Side event: Ensuring access to measures for the prevention of mother-to-child transmission of HIV among women who use drugs and women in prisons

Organized by the UNODC HIV/AIDS Section with the support of Norway and Sweden, and the International Network of People who Use drugs and the World Health Organization

Fariba Soltani, Chief of HIV/AIDS Section, UNODC; Event Moderator: So, good morning everyone, and I would like to first introduce myself. My name is Fariba Soltani and I am the chief of the HIV/AIDS Section. I would like to thank all the participants for joining today. I would like to invite Miss Miwa Kato who is the director for operations at UNODC to deliver the introductory remarks and opening remarks.

Miwa Kato, Director, Division for Operations, UNODC:  I’m very pleased to be able to participate and it’s a great honour to open this event together with the Norwegian ambassador. Elimination of mother to child transmission of HIV plays a central role in the achievement of our common goal of ending AIDS, and as a health threat by 2030. The topic of preventing mother to child transmission of HIV is very high on the agenda of member states, and is reflected in two important resolutions that are being discussed this week at the Commission on Narcotic Drugs, both initiated by the government of Norway. In May, 2017, the 26th session of the Commission on crime prevention and criminal justice adopted resolution 26 to ensuring access to measures for the prevention of mother to child transmission of HIV in prisons. In March, 2019, the 64th session of the Commission on Narcotic Drugs, so two years ago from now, adopted resolution 61 for promoting measures for the prevention of mother to child transmission of HIV, hepatitis B and C and syphilis among women who use drugs. Even though some countries have made extreme exemplary progress in promoting gender equality, the discrimination of women and girls unfortunately still is very much existing in the settings, especially visible in the gaps of the global health response. Women who use drugs continue to experience significant barriers to accessing necessary health services, and are almost never included in policy dialogue in relation to drug use and prevention of mother to child transmission of HIV. The COVID-19 pandemic exacerbated these existing disparities and inequalities faced by women who use drugs, especially in relation to gender based violence, poverty and primary care responsibilities, and increased their risk of health related harms, including for HIV and hepatitis C. In order to ensure access to PMTCT related measures for HIV prevention, treatment, care and support among women who use drugs, and women in prisons in general, the commitment and cooperation of all relevant parties responsible for health care in communities and throughout the criminal justice system is sorely needed. In early 2020 UNODC launched the UNODC UN FPA, WHO and UNAIDS technical guide on PMTCT of HIV and prisons. Since then, and based on this technical guide, UNODC with partners, conducted regional training of trainers workshops in all geographical regions. In addition, UNODC, in consultation with experts from multiple member states, academia, and members of the civil society organisations, organised an expert group meeting to develop tools for monitoring epidemiological trends in mother to child transmission of HIV in prisons, and the availability of services to prevent such transmission. It therefore gives me great pleasure today to open this side event. Also, today we are officially launching the technical brief on prevention of mother to child transmission of HIV, hepatitis B and C and syphilis among women who used drugs. The technical brief, as part of a series of UNODC publications, aims to address the needs of women who use drugs, and it was developed both to respond to the requests coming from the community of people who use drugs, and also in response to the CND resolution mentioned earlier, this publication emphasises that all pregnant women and breastfeeding women who use drugs should have at least the same access to evidence based services for the prevention of mother to child transmission as women in the general population. I would like to take the opportunity to thank who UNICEF, UN Women, and INPUD for their support and collaboration in developing this publication. I hope that the discussions following will also give us more light in terms of what we can do in applying these in practice on the ground. But it’s very important that we generate more attention and resolve to address this often neglected issue.

Fariba Soltani, Chief of HIV/AIDS Section, UNODC; Event Moderator: I give the the floor now to Ambassador,Kjersti Ertresvaag Andersen, Permanent Mission of Norway to the International Organisations in Vienna to deliver her opening remarks, and I would like to thank Norway for all the support that we have been enjoying throughout our work on HIV/AIDS. So Ambassador you have the floor.

