Thailand

On Thursday, UNAIDS Executive Director Michel Sidibé (left) urged the Prime Minister of Thailand, Abhisit Vejjajiva, to lead an HIV prevention revolution in the Asia region, with the goal of zero new HIV infections, zero discrimination and zero AIDS-related deaths. Credit: UNAIDS/V. Dithajohn

On the final day of an official country visit to Thailand, UNAIDS Executive Director Michel Sidibé praised Thailand’s Prime Minister, Abhisit Vejjajiva, for his leadership and commitment on AIDS in the country and urged Thailand to redouble efforts—and resources—on HIV prevention.

Underlining the country’s current successes, including significant advances in the provision of antiretroviral treatment and increased access to services for the prevention of mother-to-child transmission of HIV, Mr Sidibé urged Thailand to lead an HIV prevention revolution in the Asia region.

“Thailand has an outstanding record in the AIDS response which now needs to be taken to the next level,” said Mr Sidibé, encouraging Thailand to take the lead and be the first country in the region to make a concrete impact on the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. 

Thailand is known for its effective, rapid and targeted HIV response. Currently 80% of people in need have access to antiretroviral treatment and nearly 97% of pregnant women living with HIV have access to services to prevent mother-to-child transmission of HIV. The Government of Thailand funds 83% of its national HIV response, but only 14% of the national HIV budget is allocated for HIV prevention.

Prime Minister Abhisit acknowledged that HIV prevention efforts in Thailand need to be rapidly intensified and that they should be clearly focused on key affected populations, such as sex workers, men who have sex with men, and people who inject drugs. He complimented UNAIDS’ bold goal of zero new HIV infections.   Stigma and discrimination was highlighted in the meeting as one of the critical barriers in the HIV response, particularly with regard to its impact on people living with HIV and the affected communities. Prime Minister Abhisit also called attention to Thailand’s newly developed harm reduction policy and said that he was taking action to ensure the policy’s implementation across the country, starting in ten provinces.
Underlining his continued commitment to lead on the issue of AIDS, the Prime Minister expressed his interest in playing an active role in the June 2011 UN General Assembly High-Level Meeting on AIDS.

This SWING Foundation volunteer was one of many to promote messages of HIV prevention and safe sex on Valentine’s night in Bangkok. Credit: UNAIDS

High heels, sequined outfits and pumping music fill Bangkok’s ‘Soi Cowboy’ street. For many, it’s a typical evening in one of the city’s well-known red-light zones. But a closer look at the fashion parade tells that this isn’t just any other night—the elaborately designed outfits, made entirely from condoms, are part of a Valentine’s night HIV prevention drive led by SWING (Service Workers In Group) Foundation, a Thai-based non-governmental organization.

With HIV prevention-slogan banners raised high in the air—“Safe sex, safe life!”, “Heart of love, heart of condom!”— volunteers from SWING walk the temporary runway, handing out condoms and information leaflets. Such targeted HIV prevention drives are just one aspect of SWING’s work with men, women and transgendered “service workers,” SWING’s preferred terminology for sex worker.

Based in the Thai red light districts of Bangkok, Pattaya and Ko Samui, the SWING Foundation provides educational opportunities for workers, including English language classes and vocational training. The Foundation also serves as a drop-in centre where workers can stop by, eat, use the internet, prepare for the evening, and take part in HIV-related information games and sessions.

“Our activities help workers increase their self confidence and possibilities to develop their individual potential,” said Surang Janyam, who co-founded SWING in 2004. “For many, it is so hard to feel they can get support, and they fear discrimination. SWING provides a safe space and options,” she added.

An established success story in Thailand, SWING’s reputation is spreading across borders as a model for programmes that provide HIV services where they are most needed. Its success is ascribed in part to the fact that Foundation is managed and run almost entirely by current or former sex workers.

Across the Asia-Pacific region, an increase in the size and scale of programmes focused on populations at higher risk of HIV exposure—planned and implemented by the communities themselves—is urgently needed.

According to the latest available data, most epidemics in the region are still concentrated among people who inject drugs, sex workers and men who have sex with men. In a number of countries, there are signs of increased HIV infection rates among these key affected populations. Data, where available, on HIV prevention coverage from a number of countries across the region suggest that less than half—and in some cases only one third—of people from key affected populations have been reached by prevention services.

“In the Asia-Pacific region, we know that HIV responses must focus solidly on key affected populations if we are to sustain and advance progress,” said UNAIDS Executive Director Michel Sidibé, who was a special guest at the Valentine’s event hosted by SWING. “We need to drive commitment and action to ensure programmes like SWING are emulated and multiplied across the region,” he added.

