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Harm Reduction International: Questions for leaders on World AIDS Day

Date: 30 November 2011

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This December 1st, as with every other year, will see political speeches and statements from high level UN officials and others in positions of power and influence reaffirming their commitment to stopping HIV in its tracks, and sending out messages of hope and how much we’ve achieved. This year we will hear that the first AIDS free generation since the discovery of HIV may be a reality. But we are unlikely to hear what counts. As with every year, we are left more questions than answers.

To the richest nations: Where is the money you pledged?

The Global Fund to Fight AIDS Tuberculosis and Malaria has been eviscerated. With the world’s richest nations reneging on their pledges made time and again to make sure the Global Fund was adequately financed, the budget of the organisation has been halved, meaning that there will be no new grants until 2014. This is a catastrophe that will cost many, many lives. No politician from a donor state that has so betrayed the most vulnerable, the poorest and most marginalised, can stand in front of the cameras this World AIDS Day and say anything unless it is an explanation for this.

To PEPFAR: When will you begin spending on HIV-related harm reduction? 

Harm Reduction International carried out a study in 2009 on funding for the basics of HIV-related harm reduction in low and middle income countries. We estimated that funding had to scale up approximately twenty fold to a paltry $3 billion annually to meet need. At that time the President’s Emergency Plan for AIDS Relief (PEPFAR) had not spent a single penny on needle and syringe programmes. This was due to a previous ban on such funding, which President Obama’s administration lifted. In 2011 still not a single needle has been purchased by PEPFAR. Why not? And who answers for this? No strategy to fight HIV is complete unless it addresses all routes of transmission. Unless services for people who inject drugs are adequately resourced, there can be no AIDS free generation.

To governments all over the world: Why do you persist in criminalising those most at risk?

We know and have known for too long that no-one can criminalise their way out of a public health problem. There can be no better example of this than HIV related to unsafe injecting practices. We know that criminalising drug use and possession, criminalising carrying paraphernalia such as needles and syringes, focusing efforts on law enforcement over public health, and filling prisons with people who use drugs fuels HIV epidemics while squandering the limited funds available. Meanwhile we know that in the decades that drug use and possession have been crimes there has been no reduction in prevalence of drug use, and only an upsurge in drug related harms. Almost every country in the world is complicit in this state of affairs that so damages HIV prevention efforts. 

To the Executive Director of the UN Office on Drugs and Crime: Where is your public commitment to harm reduction?

Mr Fedotov, you are in charge of the lead agency within UNAIDS for HIV related to injecting drug use. In 2010 you took office with a pledge to focus on health and human rights. Since then the words ‘harm reduction’ have not emerged in any of your speeches or in official statements from your office, despite harm reduction being a proven public health intervention and a recognised aspect of the right to health. HIV prevention has dropped significantly in prominence from the public output of the UNODC. Instead you share high level platforms with the Russian government, but fail to criticise its rejection of the very policies your office is supposed to lead the UNAIDS family in promoting, and from which about a third of the entire budget of your office is derived. Are your HIV donors satisfied with your performance?

To the Russian Government: How can you so neglect your own people?

As networks of people who use drugs gather at Russian embassies in eight countries today we ask the Russian government: how can you continue to neglect some of the most vulnerable and at risk people in your nation? How can you ban opioid substitution therapy until 2020 when its is so well supported by scientific studies as an effective HIV prevention measure, when krokodil is tearing its way through people’s lives, and when 30,000 people a year die from overdose? How can you fail to fund needle and syringe programmes when your country is currently the global cautionary tale for HIV prevention, experiencing the worst epidemic in the region? Russia is not alone in failing to adequately scale up harm reduction. But it is by far the worst case. 

It need not be this way. We need not have next to no money for the AIDS response. We need not have criminal laws that get so fundamentally in the way of what is needed and what is right. We need not have leaders who refuse to even say the right thing. We need not have governments adopting policies that kill their own. But today we will get speeches and pledges, and nothing of what matters.