H.E. Kjersti Ertresvaag Andersen, Ambassador, Permanent Mission of Norway to the International Organisations in Vienna: I would like to start by thanking the UNODC CS HIV/AIDS, section for organising the event within the UNAIDS joint programme. The UNODC is the convening agency for HIV among people who use drugs, and for HIV among people in prisons and other closed settings. So we very much appreciate the work that you do, and are very close collaboration.

HIV has a disproportionate impact on communities that are already marginalised and excluded, including people who inject drugs and people in prisons and other closed settings, and unfortunately the COVID-19 pandemic is reinforcing inequalities. Norway and Sweden tabled resolutions regarding the prevention of HIV from mother to child both in the CND and the CCPCJ three and four years ago. To roughly estimate the possible gains in avoiding HIV transmission to babies, if PCT measures provided to women and persons and other close settings are women who use drugs are implemented. We are eager to hear from the panel how these resolutions have been implemented by UN agencies and countries and what obstacles remain that are necessary to still address. I would just like to say a few words on the global AIDS strategy. We’re very pleased that this strategy is newly adopted. It’s evidence based, progressive, visionary, and ambitious. We welcome the dedicated focus on ending inequalities, ending AIDS. It’s essential to close inequality gaps by addressing social and structural barriers to ensure an efficient Global AIDS response. It’s impossible to achieve this without focusing on human rights, gender equality and sexual and reproductive health and rights while upholding a zero tolerance for stigma and discrimination. The Global AIDS strategy clearly sets out Priority Action to reach targets and results, including ensuring universal access to comprehensive prevention in prisons and other close settings, as well as intensifying and redoubling efforts to scale up comprehensive harm reduction for people who inject drugs. The strategy also makes clear that women who use drugs and women in person should receive the tailored services and support they need, and that they are meaningfully engaged in HIV related decision making. The strategy also prioritises smarter programming to end vertical transmission. It will be important to put these priorities into practice. We are very pleased to note that the Global Fund has recently updated its technical guidance note on addressing HIV and TB in persons also referencing these guidelines on PMTCT and prisons from 2019. The challenge ahead is how these recommendations will be taken on board and implemented at the country level. So, I’m looking very much forward to our panel today on these and other related issues. Thank you so much.

Fariba Soltani, Chief of HIV/AIDS Section, UNODC; Event Moderator: Thank you very much, Ambassador for this very informative and very inspirational speech, as you mentioned, the very important point is the adoption of the UNAIDS global strategy. This is very important within our work, and the global strategy, focusing on inequalities. So now I have the pleasure to our first speaker, Adeeba Kamarulzaman, president of IAS, International AIDS society, to provide the first presentation.

