HIV/AIDS Epidemic Status at-a-glance

Transcription

1 HIV/AIDS Epidemic Status at-a-glance PORTUGAL National Report 25

2 HIV/AIDS epidemic status at a glance I. HIV/AIDS epidemic overview HIV infection AIDS cases HIV infection in pregnancy HIV infection in blood donors Notified HIV-2/AIDS cases ( ) AIDS Mortality National response to the HIV/AIDS epidemic Most at risk populations: HIV testing Most at risk populations: IDU prevention programmes HIV treatment Sexually transmitted infections Knowledge and behaviour indicators Young people: knowledge of HIV/AIDS ways of transmission 12 Prison inmates: risk perception on HIV ways of transmission (n=717) 12 Sex before the age of 15 among young women and men 13 Young people: condom use 13 Condom consumption Impact Indicator Data collection plan - 27 reporting National Composite Policy Index Questionnaire 18 National Coordination for HIV/AIDS Infection - Ministry of Health 2

3 1.1. HIV infection I. HIV/AIDS epidemic overview HIV infections newly diagnosed and rates per million population and cumulative totals HIV infections N Rate per million Cumulative total reported N Rate per million Cumulative total reported Cases/ million Cases/ million IDU Homo/bisexual men Persons infected through heterosexual contact Persons infected through MTC transmission Source: EuroHIV. HIV/AIDS Surveillance in Europe. End-year report 23. Saint-Maurice: Institut de veille sanitaire, 24. No. 7. EuroHIV. HIV/AIDS Surveillance in Europe. End-year report 24. Saint-Maurice: Institut de veille sanitaire, 25. No AIDS cases AIDS cases and incidence rates per million population by year of diagnosis adjusted for reporting delays AIDS cases N Incidence rate per million Cumulative total reported N Incidence rate per million Cumulative total reported Cases/ million Cases/ million IDU Homo/bisexual men Persons infected through heterosexual contact Persons infected through MTC transmission Source: EuroHIV. HIV/AIDS Surveillance in Europe. End-year report 23. Saint-Maurice: Institut de veille sanitaire, 24. No. 7. EuroHIV. HIV/AIDS Surveillance in Europe. End-year report 24. Saint-Maurice: Institut de veille sanitaire, 25. No. 71. National Coordination for HIV/AIDS Infection - Ministry of Health 3

4 HIV asymptomatic cases, by mode of transmission and year of diagnosis Source: CVEDT INFECÇÂO VIH/SIDA (25) A Situação em Portugal a 31 de Dezembro de 25. Doc135.CNSIDA. Lisboa HIV infection in pregnancy Respondent Public Hospitals (n) HIV infection in pregnant women 1 Deliveries (n) HIV+ parturient (n) Proportion %(95% CI) (.4-.5) (.4-.5) (.3-.4) HIV infected women in ARV treatment during pregnancy 1 Respondent Public Hospitals (n) Deliveries (n) Women in ARV treatment (n) Proportion %(95% CI) ( ) ( ) ( ) 1 National Coordination for HIV/AIDS infection. Survey of Portuguese Public Hospitals Interim results. 25 National Coordination for HIV/AIDS Infection - Ministry of Health 4

5 HIV infected women receiving ARV prophylaxis during labour 1 Respondent Public Hospitals (n) Deliveries (n) Women receiving ARV prophylaxis (n) Proportion %(95% CI) ( ) ( ) ( ) Women with no HIV testing or unknown result at delivery 1 Respondent Public Hospitals (n) Deliveries(n) No HIV testing or unknown result (n) Proportion %(95% CI) ( ) (.8-1.) ( ) Women (within those with no HIV testing or unknown result at delivery) tested with rapid test during labour 1 Respondent Public Hospitals (n) Deliveries (n) Rapid test in labour (n) Proportion %(95% CI) (1.4-33) ( ) ( ) National Coordination for HIV/AIDS Infection - Ministry of Health 5

6 1.4. HIV infection in blood donors Blood donors by age group - 25 (n=135826) donors <6 age group M F 126 Source: Portuguese Blood Institute Ministry of Health - 25 HIV+ blood donors by age group - 25 blood units M F <6 age group Source: Portuguese Blood Institute Ministry of Health - 25 HIV infection in blood donors (cases/million) Notified HIV-2/AIDS cases ( ) Cumulative total reported of asymptomatic HIV infections and AIDS cases, (n=854) 3% of the total notified cases. 3 2 Portuguese Blood Institute Ministry of Health - 25 National Coordination for HIV/AIDS Infection - Ministry of Health 6

7 1.5. AIDS Mortality AIDS deaths by gender Male Female deaths AIDS deaths by age 5 deaths >5 3 CVEDT INFECÇÂO VIH/SIDA (25) A Situação em Portugal a 31 de Dezembro de 25. Doc135.CNSIDA. Lisboa INE - Estatísticas da Saúde 22 5 INE - Estatísticas da Saúde 22 National Coordination for HIV/AIDS Infection - Ministry of Health 7

