I en ny rapport rekommenderar ECDC att Finland ska överväga att implementera säkra injektionsställen och substitutionsbehandling i fängelser.
ECDC har släppt rapporten om sitt besök i Finland som gick av stapeln i Oktober 2012. Den ger en översikt av Finlands nationella strategier och program för hiv och sexuellt överförbara sjukdomar. Besöket genomfördes i Helsingfors under tre dagar och bestod av möten med flera institutioner och organisationer. ECDC talade med representanter från social-och hälsovårdsministeriet, Institutet för hälsa och välfärd, Brottspåföljdsverket, och olika icke-statliga organisationer.
Här följer deras slutsatser och rekommendationer (på engelska), hela rapporten finns som vanligt i en PDF- fil nedan.
· Prevention and care need to be adapted to a changed HIV epidemiology. Most infections seem to now occur among heterosexuals, either migrants coming from high-prevalence countries or Finnish nationals with travel-associated HIV infections. It is recommended that monitoring should be strengthened and surveillance for both situations should be improved in order to address or reinforce messages around trave lassociate infections, but also to review the access to treatment and care for those who are foreign-born residents of Finland.
· Late diagnosis is frequent in all sub-populations. Efforts should be undertaken to increase uptake of testing in all relevant groups by lowering thresholds and barriers, e.g. by expanding anonymous testing opportunities.
· HIV prevention especially targeted and adapted for men who have sex with men needs to be strengthened. Options include to expand drop-in testing, counselling facilities, and outreach work. The gay community should be more involved in prevention activities and gay-friendly services should be developed.
· Knowledge about HIV incidence is insufficient, especially in men who have sex with men; there is also a lack of knowledge in this group about what constitutes risk behaviour. It is suggested that small-scale surveys should be conducted to obtain relevant epidemiological and behavioural information. Corresponding surveys should be carried out for migrants, sex workers and travel-associated HIV infections. Sexual orientation and sexual behaviour should be systematically integrated into general health surveys.
· Finland has a good system of collecting laboratory data and physician reports. It is suggested that a national treatment registry should be developed on this basis in order to monitor HIV care.
· It is suggested that guidelines should be developed for non-occupational post-exposure prophylaxis.
· It should be considered whether harm reduction would be expanded by providing clean injection rooms in low-threshold health service centres for IDUs.
· It is suggested that it should be considered whether substitution treatment could be started in prison.
· Prison staff should be offered training in order to influence attitudes towards, and knowledge about, actual HIV infection risks.
· Services for the care, surveillance and prevention of sexually transmitted infections appear to be widely fragmented. It is suggested that this should be further investigated, with a strong focus on STI services and surveillance. Preliminary suggestions, however, include investing in training and quality improvement especially for counselling, patient follow-up and surveillance tasks. National guidance for municipal health services and non-governmental organisations on care, surveillance and prevention should also be considered.
There are several suggestions for concrete actions:
· Consider the participation of Finland in the European Gonococcal Antimicrobial Surveillance
· Programme (Euro-GASP): antimicrobial resistance data are available and could easily be used to
· Assist monitoring and quality assurance efforts at the European level.
· A follow-up visit to Helsinki in order to arrange the details of Finland’s participation in Euro-GASP and
· Review the STI services in more detail could be conducted in a short time.
· Consider auditing the quality of fragmented HIV testing services and test compliance with the
· National guidance for HIV testing (‘HIV-testauksen periaatteita’).
· Review the communication strategy for prevention among men who have sex with men as there
· Seems to be a gap between messages and targeted community. ECDC will provide support in 2013,
· When the Centre will start developing guidance materials on HIV and STI prevention in men who
· Have sex with men.
· The ongoing HIV and HCV prevalence study on sex workers provides the opportunity to include
· Behavioural risk data.
Country mission Finland: HIV, sexually transmitted infections, and hepatitis B and C