Adeeba Kamarulzaman, MBBS, FRACP, FAMM, FASc, HonLLD Monash, DPMP, Dean of Medicine, Professor of Infectious Diseases, Faculty of Medicine, University of Malaya, President of the International AIDS Society: Good afternoon everyone from Kuala Lumpur. Eliminating mother to child transmission of HIV is absolutely crucial to achieve our shared goal of ending AIDS as a public health threat by 2030. As we all know, since 2015 The Start Free stay free framework laid out basic concepts to support countries to achieve the elimination of mother to child transmission by firstly eliminating new HIV infections among children and reducing the number of children newly infected annually to less than 40,000 by 2018 and 20,000 by 2020. And the second goal is to reach and sustain 95% of pregnant women living with HIV with lifelong HIV treatment by 2018. However, despite the progress made to prevent the HIV transmission from mothers to their children. children, unfortunately, are still becoming infected due to unequal access to treatment services in many parts of the world. During 2019, an estimated 150 children had HIV globally. So we are indeed very far from the 2020 target of 20,000 by many levels. The coverage of antiretroviral medicines for pregnant women living with HIV reached 85% globally. However, again due to stigma, discrimination and punitive laws, many women in key populations continue to face numerous barriers in accessing HIV testing and antiretroviral treatment when they are pregnant women who use drugs face particular challenges. As we all know stigmatised and criminalised for decades. They have been pushed to the margins of society, harassed, imprisoned, and denied services, making them even more vulnerable to HIV. And in particular, discrimination towards women who use drugs who are pregnant remains a reality in healthcare facilities. Few harm reduction programmes tailor their services to meet the needs of women. Many such programmes, do not provide PMTCT services or referrals, childcare facilities, sexual and reproductive health services, services to tackle gender based violence or adequate opening hours, or even staff trained to respond to gender specific needs. Now on top of all these existing problems, we have the COVID pandemic, which has already stretched services due to COVID 19 pandemic. In many countries, HIV services have been disrupted and supply chains for key commodities have been stretched. Studies that we have so far are looking into the impact on services, addressing the needs of women who use drugs. Harm reduction services were closed in many countries during the lockdowns because they are not considered essential services. Despite increased demand, survey of 25 European countries, reported a 60% decrease in the availability of drug treatment. The service should reduce access to harm Reduction Services, with increased risk of shared injecting equipment, leaving women who are already at increased risk of HIV, Hep C. There has been a shift to online programming, which can be a barrier for many women staying home.  An INPUD survey found 37% reported increased violence, including intimate partner violence towards women who use drugs, interruptions to drug supply and decreased access to services have increased intermittence of forced withdrawals, decreasing tolerance, and potentially increased risk of overdose. Pandemic restrictions, also increased likelihood of injecting alone or at home, increasing the risk of fatal overdose. Delayed screening and treatment for health issues during the pandemic disproportionately affected women, especially in relation to sexual and reproductive health. And finally, the pandemic has also made it more difficult for women to access PMTCT services, as well as other STI and cervical cancer screening. Yet despite this seemingly insurmountable challenges, there are some promising responses that have been reported since the beginning of the pandemic. PLM interventions became not only a vital link between people who use drugs and life saving services, but important actors in making HIV in harm reduction services sustainable and uninterrupted by ongoing lockdowns. The pandemic also provided an opportunity for harm reduction programmes to adapt and change to more flexible ways of service delivery, including simplified prescription requirements, take home opioid agonist therapy, integrated mobile, mobile COVID-19 and hybrid and access to online counselling and communication. Despite these innovations, there’s still more that needs to be done to achieve the elimination of mother to child transmission among women who use drugs. And I would like to conclude with several recommendations. Firstly, ensure that harm reduction services and health coverage systems are structured in a way that makes services accessible and acceptable to women these drugs. Secondly, protect and promote the human rights of women who use drugs by treating them with dignity and providing equal access to health and social services, eliminate the multiple intersecting forms of stigma and discrimination, experienced by women who use drugs, including while accessing health legal education, employment and social protection services, or when interacting with law enforcement. Support Fund and empower community based organisations, including organisations and networks of women who use drugs so that they are included in all aspects of the design. And we have seen throughout the pandemic how crucial community based organisations have played in ensuring continued services. And finally, implementation and monitoring and evaluation of drug policies and programmes, as well as in the design and delivery of HIV health and social protection, protection services. When we can ensure that pregnant women who use drugs and living with HIV are diagnosed early, started on and retain on antiretroviral medicine during pregnancy delivery and breastfeeding, we will make a significant step to achieve elimination of new infections among children and reduce HIV related deaths among pregnant women and new mothers. So on behalf of is I thank you once again for inviting us to be a part of this panel this morning and afternoon.

Fariba Soltani, Chief of HIV/AIDS Section, UNODC; Event Moderator: Thank you very much. The recommendations you provide are really very important to the work we do and to the whole work on harm reduction especially addressing women who use drugs and ensuring that their needs are actually covered. Now I would like to invite our second speaker, the executive director of international network of people who use drugs, Miss Judy Chang, who’s going to present us with the perspective of the community of women who use drugs.

