited by James Baer.v
ContentsAcknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iiiAbbreviations and acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ixDefinitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xIntroduction. 1Chapter 1. Stimulant drugs, HIV and hepatitis, and key populations.51.1 Stimulant drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51.2 Stimulant drug use and risks of HIV/HBV/HCV transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71.3 Stimulant drug use and HIV/HBV/HCV transmission risks among key populations. . . . . . . . . . . . . . . . 81.4 The impact of criminal sanctions on HIV transmission among key populations . . . . . . . . . . . . . . . . . . . . 10Chapter 2. Core interventions . 132.1 Condoms, lubricants and safer sex programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132.2 Needle and syringe programmes and other commodities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152.3 HIV testing services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172.4 Antiretroviral therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192.5 Evidence-based psychosocial interventions and drug dependence treatments . . . . . . . . . . . . . . . . . . . . . 202.6 Prevention, diagnosis and treatment of sexually transmitted infections, hepatitis and tuberculosis . . . 232.7 Targeted information, education and communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252.8 Overdose and acute intoxication prevention and management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Chapter 3. Care and support for people who use stimulant drugs.293.13.23.33.4Supporting adherence to antiretroviral therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Sexual and reproductive health care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Mental health care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Socioeconomic support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Chapter 4. Critical enablers .334.1 Supportive laws and policies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344.2 Empowering the community and meaningful community engagement. . . . . . . . . . . . . . . . . . . . . . . . . . . . 354.3 Addressing stigma and discrimination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364.4 Alternatives to arrest and incarceration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374.5 Preventing and addressing violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374.6 Closing compulsory drug detention and rehabilitation centres. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38vii
HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGSChapter 5. Implementation considerations .395.1 Intersection between groups of people who use stimulant drugs and overlapping risks. . . . . . . . . . . . . . 395.2 ChemSex and HIV prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405.3 Outreach work (including virtual settings) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415.4 Community-based interventions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415.5 Gender-responsive services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435.6 Young people who use stimulant drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Chapter 6. HIV harm reduction checklists for people who use stimulant drugs. 471. Checklist for policymakers and managers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472. Information for people who use stimulant drugs (without injecting) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483. Information checklist for people who inject stimulant drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 484. Checklist for self-care and stimulant drug use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49References. 51viii
Abbreviations and acronymsAIDSARTARVATSCSOEMCDDAHBVHCVHIVHLM 2016HTSIDUITUNODCUSAIDAcquired immunodeficiency syndromeAntiretroviral therapyAntiretroviral drugAmphetamine-type stimulantsCivil society organizationEuropean Monitoring Centre for Drugs and Drug AddictionHepatitis B virusHepatitis C virusHuman immunodeficiency virusUnited Nations High Level Meeting on Ending AIDS (2016)HIV testing servicesImplementing comprehensive HIV and HCV programmes with people who injectdrugs: practical guidance for collaborative interventions (UNODC, 2017)Information, education and communicationInternational Network of People Who Use DrugsLow dead-space syringeMethylenedioxymethamphetamine (Ecstasy)Implementing comprehensive HIV and STI programmes with men who have sex withmen: practical guidance for collaborative interventions (UNFPA, 2015)New psychoactive substancesNeedle and syringe programmeGlobal Network of Sex Work ProjectsOpioid substitution therapyPost-exposure