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

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 IDUsHIV Epidemic Among IDUs

Fastest GrowingFastest 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

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

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%

Major Initiatives at Global Major Initiatives at Global Level: Level:

Winning on the Policy FrontWinning 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 General’s 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

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

Countries and RegionsCountries and Regions

Small VictoriesSmall 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 Country and Regional Scenario Small VictoriesVictories

• 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 67 43 to 53

• 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

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

Sub-Optimal Sub-Optimal

Level of Services Level of Services

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

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

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

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 WarmingAIDS