Judy Chang, Executive Director, International Network of People Who Use Drugs: So INPUD are a global key based network, and we work to protect the health and defend the rights of people use drugs. Our membership is based on eight regional networks as well as the international network of women who used drugs. I am a woman who uses drugs, I have been an injecting heroin user for about 20 years, and on opiate agonist therapy for about 15, and I’m currently on buprenorphine. So we know women who use drugs are universally ignored and invisible, and you know we’re very far away as a population for reaching the global HIV targets. So from the UNODC 2020 World Drug Report, it was estimated there are 269 million people who use drugs, and though of course, data is really scarce on women who use drugs. We know that there’s approximately 1/3 of that 269 million are women who use drugs. We know that women who use drugs and sell drugs are exponentially increasing as the war on drugs is being doubled down upon and of course this intersects with gender inequality, there are extreme barriers to accessing services, including prevention of mother to child transmission that women who use drugs face. Before we talk about addressing these barriers and how to address these barriers, it’s important to outline and articulate and understand some of these barriers as well. So overall there is very low access for harm reduction services. It’s estimated that approximately only 1% of people who inject drugs live in countries where there’s high or sufficient coverage of harm reduction. And of course this would be even lower for women as well. The access and availability of harm reduction is incredibly critical, because it’s an entry point to other health services. And many of us have experienced really traumatic experiences in one way or in contact with more broader health services especially when they’re low threshold and are the entry point being able to protect and maintain our health. Sexual reproductive health services are really sensitised to the needs of women who use drugs. And what this means in reality is that we’re often denied treatment or casually dismissed, and of course this is the moral judgments around drug use and the idea of women whose drugs not being able to be fit mothers, and we know this is stigma and discrimination and prejudice. When we are in contact with health services, we’re often told that we immediately somehow magically have to commit to abstinence. And of course, this means being forced or coerced into withdrawal. And we know that this is not only counterproductive but incredibly dangerous, especially during pregnancy and of course pregnancy is a very stressful time-  there’s a lot of future unknowns, and pressure of having to deal with prejudicial and discriminatory health services makes up for a very cruel and difficult situation that we’re putting women who use drugs into. We know that the safest course of action for women who use drugs during pregnancy is methadone and buprenorphine, and yet in some states we also know that merely being on methadone whilst pregnant leaves people vulnerable to charges of foetal assault or child abuse. I also want to point out that we have to see health as being linked to all these other kinds of factors in life as well, economic, and social. And, our needs go beyond health. We’re not going to be empowered to protect our health without food, shelter, economic, safety and security. Many of us have experienced gender based violence and there’s disproportionately high rates of intimate partner violence, and often there are no kind of redress mechanisms in place and there’s not enough Legal Aid, specifically for women who use drugs. We really do need to be addressing these social structural issues in tandem. Now is the time with COVID that we really had to examine this overall, not only for people who use drugs but of course everyone where we see how critically important social and economic needs are. We know that health does not exist in a vacuum. Laws not only criminalise drug use, but also countries criminalise HIV exposure and transmission, meaning that women who use drugs living with HIV will avoid reproductive health services. In many countries, there are also no specific protective laws to stop health services from recording and subjecting women to coerced HIV testing for sterilisation and abortion. As I mentioned before, drug use during pregnancy is also specifically criminalised in many countries, and allow forced abortion termination and also termination of parental rights of women who use drugs. So, in mentioning the stigma and discrimination, I think what we really need to be pointing to is that there needs to be that trust between women whose drugs, and health services, especially sexual reproductive health services and PMTCT services. And we’ve got to, look at removing this moral layer around drug use, pregnancy and children who are blamed and shamed and risk imprisonment. I think, in this situation at best those of us who can do hide our drug using status, which means we’re not getting the specific advice and guidance that we need. At worst, it means future surveillance, lack of confidentiality and basically being trapped by child protection health services and being denied the health services we need. We know we have the tools and technologies to prevent mother to child transmission of HIV, hepatitis and syphilis and it’s really stopping us in being able to access this treatment. You know my punished for wanting to or merely trying to you know take responsibility for our own health, and our children’s health. In essence, that means we’re being faced with these impossible choices.

Some of the actions that do need to be taken. We need gender sensitive harm reduction services. There should be training for sexual and reproductive health providers to understand the needs of women who use drugs. We need to focus more on advocacy, removal of laws that criminalise women who use drugs, and be able to protect and maintain confidentiality. There should be social and legal support for women who use drugs and of course link to other services such as shelters, and we found during COVID 19 as well. There was rise in domestic violence, and a lot of the shelters wouldn’t take women who use drugs solely based on drug use and status. Of course, there needs to be support for empowerment of women who use. It’s really important that women are able to collectivise together articulate their needs and then be able to advocate based on these needs so that policies and programmes are more aligned and sensitive to basically what is going on. So I think if we don’t do anything about the above, we know that HIV incidence will increase. This is evidently a travesty when we have the means at our disposal to actually prevent.

In closing, I will say with COVID it evidently disrupted many harm reduction and treatment services for women living with HIV and women who use drugs. Unfortunately there isn’t much data, but the European Women’s Network on AIDS conducted a survey amongst women living with HIV and key populations, and really exposed the impact of COVID on these populations. I think with COVID, we talk a lot about lessons learnt, and we’ve talked about innovations. But I just want to emphasise, I don’t think it’s so much about innovations but doubling down on what we always know has been needed -basically removing punitive laws and policies, addressing social needs and social protection needs, and supporting communities and doing their work because a lot was done by communities including communities of women who use drugs in COVID and a lot of us had to do it on our own because there there hasn’t generally been that much support for empowerment of women who use drugs. So, just really wanted to underline that point that we need to be working on addressing the barriers that impede the health and human rights of women who use drugs but also future generations as well. Thank you.

Fariba Soltani, Chief of HIV/AIDS Section, UNODC; Event Moderator: Thank you very much, Judy. It is very important to listen to the community’s needs when we are doing any programming and we value the work that we are doing together with INPUD on all the work that is happening within the HIV section of UNODC. It is a very valuable partnership for us to bring in the perspective of the community and especially highlighting the stigma and the discrimination that is felt by the community, especially from health workers who are supposed to be there to assist them to support the community. And also what you mentioned about the community and how they’ve taken the burden of providing services during this COVID pandemic without much support. So I thank you for all your work, what the community is doing, and look forward to working more closely with you in rolling out the technical work in the future.

So our next speaker is Dr Professor Gabriele Fischer, the head of the addiction research and the Centre for Public Health Department of Psychiatry and psychotherapy for the Medical University of Vienna, who will highlight the perspective of services in prisons, and the human rights aspect of PMTCT. The floor is yours.

Univ. Prof. Dr. Gabriele Fischer, Medical University Vienna, Centre for Public Health Department of Psychiatry & Psychotherapy, Head: Addiction Research, Head: Human Rights Commission 3, Austria: I would like to not only focusing on HIV, but like to emphasise the spectrum of infectious disorders. If you look into prison, we find the amount of infected inmates on the global prison population with HIV, and also figures on tuberculosis. Tuberculosis and HCV is increasing, because very effective treatment, not only for treating HIV but for treating HCV as well. In talking about women, women’s right and special needs, pregnant women get sick and are getting pregnant, so I think the highest priority needs to be given into prevention. As you know, pregnant women are getting sick and sick women are getting pregnant, so we have to focus on that public health issue. And in addition, if it is very often the case in substance use disorder. One focus I think we need to give is that Mother Child Health, very often in some countries it’s surrounded by specialised centres who are not in the vicinity of centres treating Mother and Child Health. We have to make sure that we are not sending the patient around, but having specialists in the Centre for substance use disorder patients. If it comes to prison, it’s a very difficult for the vulnerable population of women because the facilities are not as good as for male prisoners. There is a study from the United States, just focusing on the increase in consideration of demand and the rate of growth in women. Imprisonment was twice as high as for males. And in a statistical review, data are indicated for us alcohol abuse and drug abuse, and it’s very striking the increasing number of women. I do know the weakness of this data from the United States is that the United States is not the key model for adequate diagnostic equipment, depending on the issue that prisons are mostly run privately.

Adequate treatment of drug dependence and opioid maintenance treatment, this is listed under diagnosis and treatment. The key issue to focus on HIV/HCV testing at the entry of the prison. And of course, it has to be offered periodically, because we do know that this population is very often exposed to increased risk in the custody setting, which actually might increase their vulnerability for acquiring an infectious disease in prison. Of course, one sensitive issue is a very successful tool to reduce infectious diseases is the live syringe programmes. Opiate maintenance treatment I think there is no question about the efficacy of this. It should be made available based on the human rights treaties and of course this is really important to address to governments for the countries who signed the optimal protocol to prevent torture, and the convention for persons with disabilities, but there is no doubt about the efficacy of opioid maintenance treatment in prison. And we do know also in pregnant women, it says safe treatment to be acquainted with all through the pregnancy, and very often it stabilises the immunologic functioning of a person and provides a good start for neonates. The best medication research advice is doubtless methadone, but we do have other effective opioid medication for maintenance in pregnancy Also in a in a prison setting, which of course has not been looked into, pregnant women so far in clinical studies, but we do know that plasma delivery system shows very constant buprenorphine levels and buprenorphine is safe medication for pregnant women and the foetal development. This is a piece of global data on how opiate maintenance treatment is provided worldwide to prisoners, and this is a very disappointing result, because the orange column shows you there at least 50% of people are treated with opioid maintenance treatment. Countries should develop policy for alternatives to imprisonment, as long as these alternatives are not labour. Authorities are faced with specific population in need of treatment adherence support. In some countries, if a drug dependent woman is pregnant, of course depending on the delinquency, they are going to be released. And they encode prioritisation of treatment instead of incarceration, but this model needs to be extended globally. I want to focus on that substance use disorder. If you’re not picking up the broad spectrum of psychiatric comorbidities, we will not be able to stabilise the women and their pregnancy because it’s even a higher risk because of their hormone changes of intensifying the underlying psychiatric disorder, which of course is to a high percentage related to affective disorders like anxiety Post Traumatic Stress Disorder. Adequate HIV treatment during pregnancy is the key role in order to have the basis for a healthy and HIV negative pregnant woman and we do know that opiate maintenance equipment is safe. We have to be careful in the administration of other psychopharmacological treatment. I thank you for your attention.

Fariba Soltani, Chief of HIV/AIDS Section, UNODC; Event Moderator: So, I would like to invite our next speaker Morkor Newman Owiredu from Department of global HIV, hepatitis and STI programme from WHO to present on the achievements of the triple elimination of mother to child transmission of HIV, syphilis and hepatitis B virus. You have the floor.

Morkor Newman Owiredu, Department of Global HIV, Hepatitis and STI Programmes, WHO Switzerland: We are going to focus on looking at the critical components of promoting the achievement of triple elimination which is ensuring access to the measures which prevents mother to child transmission of HIV among women who use drugs, and women in prison. So, first of all, just briefly, a reminder of what the initiative is, which is an initiative for elimination of mother to child transmission and it’s of HIV, syphilis and hepatitis B. It looks at preventing new infections among girls and women of childbearing age and this is through prevention and also, pre and post exposure prophylaxis. Then we look at ensuring access to sexual reproductive health services which has come up in the previous speakers. And for this, it’s both family planning or preventing of unintended pregnancies, by integration and also access, increase in access to SRH services, as has been already mentioned in gender-based violence and prevention and management of STI is then actual prevention of transmission from the mother to the infant or to the foetus. This needs timely initiation of HRT, and lastly lifelong treatment because all women who are living with HIV, their children and their families need appropriate and comprehensive treatment care and support. This needs to apply in the context of women who use drugs, and women who are in prison and as Judy says, this is a really important part of the presentation. This just gives the context where we look at the criteria for validation, and the most important thing to consider here is that we need antenatal coverage, 95% system coverage, as well as treatment coverage for syphilis at 90%. We are looking for a 95% coverage requirement if we really want to eliminate mother to child transmission.

The hardest to reach, which is usually the 10 or 15% of any coverage indicator is toughest, and to get those the most common challenges we have found to get to women who use drugs are that. And this is noted from the countries who have applied for validation, that we have human rights issues which have been mentioned already, and there’s inadequate addressing of marginalised populations within these human rights issues. There’s also challenge with identifying exposed infants, again in the hardest to reach, and even worse for Hepatitis B. And yet, to get to the SPT targets, we have said, we are leaving no one behind. So we must focus on these hard to reach populations.

What is the solution? We need to ensure access, and for this, the differentiated HIV services for key populations is the key. We need to overcome the specific challenges with the provision of care, and the access to women and girls in this group, also to ensure sustainability by engaging relevant health stakeholders, especially the communities, and then also expose infants to ensure they get the required care whether prevention or treatment if they happen to have gotten infected. So for this, we need a client centred approach and this simplifies and adapts HIV service across the cascade and reflects the preferences, and the expectations of the groups of people. What’s the advantage? It provides acceptable and available services, including sexual and reproductive health services, improves efficiency of testing and treatment, and the rates of initiation and retention also go up once services are differentiated and that are addressing the populations. It also ensures that people’s rights to confidential nonjudgmental and quality care for HIV, syphilis and hepatitis B. We have tools for these and recommendations and it’s important for us to note that we need both task shifting and decentralisation of delivery of a services means peers within women living in prisons or women who use drugs are perfectly capable of delivering services. We need access to harm reduction services, ensuring access will reach these hard to reach women and girls, by providing differentiated services. And given the synergies for HIV, syphilis and hepatitis B, we need to have an integrated approach. This integrated approach can be done by strengthening reproductive maternal neonatal child both within and outside prisons, and this would better address the populations, if we really want to reach health for all women in prisons and women who use drugs must be well and effectively addressed. Thank you.

Fariba Soltani, Chief of HIV/AIDS Section, UNODC; Event Moderator: Thank you very much for this very important and very informative presentation. I am very delighted to just give the floor to our own expert on drug use and HIV from the UNODC HIV/AIDS section.

Monica Ciupagea, MD, Expert – Drug use and HIV, HIV/AIDS Section, United Nations Office on Drugs and Crime: So, my task today actually is to inform everyone about the technical brief on prevention of mother to child transmission of HIV, hepatitis B, C. This is available as of now, on our website. It will be made available in printed form, as requested. When, in the absence of any prevention of mother to child transmission during pregnancy, delivery or breastfeeding that HIV transmission is between 15 to 45% from the mother to their children. but when these prevention measures are available, the transmission almost 0. This is also highlighted in the resolution that was mentioned today, and this was the engine behind developing this technical brief. This group remains hard to reach because of stigma, discrimination because of very many barriers that actually were exacerbated during the COVID pandemic as Judy mentioned adding more gender based violence. Isolation, mental health problem, but also the burden of poverty and the burden being the primary person who will provide care in that family.

So this is the technical brief. This is the publication that is currently now on the website available, and it was developed in collaboration with a very hard working technical working group consisting of our colleagues from international network of people who use drugs, international network of women who use drugs, World Health Organisation. UNAIDS, UNICEF. It provides five main recommendations. In order to scale up the prevention of mother to child transmission among women who use drugs. The first recommendation is to make the four components of the World Health Organisation comprehensive PMTCT package including harm reduction available for women who use drugs. The second recommendation is to remove barriers preventing women who use drugs from accessing the services for sexual and reproductive health and HIV that they and their children need, including for MPCP. The second recommendation is to integrate services for sexual and reproductive health and PMTCT within harm reduction and drug dependence treatment services, and establish strong linkages between the services. The fourth recommendation is to include representatives from the community of women who use drugs in strategic planning, implementation, monitoring and evaluation of PMTCT services. And the last recommendation is to include these aggregated indicators and targets for women who use drugs within the monitoring and evaluation framework of the country’s elimination of mother to child transmission plans. So now that the publication is available, what are the next steps that we plan to do? First of all is to build up the capacity of health staff in harm reduction services and community based organisation but also law enforcement to be active actors that will enable women who use drugs to access prevention to mother to child transmission. The thing that we will continue to do is to increase the community engagement in the services because without the involvement of the community we learned this lesson over and over again in addressing the AIDS epidemic. Only with increasing community engagement we can increase the accessibility, and the replicability of this measure and we strongly recommend in this publication. Countries should ensure that there are consultations with the community networks of women who use drugs but also women in prison, and sex workers and those who are living with HIV, and we emphasise again and again that the engagement of the community is critical in the development, implementation and moratorium of this plan. So I hope that next year we will discuss more about how these steps were implemented, and we hope that we will reach out to as many people as possible to make aware that these technical brief exists.

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