Ministry of Health, Republic of Moldova

National Center of Health Management

www.cnms.md

Republic of Moldova

National updates of HIV and hepatitis epidemiology and responses in PWID

General information (2013)� Population - 4.1 million (including Left

Bank with a population of 520,000 people)

� GDP per capita in PPS (Purchasing Power

Standards) – 3400

� Unemployment rate, % of labor force – 5,1

� Population below poverty line – 12,2

� Prison population rate (per 100,000 of

national population) - 151,0

� Frozen conflict on Dniester River

Trends in newly registered HIV cases and number of HIV tests (in thousands), years 1987-2013

93

470

609

713735

709

474

417

362

258280

234

101 91116 111

159

240257 254

290 296 298 291 297327

231

0 9 6 2 0 2 3 3 7

55

407

413

157176

234 206

360

538

618

731

790

704 704

721

764

706

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

# tests, thousands new cases

Source: Dermatology and Communicable Disease Hospital: Annual Epidemic Update 2014.

Number of new HIV cases to 100,000 population, Republic of Moldova, Right bank, years 2000-2013

5.54.7

6.08.4

12.814.7

17.419.3 17.9 17.9 18.3 19.5 18.0

2.5 4.2 4.7 6.28.6 10.0 11.5 12.6 13.2 13.6 14.4 14.3 13.73.7

6.3

13.4

21.2

38.641.4

52.0

63.8

49.046.0

44.2

54.3

46.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Incidence Right Bank Left Bank

Source: Dermatology and Communicable Disease Hospital: Annual Epidemic Update 2014.

Epidemiological situation� The prevalence in the general population is still well below 1%

� The gender distribution ratio has changed over time, with an increase of

share of women reported HIV cases per year from 26.5% in 2001 to 46.3%

in year 2013

� The HIV epidemic in Moldova continues to be concentrated among key

populations, mostly people who inject drugs in civilian and prison sectors,

with an increasing contribution of SWs and MSM

Key populations size estimations (#)

2013 PWID SWs MSMs

Right Bank 19 400 10 000 9 700

Left Bank 10 800 2 000 3 800

Total 30 200 12 000 13 500

PWID SW MSM

Year 2009 2013 2009 2013 2009 2013

Estimation 31 600 30 200 14 800 12 000 22 300 13 500

HIV prevalence among key populations, IBBS 2009/2010 and 2012/2013, (%) Moldova

Site

PWID SW MSM

2009 2012 2009 2012 2009 2012

Chisinau 16.4 8.5 6.1 11.6 1.7 5.4

Balti 39 41.8 23.4 21.5 0.2 8.2

Tiraspol 12.6 23.9 … … … …

Ribnita … 43.7 … … … …

HIV prevalence in the age group 15-24 years of key populations, IBBS 2009 and 2012, (%) Moldova

Chisinau Balti Tiraspol

2009 2012 2009 2012 2009 2012

PWID 1.7 [0-30.8] 2.0 [0-5.2] 18.7 [7.4-34.4] 6.6 [0.0-16.0] 13.6 [3.2-24.9] 1.1 [0-3.4]

SWs 1.6 [0-5.4] 6.5 [1.3-13.5] 15.6 [9.0-21.5] 8.7 [2.2-14.9] … …

MSM 0.6 [0-1.1] 3.2 [0-5.1] 0 6.9 [1.3-13.4] … …

HIV prevalence in people who inject drugs, IBBS 2001, 2004, 2007, 2009, and 2012, (%) Moldova

City 2001 2004 2007 2009 2012

Chisinau 15.8 14.4 17.5 16.4 8.5

Balti 60.3 39.7 44.8 39 41.8

• The key behavioral indicators show that using sterile syringe has become the norm in PWID (98% used a

clean syringe at last injection in 2012, only 82.3% in Tiraspol),

• The integrated indicator for indirect sharing is still high (37.3% in Balti, 58.1% in Chisinau and 81.0% in

Tiraspol).

• Slower progress has been seen in adopting safer sexual behaviors and reversing trends in particular

groups: condom use at last sex among PWID averaged 35.1% in Chisinau, 42.8% in Balti, 36.5% in Tiraspol.