prophylaxisPrevention of mother-to-child transmissionPre-exposure prophylaxisSustainable Development GoalSexually transmitted infectionImplementing comprehensive HIV/STI programmes with sex workers: practicalapproaches from collaborative interventions (WHO, 2013)TuberculosisImplementing comprehensive HIV and STI programmes with transgender people:practical guidance for collaborative interventions (UNDP, 2016)Joint United Nations Programme on HIV/AIDSUnited Nations Development ProgrammeUnited Nations Population FundUnited Nations General Assembly Special Session on the World DrugsProblem (2016)United Nations Office on Drugs and CrimeUnited States Agency for International DevelopmentWHOWorld Health MTCTPrEPSDGSTISWITTBTRANSITUNAIDSUNDPUNFPAUNGASS 2016ix
HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGSDefinitionsAmphetamine-typestimulants (ATS)A group of drugs, mostly synthetic in origin, whose principalmembers include amphetamine, methamphetamine and MDMA. ATSare available in the form of crystals (methamphetamines), powder orformulated tablets. ATS can be taken orally, intranasally (snorted),smoked as a vapour (pipe), inserted anally or injected.ChemSexThe use of any combination of crystal methamphetamine,mephedrone and GHB/GBL by men who have sex with men before orduring sex, to facilitate sexual sessions lasting several hours ordays with multiple sexual partners. ChemSex is a term usedprimarily in western Europe; in other parts of the world, the termsvary, e.g., “party and play” (PNP/PnP) in the United States ofAmerica, or “high-fun”, “chem-fun” in Asia.Coca pasteAn intermediate product in the process of extracting cocainehydrochloride from coca leaves. It is accessible in urban areas inLatin America and is known by many street names, such as pastabase, coca or paco. Coca paste is usually rolled into a cigarettemixed with tobacco and/or cannabis and smoked.CocaineThe main psychoactive alkaloi
nificant contributions include Gilberto Gerra, Chief, Drug Prevention and Health Branch; Monica Beg, Chief, HIV/AIDS Section and Global Coordinator for HIV/AIDS; and Monica Ciupagea, Expert on Drug Use and HIV and Civil Society Focal Point. The guide builds on a discussion paper developed by Steve Shoptaw of the Departments of Family
Strategy 8- Develop partnerships to conduct integrated HIV prevention and care planning Strategy 9- Implement structural strategies to support and facilitate HIV surveillance and prevention Strategy 10- Conduct data-driven planning, monitoring, and evaluation to continuously improve HIV surveillance, prevention, and care activities
Epi Profiles Summary: St. Louis HIV Care Region 2017 Epidemiologic Profiles of HIV, STD, and Hepatitis in Missouri 63 Figure 5. HIV disease deaths*, by selected race and year of death, St. Louis HIV Care Region, 2008-2017† *Includes deaths that have occurred among those diagnosed with HIV disease in the St. Louis HIV Care Region.
Jul 25, 2011 · Multispot HIV-1/HIV-2 2004 Reveal G3 2003 OraQuick Advance 2002 Clearview Complete HIV 1/2 2006 Clearview HIV 1/2 Stat Pack 2006 . Rapid HIV Test Results without Rapid Test Kits . On-board Refrigeration of Multiple Different Assays . . COMPLETE HIV-1/2 (-5) HIV-1/2 STAT-PAK
City-only care plan to HRSA. The Integrated HIV Prevention and Care Plan is a vehicle to develop a coordinated approach to addressing the HIV epidemic at the state and local levels. The progress on achieving the objectives presented in the Integrated HIV Prevention and Care Plan will be
HIV medication costs approximately 15,000 Euro per year. In Finland, the place of domicile of the HIV positive person pays for the medication. How will HIV affect my life? HIV will not affect your work, studies or hobbies. A person with HIV can date, get married and have children. HIV will not stop you from living a full life.
RESEARCH ARTICLE Acceptability of oral rapid HIV testing at dental clinics in communities with high HIV prevalence in South Florida Erin L. P. Bradley1*, Denise C. Vidot2, Zaneta Gaul3, Madeline Y. Sutton1, Margaret Pereyra4 1 Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States .
living with HIV, and community advocates responsible for promoting the best interests and care of adults living with HIV. They should be read in conjunction with other published British HIV Association (BHIVA) guidelines. Of note, the term 'HIV' refers to HIV-1 throughout these guidelines. 1.2 Methodology 1.2.1 Guideline development process
Anonymous HIV testing (without giving your name) is available at certain public testing sites. HIV testing is a routine part of health care but you have the right to decline an HIV test. If you wish to decline HIV testing, inform the health care provider. HIV Testing for Young People Aged 13-18:
