HIV, TB, STI and hepatitis in Sweden 2015 Preliminary epidemiological data and other news

Transcription

1 HIV, TB, STI and hepatitis in Sweden 2015 Preliminary epidemiological data and other news Monica Ideström/Torsten Berglund Public Health Agency of Sweden NDPHS, HIV, TB & AI EG-meeting, Warsaw 3-4 th of March 2016.

2 HIV - accumulated numbers and prevalence A total of ca reported HIV cases in Sweden Prevalence: Approx people are currently living with a known HIV infection in Sweden (April 2015) 0,07% or 690 PLWH per 1 million inhabitants (9.8 million inh. in Sweden Dec 2015).

3 Preliminary data HIV, TB and STI 2015 Number of cases Incidence Last year HIV: 450 cases (4,6/ ) 5% TB: 835 cases (8,5/ ) + 22% Hepatitis C: cases (20/ ) + 3% Acute Hepatitis B: 151 cases (1,5/ ) +29% Syphilis: 329 cases (3,3/ ) + 26% Chlamydia: cases (384/ ) + 4% Gonorrhoea: cases (17/ ) + 20%.

4 MSM2013 a study about sex, HIV and health among men who have sex with men in Sweden, published 2016 In comparison with previous Swedish MSM surveys and EMIS, substantial structural differences remain between MSM living in metropolitan areas and MSM residing in the rest of Sweden. - MSM do not have equal access to preventive services across the country. - About half of the men who had anal intercourse with a nonsteady partner at their most recent sexual encounter had used a condom. - Most of the men had at some point been tested for HIV and other sexually transmitted infections. - 4 % of the men reported that they are living with HIV - Comparison over time showed a tendency of increased sexual risk-taking behaviour, but also increased HIV testing. - The study also involved a development of the study design

5 Integration of services (reproductive, TB, hepatitis, STI prevention and treatment) for key populations Migrants The county councils have an obligation to offer a health examination for all asylum seekers. Ca 40 % undergo health screening. The obligation does not involve family linked immigration (except family members to asylum seekers). The counties decides for themselves how to organise. Testing for HIV, STI, TB and hepatitis are offered but voluntary. Asylum seekers is a hard to reach group. Many are young men and that is a hard to reach group in the total population as well. But family linked immigration of women and children will have access to mother and child health care programs

6 Migrants (continuation) 80 % of patient diagnosed with HIV in Sweden, has got HIV either in connection with a stay abroad or, more often, prior to immigration to Sweden. Among migrants who have been diagnosed with HIV we estimate that 20 % where diagnosed within two month after arrival. Ca 30 % are diagnosed after more than one year in Sweden. Foreign origin is a risk factor for late diagnosis in Sweden. The proportion of migrants infected after arrival is probably underestimated. All diagnosed with HIV and TB get free care and medication. Also undocumented have that right

7 Prevention for people who inject drugs In 2015 The public health agency of Sweden published a Guidance for health promotion and preventive work with hepatitis and HIV directed at people who inject drugs. The objective is to support regional and local actors who in their work come in contact with PWID. Starting point is everyone's right to health

8 PWID (continuation) HIV prevention programmes for PWID are not delivered at scale. The national NSP coverage is insufficient. The background is legal and political. But there is now an ongoing process to change restrictive laws and policies. NSP will, with great certainty, grow. Today there are only three out of 20 county councils who offer NSP. NSP are most often in lowthreshold setting in connection with an infectious disease clinic with the obligation to offer the service of a midwife to women. Many PWID are regularly in detention and prison. There they are offered HIV-tests and vaccination against HVB, and OST. OST is available for PWID in low-threshold health care settings but with restrictive policies

9 Tuberculosis Recommendations for preventive measures against tuberculosis - Health surveillance, contact tracing and risk-group vaccination. Updated 2012 Recommend health surveillance for migrants from countries with high risk of tuberculosis according to WHO ( 100 cases per population) BCG vaccination of children Screening for the work in the sensitive environment Screening of immigrants Screening of pregnant women

10 Pregnant women All women included all migrant women with out regard of legal status must be offered: Testing for syphilis, HIV and Hepatitis B The test is voluntary and like all maternal health care free of charge. More the 90 % accept the offer. The offer is made to have the possibility of treatment to protect from MTCT. TB testing will be offered to women from countries with high risk. All women who are first time pregnant are also offered a test for Chlamydia. Often the combo test with gonorrhoea. Maternal healthcare will also offer counselling for unwanted pregnancies

11 Young and young adults In 1955 the government decided to have mandatory sexual and relationship education in schools in Sweden. Today starting at the age of six, there is ageappropriate education including gender equality, body integrity, relationship and sexuality. In 1975 Youth friendly services was established in Sweden. Today there are small or bigger clinics in all cities with a high school. They include all young people and many clinics are LGBT- certified. The initiative came with the new law on abortion as a low-threshold service for contraceptives. Today also with STI prevention. Youth clinics provides counselling for unwanted pregnancies. About 93 percent of all abortions are performed before 12 weeks. Medical abortion is most common and is used in nearly percent of all abortions.

12 Young (continuation) 18 out of 21 counties provides Internet testing for Chlamydia free of charges. This opportunity has increased the testing among young men, which is one of the target groups. TB testing is not included in the prevention work with young people except from the health screening of migrants. Sweden has during the last few years got a large group of unaccompanied migrant minors, mainly young boys applying for asylum and residence permit

13 Young and young adults most at risk Young LGBT persons Injecting drugs Migratory situations - unaccompanied minors Socially marginalised In detentions and/or involved in crime Harmful use of alcohol Many sexpartners Having sex for money or other benefits Exposed for/forced to sex against their will Having repeated STI infections Having unprotected sex with new partner

14 A governmental initiative: UMO is a website for anyone between the ages of 13 and 25. Where you can find answers to questions about sex, STI, health and relationships. You get personal answers on your questions

15 Risk of transmission of infection in treated HIV infection Free access in English: Scandinavian Journal of Infectious Diseases Volume 46, Issue 10, 2014, p

16 Awareness raising towards primary healthcare Soon you who is working here will have questions about HIV. Do you have the answers? What do you know about HIV today?.

17 How the HIV virus infects human cells and how modern ART works

18 Webb place for the public:

19 HIV today is not like yesterday. Did you know that the treatment of HIV in Sweden today are so effective that it lowers the level of the virus to virtually zero and the risk of transmission is very low? Living with HIV today is not like yesterday. Read more on

20 .

21 .

22 .

23 .

24

25 Improving Quality in HIV Prevention in Europe Choosing the right Quality Improvement Tool for your HIV Prevention Project