Risk reduction services� 6 projects provided NEP and were active in 23 administrative

units in the civil sector:

� New beneficiaries covered during 2013 - 2066 beneficiaries

� Number of IDUs who received at least one service during

2013 - 8712 beneficiaries

� Number of syringes distributed by PRR in 2013 is 1 963 500

units

� Number of condoms distributed in the period of January 1 -

31 December 2013 – 778 791 units

� Methadone substitution treatment available 3 sites (2 in

Chisinau and 1 in Balti)

� NEP and OST available in 11 out of 13 penitentiary institution

Risk reduction services (2)� The risk reduction program services package for IDUs provided in the civil

sector of the Republic of Moldova in 2013 included the following:

� syringes exchange,

� methadone substitution therapy as basic pharmaceutical remedy,

� information/education/outreach on HIV/AIDS and ways to prevent STIs in the

context of high risk practices (distribution of information materials, condoms,

counselling and testing, education and information seminars),

� referral to medical and social services, diagnosis/treatment of hepatitis,

diagnosis/treatment of TB.

Number of methadone substitution treatment beneficiaries in the civil sector, Republic of Moldova

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

New beneficiaries 0 18 19 175 124 147 129 85 68 47

Permanent beneficiares 0 15 16 134 117 242 303 261 267 288

Cumulative 9 27 46 221 345 492 621 706 774 899

0

200

400

600

800

1000

1200

1400

Number of methadone substitution treatment beneficiaries in the penitentiary sector, Republic of Moldova

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

New beneficiaries 0 7 21 47 68 57 55 23 15 20

Permanent beneficiares 0 0 14 28 32 28 49 51 53 62

Cumulative 0 7 27 74 142 199 256 277 292 312

0

50

100

150

200

250

300

350

400

Prevalence of HVB and HVC among PWID, IBBS 2007, 2009/2010 and 2012/2013, (%) Moldova

Data

collection

site

2007 2009 2012/2013

HVC Prevalence HVB Prevalence HVC Prevalence HVB Prevalence HVC Prevalence HVB Prevalence

# % # % # % # % # % # %

Chişinău 67/183 36,6 12/183 6,6 225/301 72,8 34/301 10,9 231/339 65,4 25/339 6,6

Bălţi 97/145 66,9 5/145 3,4 249/362 70,2 41/362 14,2 164/362 38,5 36/362 12,4

Tiraspol 13/68 19,1 7/68 10,3 84/281 20,5 25/281 7,5 110/293 35,3 14/295 4,1

Rîbniţa - - - - - - - - 51/97 61,4 0/97 0,0

Indicators summary among prisoners, IBBS 2007, 2009/2010 and 2012/2013, (%) Moldova

Indicator 2007 2010 2012

Mean age, years 33,0 33,6 34,8

Injecting drugs during the last year,%4,7

(25 resp.)

3,0

(16 resp.)

2,7

(14 resp.)

The average duration of injecting drug use, years 7,8 8,4 6,8

Average age at first drug injection, years 23,2 21,5 24,0

Injecting drug last month,% 9 resp. 2 resp. 1 resp.

Injecting heroin last month,% 1 resp. 2 resp. 1 resp.

Injection of opium extract, last month,% 9 resp. 1 resp. -

The use of sterile syringes the last injection, last month,% 100,0 100,0 100,0

Indirect sharing of injecting equipment, last month,% 6 resp. 2 resp. 0

HIV Prevalence, % 4,2 3,4 1,9

HVB Prevalence, % 11,3 16,3 8,6

HVC Prevalence, % 21,0 15,5 13,1

Prevalence of antibodies to Treponema pallidum,% 13,5 13,4 -

Response� The National AIDS Programme (NAP) for years 2011-2015 was endorsed

through the Government Decision of 24 December 2010

� In June 2011 the National Programme on Prevention and Control of

HIV/AIDS and STI underwent a Joint AIDS National Strategy (JANS)

assessment

� recommendations to change its focus and reprioritize its goals to better match the

epidemic profile.

� The work on developing the new NAP will start in 2015 to get the new

plan for years 2016-2020 approved.

� Evaluation of the current NAP will be performed in second half of 2014 to

early 2015 with support from UNAIDS.

National Center of Health Management

MD 2009, Chișinău, 3 A. Cosmescu str.,

Tel. : (+373) 22 727386, Fax : (+373) 22 723000

www.cnms.md, centru.management@ms.md

Thanks for your attention