8 2. National response to the HIV/AIDS epidemic 2.1. Most at risk populations: HIV testing Drug users HIV testing Drug treatment public services 6 23 % 24 % First-time clients HIV testing , , HIV , ,2 Public Detoxification Units 6 23 % 24 % Clients HIV testing , ,6 HIV , ,7 Certified Detoxification Units 6 23 % 24 % Clients HIV testing , ,9 HIV , ,4 6 IDT. Relatório Anual. 23 A Situação do País e Matérias de Drogas e Toxicodependências. Vol.I Informação Estatística.23. IDT. Relatório Anual. 24 A Situação do País e Matérias de Drogas e Toxicodependências. Vol.I Informação Estatística.24 National Coordination for HIV/AIDS Infection - Ministry of Health 8

9 Public Therapeutic Communities 6 23 % 24 % Clients HIV testing 57 1, 75 1, HIV+ 8 14, 5 6,7 Certified Therapeutic Communities 6 23 % 24 % Clients HIV testing , ,8 HIV , ,8 HIV infection in prison inmates (n=717) ,8 9,9 9,5 8 % M (n=272) F (n=445) Total Source: CNLCS/DGSP/IDT/Fundação Calouste Gulbenkian. Projecto SIDA em meio prisional. Abril 25 National Coordination for HIV/AIDS Infection - Ministry of Health 9

10 2.2. Most at risk populations: IDU prevention programmes Needles and syringes exchange programme 22 IDU prevalence rate per thousand inhabitants (aged 15-64) 4,3 6, , Total of syringes exchanged (by year) , 2.., syringes 1.5., 1.., 5., Number of syringes exchanged (by site and year) syringes Pharmacies Partnerships protocols w ith NGO Mobile Units The decline in injecting drug use among first-time clients within the public drug treatment service network should be highlighted: in 24, 25% of new clients in public services reported injecting drug use in the last month before the first-time appointment, down from 28% in 23 and 22 and from 32%, 36% and 45% 7 Negreiros et al. Estimativa da prevalência e padrões de consumo problemático de drogas em Portugal. Faculdade de Psicologia e de Ciências da Educação Universidade do Porto CNLCS. National Needles and Syringes Exchange Programme Report 25. National Coordination for HIV/AIDS Infection - Ministry of Health 1

11 in 21, 2 and 1999, respectively 9, which may account for the reduction in the number of syringes exchanged by site and year HIV treatment The Portuguese National Health Service provides free antiretroviral treatment for all HIV infected persons Sexually transmitted infections Notified Syphilis cases (by year of diagnosis) 12 1 notified cases Male Female Source: DGS. Doenças de Declaração Obrigatória Cumulative total of notified Syphilis cases (by age group) notified cases M F >75 age group Source: DGS. Doenças de Declaração Obrigatória IDT. Trends in Drug and Drug Abuse Indicators- Executive Summary of Volume I of he Institute on Drugs and Drug Addiction s National Report 24 to the National Parliament.24 National Coordination for HIV/AIDS Infection - Ministry of Health 11

12 2.5. Knowledge and behaviour indicators Young people: knowledge of HIV/AIDS ways of transmission Knowledge of HIV/AIDS ways of transmission in young women and men attending school (n=6131, mean age 14, S.D.-1.85) 1 Yes (%) No (%) DK* (%) Using infected injection material (n=641) Infected mother child (n=66) Unprotected sex, even if just once (n=599) Blood transfusion (n=616) Even looking healthy a person can be infected (n=5976) Infected men having unprotected sex with other men (n=613) Sharing meal and drinking instruments (n=618) Hugging an infected person * Don t know Prison inmates: risk perception on HIV ways of transmission (n=717) 11 Risk perception Major (%) Small (%) None (%) DK/DA* (%) Sexual intercourse with someone healthy-looking Mosquito bite Sharing a meal with someone who is infected Public restrooms In hospital blood transfusion M 27.2 F 29 M 2.6 F 14.4 M 33.1 F 35.3 M 33.5 F 61.3 M 19.9 F 13.2 M 8.8 F 4.9 Sexual intercourse with female sex workers M 87.5 * Don t Know/Don t Answer F Matos, M. e equipa do Projecto Aventura Social & Saúde (23). A Saúde dos adolescentes portugueses (Quatro anos depois). Edições FMH: Lisboa. 11 Amaro, Fausto Conhecimentos, opiniões e comportamentos da população reclusa de dois estabelecimentos prisionais. Interim report. CNLCS/ISCSP. 25 National Coordination for HIV/AIDS Infection - Ministry of Health 12

13 Sex before the age of 15 among young women and men Age at sexual initiation in adolescents attending school 12 No sexual activity 3634 young women and men attending school (mean age 15,2 S.D. 1.35) 76.3% Had sexual intercourse 23.7% 11 years 17.2% F -1.9% M 24.5% between 12 and F 18.9% 13 years 26.1% M 29.5% 13 years 56,8% F 79.3% M 46.% Young people: condom use Condom use by years-old students young women and men attending school years (56.1% F) No sexual activity 4926 Had sexual intercourse 36 No information on condom use 355 Information on condom use 2651 Never 317 (1%) Occasional 295 (11%) Frequent 571 (22%) Consistent 1468 (55%) 12 Matos, M. e equipa do Projecto Aventura Social & Saúde (23). A Saúde dos adolescentes portugueses (Quatro anos depois). Edições FMH: Lisboa. 13 Correia, T. Saúde Reprodutiva Planeamento Familiar, Conhecimentos e Comportamentos Sexuais dos Adolescentes Portugueses. Porto. 24. National Coordination for HIV/AIDS Infection - Ministry of Health 13

14 Reasons for non-consistent condom use (%) 13 n= 36 young women and men attending school years F (%) M (%) Don t know how to use it Ashamed to buy it Decreases sexual pleasure Using another contraceptive Decreases partner confidence Being faithful Surely the partner is faithful Not used to condoms since the beginning Condom consumption condoms units Source: National AIDS Coordination. Information on condoms sold in pharmacies and supermarkets and distributed through health system services/programmes. National Coordination for HIV/AIDS Infection - Ministry of Health 14

15 3. Impact Indicator AIDS cases in young women and men aged (by year of diagnosis) 25 2 cases 15 1 AIDS year Source: CVEDT/INSA. Situação a 31 de Dezembro de 25. AIDS cases in IDU (by year of diagnosis) ! Source: CVEDT/INSA. Situação a 31 de Dezembro de 25. National Coordination for HIV/AIDS Infection - Ministry of Health 15

16 projections indicate, for the next few years:* - an increase in the annual number of new AIDS cases in the Heterosexual and Other transmission categories, with special emphasis on the latter; - a slowing down of the annual number of new AIDS cases in the Injecting Drug Users transmission category; - an apparent change in the decreasing tendency in he Homo/Bisexual category projections show that the AIDS epidemic will remain a major public health problem in Portugal in the coming years. 14 *Given the Portuguese epidemic and notification system specificities, the cited paper mentions several potential sources of error in the analysis, for example, the incubation period distribution is not precisely known, there is inaccuracy in the observed disease incidence over time and assumptions made relative to the underreporting percentage. Yet the most important inaccuracy is probably the introduction of HAART, which should be taken into account and is not. 14 Amaral, J.A., E.P. Pereira & M.T. Paixão. Data and projections of HIV and AIDS in Portugal: An Unstoppable Epidemic?. Journal of Applied Statistics, Vol.32, No.2, , March 25. National Coordination for HIV/AIDS Infection - Ministry of Health 16

17 5. Data collection plan - 27 reporting Setting/ Population Method of Data Collection General Population IDU MSM FSW House hold survey Questionnaire adapted from BSS Guidelines for repeated behaviour surveys in populations at risk of HIV FHI Desk review Death certificates review IDU VCT programme M&E (drug treatment public services) Questionnaires adapted from BSS Guidelines for repeated behaviour surveys in populations at risk of HIV FHI and HIV infection prevalence IDU VCT programme M&E (risk reduction and damage minimization services) Questionnaires adapted from BSS Guidelines for repeated behaviour surveys in populations at risk of HIV FHI and HIV infection prevalence Survey of MSM Questionnaires adapted from BSS Guidelines for repeated behaviour surveys in populations at risk of HIV FHI Survey of female sex workers Questionnaires adapted from BSS Guidelines for repeated behaviour surveys in populations at risk of HIV FHI X X X X X X X X X X X X X X X X X X Education system School-based survey X X Workplace HIV/aids Workplace Platform monitoring X X X X X X Health care system Prison system HIV prevalence about parturient VCT and ARV prophylaxis survey VCT programme M&E Monitoring of HIV prevalence among attendees at VCT Centres and outreach VCT Desk review HIV/aids Diagnostic Related Groups review Desk review Monitoring ARV consumption Prison system survey Monitoring of HIV prevalence X X X X X X X X X X X X X X X X X X X X X X X X X BSS - Behaviour Surveillance Survey M&E - Monitoring and Evaluation National Coordination for HIV/AIDS Infection - Ministry of Health 17

18 6. National Composite Policy Index Questionnaire Sent through CRIS - Country Response Information System. National Coordination for HIV/AIDS Infection - Ministry of Health 18