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

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

HIV Epidemic Among IDUs Fastest Growing

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

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

outside region Source: UNAIDS/WHO July 2006 Africa is facing a second epidemic of IDUs Recent trends in HIV infection, 2003–2005 The Global View of HIV, End 2006 Kenya: 22.9% to 50% South Africa: 19.4%

Major Initiatives at Global Level: Winning on the Policy Front

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 Generals Report 2007

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 Data includes: International donors, Domestic spending (including public spending and outof pocket expenditures) International Foundations and GF included from 2003 onwards, PEPFAR included from 2004 onwards Signing of DOC

Countries and Regions Small Victories

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 Victories Baltic countries introduce prison program with UNODC Central Asian countries scale up

Number of Countries with Harm Reduction Programs Global Substitution Treatment Global Needle Syringe Programmes 39 to 6743 to 53

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

Regional 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

Sub-Optimal Level of Services

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

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 Unpublished, (Result from a nine country survey, 2007) No. of countries

Major Challenges Ahead

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