1. Drug policy and harm reduction: impact of the US policy Raminta Stuikyte Central and Eastern European Harm Reduction Network

2. The US on drugs and harm reduction Federal ban to buy needles and syringes using federal money (for programs and for research) Guidance on the Definition and Use of the Child Survival and Health Programs Fund and the Global HIV/AIDS Initiative Account, USAID, 2004 Promotion of war on drugs At least 7 federally-funded reviews and reports conducted by public health officials, researchers and US government agencies have concluded that syringe exchange programs are effective, safe and cost effective. Letter of over 130 diverse individuals and organizations in the USA to US Ambassador to Combat HIV/AIDS Globally; May 2005

3. In the US Needle exchange is not funded through federal money –A number of states, cities and private donors are funding needle exchange –In 2002, 25 million needles and syringes distributed for population of about 290m In Australia (population=20m), 32m needles and syringes distributed War on Drugs: –The number of incarcerated drug offenders has increased 12-fold since 1980 –22% of people incarcerated charged for drug offences –No substitution treatment in federal prisons –Some jails do have substitution treatment –No needle exchange in prisons and jails

4. Affects on US-funded programs Major revisions in 2004 Revisions of publications and removing references to harm reduction Revisions of programs In some cases, programs –the US money for salaries and infrastructure –needles/syringes from other sources if there were replacing funds

5. Context of the US drugs/AIDS policy affects on other countries There is still lacking understanding of harm reduction in the world A number of governments look to the United States for guidance about how best to respond to the HIV/AIDS epidemic

6. The US and the UN UN AIDS policy framework: UNAIDS Prevention Policy –for 12 months the US pushed to remove references to harm reduction and needle exchange –Reservation of the US in adopted document 2005 UN drug policy framework –The US is major funder of UN agency on drugs UNODC –2004: US high level official threatened UNODC chief to cut funding to UNODC unless he assured that UNODC would abstain from any involvement in or expression of support for harm reduction, including needle exchange. –No references to needle exchange and harm reduction in UNODC documents and pubic statements since that time

7. The US and developing countries The harshest affect on countries with major HIV epidemics among injecting drug users (IDUs), –esp in Asia where FHI/USAID was key funder of HIV prevention among IDUs Indonesia: –the government marked harm reduction as a key HIV prevention priority. The collaboration with FHI (financially supported by USAID) and Indonesian partners have had to review programs and projects since FHI could no longer support harm reduction activities. Some projects were halted while other were temporarily suspended.

8. Thailand: –War on Drugs announced in 2003 extra-judicial assassination of over 2,200 drug users –War on Drugs reannounced and continued in 2004 and so on –No needle exchange; limited and hardly accessible one methadone program Uzbekistan: –A project in Tashkent reported that 30% of over 1,400 sex worker clients are also IDUs, and that 30% had acknowledged sharing needles and syringes. The project had not initiated needle/syringe exchange because it received the bulk of its funding from USAID, which does not permit the use of its funds for such activities.

9. Conclusions The policies of external donors can have a disproportionate impact on harm reduction projects in countries where national or local governments provide little or no funding for them. The US policy on drugs and harm reduction is fueling HIV in countries with injecting drug use- driven epidemics, where it is essential to have wide scale harm reduction (evidence based, relatively low-cost and not requiring strong health/social infrastructure strategies).