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HIV and Harm Reduction
Winning on policy front :Faltering on Implementation
JVR Prasada Rao, UNAIDS
XVIII International Harm Reduction Conference Warsaw, 13th May 2007
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Outline
• HIV epidemic among IDUs
• Winning on the global front- major initiatives at global level
• Regional and country success: small victories
• Sub optimal level of services
• Major challenges
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HIV Epidemic Among IDUsHIV Epidemic Among IDUs
Fastest GrowingFastest Growing
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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
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Source: UNAIDS/WHO July 2006
80% of all HIV positive IDUs are in developing countries
+ 21%
+ 55%
+ 11%
+ 34%
+ 5%
+ 21%
+ 17% + 6%
+ 23%
Recent trends in HIV infection, 2003–2005Recent trends in HIV infection, 2003–2005The Global View of HIV, End 2006
Eastern Europe faces the most growing epidemic
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Source: UNAIDS/WHO July 2006
Africa is facing a second epidemic of IDUs
Recent trends in HIV infection, 2003–2005Recent trends in HIV infection, 2003–2005The Global View of HIV, End 2006
Kenya: 22.9% to 50%
South Africa:19.4%
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Major Initiatives at Global Major Initiatives at Global Level: Level:
Winning on the Policy FrontWinning on the Policy Front
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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
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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
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Winning on the Global Front: Resources Scale Up
1.6
3.2
4.7
6
8.3
0
1
2
3
4
5
6
7
8
9
2001 2002 2003 2004 2005
Bill
ions
(US$
)
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
Signing of DOC
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Countries and RegionsCountries and Regions
Small VictoriesSmall Victories
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• Brazil, China, Malaysia – national programming
• Viet Nam Government and Party endorses Harm Reduction
• Brazil, China, Malaysia – national programming
• Viet Nam Government and Party endorses Harm Reduction
Country and Regional Scenario Small Country and Regional Scenario Small VictoriesVictories
• Baltic countries introduce prison program with UNODC
• Central Asian countries scale up
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Number of Countries with Harm Reduction Programs
Global Substitution Treatment
Global Needle Syringe Programmes
39 to 67 43 to 53
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• Brazil, China, Malaysia – national programming
• Viet Nam Government and Party endorses Harm Reduction
Country and Regional Scenario Small Country and Regional Scenario Small VictoriesVictories
• Baltic countries introduce prison program
• Central Asian countries scale up
• Baltic countries introduce prison program
• Central Asian countries scale up
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Regional ResponsesRegional Responses
• AusAid 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
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Sub-Optimal Sub-Optimal
Level of Services Level of Services
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Sub-optimal ServicesSub-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
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Resource Need for Prevention among IDU
Annual IDU prevention need: 200 million
Total Prevention resource need: 11
billion
Low spending
on IDUs even
in Thailand
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0 3 6 9
< 5%
5-25%
> 25%
Funding : Largely External What % of Resources are Domestic ?
Source: UNAIDS, RSTAP. Unpublished, (Result from a nine country survey, 2007)
No. of countries
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Major Challenges Ahead
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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
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Most Important Global Challenges
Global WarmingAIDS