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HIV and Harm Reduction Winning on policy front : Faltering on Implementation JVR Prasada HIV and Harm Reduction Winning on policy front : Faltering on Implementation JVR Prasada Rao, UNAIDS XVIII International Harm Reduction Conference Warsaw, 13 th May 2007

Outline • HIV epidemic among IDUs • Winning on the global frontmajor initiatives at Outline • HIV epidemic among IDUs • Winning on the global frontmajor initiatives at global level • Regional and country success: small victories • Sub optimal level of services • Major challenges

HIV Epidemic Among IDUs Fastest Growing HIV Epidemic Among IDUs Fastest Growing

More countries and territories in which drug injecting and associated HIV infection is reported More countries and territories in which drug injecting and associated HIV infection is reported

The Global View of HIV, End 2006 Recent trends in HIV infection, 2003– 2005 The Global View of HIV, End 2006 Recent trends in HIV infection, 2003– 2005 + 55% 80% of all HIV positive IDUs are in developing countries Eastern Europe faces the most growing epidemic + 6% + 17% + 34% + 21% + 11% + 21% + 5% + 23% Source: UNAIDS/WHO July 2006

The Global View of HIV, End 2006 Recent trends in HIV infection, 2003– 2005 The Global View of HIV, End 2006 Recent trends in HIV infection, 2003– 2005 Kenya: 22. 9% to 50% South Africa: 19. 4% Africa is facing a second epidemic of IDUs Source: UNAIDS/WHO July 2006

Major Initiatives at Global Level: Winning on the Policy Front Major Initiatives at Global Level: Winning on the Policy Front

Winning on the Policy Front – High Level Meeting on AIDS 2006 • High Winning on the Policy Front – High Level Meeting on AIDS 2006 • High Level meeting on AIDS 2006 • UNAIDS recommendation to cost for 80% coverage for harm reduction • Stigmatisation is addressed – Highly stigmatized population like. . . IDUs and prisoners. . . must become programmatic priorities in national plans that are costed – UN Secretary General’s Report 2007

Winning on the Global Front – UN policy on priority for prevention for IDUs Winning on the Global Front – UN policy on priority for prevention for IDUs • Priority for IDU interventions in prevention package • Comprehensive nature of the package • Global Division of Labour among UN agencies – GTT Follow up

Winning on the Global Front: Resources Scale Up Signing of DOC Data includes: International Winning on the Global Front: Resources Scale Up Signing of DOC Data includes: International donors, • Domestic spending (including public spending and out of pocket expenditures) • International Foundations and GF included from 2003 onwards, PEPFAR included from 2004 onwards

Countries and Regions Small Victories Countries and Regions Small Victories

Country and Regional Scenario Small Victories • Brazil, China, Malaysia – national programming • Country and Regional Scenario Small Victories • Brazil, China, Malaysia – national programming • Viet Nam Government and Party endorses Harm Reduction • Baltic countries introduce prison program with UNODC • Central Asian countries scale up

Number of Countries with Harm Reduction Programs Global Needle Syringe Programmes 39 to 67 Number of Countries with Harm Reduction Programs Global Needle Syringe Programmes 39 to 67 Global Substitution Treatment 43 to 53

Country and Regional Scenario Small Victories • Brazil, China, Malaysia – national programming • Country and Regional Scenario Small Victories • Brazil, China, Malaysia – national programming • Viet Nam Government and Party endorses Harm Reduction • Baltic countries introduce prison program • Central Asian countries scale up

Regional Responses • Aus. Aid Funding of 50 million USD for Asia region on Regional Responses • Aus. Aid Funding of 50 million USD for Asia region on harm reduction • Regional Task Force in Middle East and Asia : Partnership between NGO, UN, Academics. Donors and Governments • Harm Reduction Network in Eastern Europe

Sub-Optimal Level of Services Sub-Optimal Level of Services

Sub-optimal Services • 1 in 8 IDU has access to risk reduction message • Sub-optimal Services • 1 in 8 IDU has access to risk reduction message • 1 in 33 has access to clean needle program • 33, 000 has access to substitution program • Less than 10% IDU have access to ART AND Criminalisation continues

Resource Need for Prevention among IDU Low spending Total Prevention resource need: 11 billion Resource Need for Prevention among IDU Low spending Total Prevention resource need: 11 billion Annual IDU prevention need: 200 million on IDUs even in Thailand

Funding : Largely External What % of Resources are Domestic ? No. of countries Funding : Largely External What % of Resources are Domestic ? No. of countries Source: UNAIDS, RSTAP. Unpublished, (Result from a nine country survey, 2007)

Major Challenges Ahead Major Challenges Ahead

Challenges: What stands between targets and current coverage? • Poor resources • Vacillating political Challenges: What stands between targets and current coverage? • Poor resources • Vacillating political commitment • Lack of services & mainstreaming • Burden of service delivery on civil society without resource or capacity • Poor synchronisation of law & health • No procurement system • External funding

Most Important Global Challenges Global Warming AIDS Most Important Global Challenges Global Warming AIDS