In Soi Cowboy on Valentine’s night, the message is loud and clear: Nothing about us without us. “We care about you!” shouted SWING co-founder Khun Tee through a megaphone, as his colleagues paraded by in their colourful condom combinations. “HIV is real—please use a condom every time you have sex with anyone!”

UNAIDS Executive Director Michel Sidibé (left) met with M.R. Sukhumbhand Paribatra, Governor of Bangkok, on 16 February at the Bangkok Metropolitan Administration City Hall. Credit: UNAIDS/V. Dithajohn

In an official mission this week to Thailand, UNAIDS Executive Director Michel Sidibé held discussions with M.R. Sukhumbhand Paribatra, Governor of Bangkok, on progress, challenges and opportunities for the AIDS response in the Thai capital. During the meeting, Mr Sidibé asked for increased support to help make Bangkok the first city to reach the goal of "zero new HIV infections."

Acknowledging the specific challenges faced by mega-cities in Asia—where new HIV infection rates among some key populations, including men who have sex with men, remain high and where migration is a complex daily reality—Mr Sidibé urged the Governor to play an active role in the June 2011 UN General Assembly High-Level Meeting on AIDS with other high-level city officials from mega-cities around the world. "This would be a perfect opportunity to tell the world that Bangkok is committed to getting to zero," said Mr Sidibé.

In his discussions with Mr Sidibé, Governor Paribatra said that a focus on marginalized populations, particularly migrants, is critical to effective AIDS responses in Bangkok. While underscoring the complexity of city-based approaches to the HIV epidemic, he stressed his intention to rise to the challenge of "zero new HIV infections" in the Thai capital. Governor Paribatra expressed interest in attending the High-Level Meeting in June and in addition hosting a "getting to zero" gathering of officials from other mega-cities in the region during his term.

In an official visit to the Suan Kalub Palace in Bangkok, UNAIDS Executive Director Michel Sidibé met with HRH Princess Soamsawali of Thailand.

In an official visit to the Suan Kalub Palace in Bangkok on Monday, UNAIDS Executive Director Michel Sidibé commended HRH Princess Soamsawali of Thailand for her “tireless dedication, commitment and leadership” in the country’s HIV response.

“Through deeds, words and provision of resources where they are most needed, Your Royal Highness has shown true vision and commitment on HIV,” said Mr Sidibé, who is currently in Thailand on a three-day country mission. “I look forward to our ongoing collaboration to save and improve lives,” he added.

Presenting the Princess with a commemorative plaque for her ongoing efforts to prevent mother-to-child transmission of HIV (PMTCT) and HIV-related stigma and discrimination, Mr Sidibé noted Princess Soamsawali’s longstanding involvement in the HIV response, which dates back some 25 years.

Through her patronage of the Thai Red Cross, HRH Princess Soamsawali helped bring PMTCT services to Thailand in 1996, several years before a PMTCT programme was introduced as part of Thailand’s national response to the HIV epidemic. Within the programme, triple antiretroviral therapy is made available for all pregnant women living with HIV, independent of their CD4 count.

During their meeting, UNAIDS Executive Director and HRH Princess Soamsawali emphasized the importance of ensuring access to HIV programmes for marginalized populations and those at higher risk of  HIV exposure—particularly men who have sex with men and illegal migrants.

While noting progress in Thailand’s HIV response, the Executive Director highlighted that more needs to be done. An estimated 530 000 people in Thailand are living with HIV and prevalence of the virus among people aged 15-49 is 1.3%.

“I would like to see Bangkok free of HIV,” said Mr Sidibé. “This means greater action is needed to break down barriers to ensure support is given to those who need it most,” he said. HIV programmes supported by HRH Princess Soamsawali provide antiretroviral treatment to marginalized populations, and the Princess underlined that her support in this area would continue.

Mr Sidibé’s official visit to Thailand, which ends on 17 February, includes a number of meetings with high-level government officials and representatives from civil society organizations.

Steve Kraus, Director of the UNAIDS Regional Support Team for Asia and the Pacific greet HRH Princess Bajrakitiyabha of Thailand at the launch of the Asia Pacific UNiTE campaign. 25 November, 2010.

Women aged 15-44 are more at risk from rape and domestic violence than from cancer, car accidents, war and malaria, according to World Bank data. The most common form of violence experienced by women globally is physical violence inflicted by an intimate partner, with women beaten, coerced into sex or otherwise abused.

On the 25 of November, to coincide with the International Day for the elimination of violence against women, the United Nations Secretary-General’s campaign “UNiTE to End Violence Against Women” was launched in Bangkok, Thailand. The event was attended by Her Royal Highness Princess Bajrakitiyabha of Thailand, H.E. the Prime Minister of Thailand, Mr Abhisit Vejjajiva and together with heads of regional offices of United Nations agencies.

“All forms of violence against women constitute a violation of human rights and a degradation of dignity and gender equality,” said Her Royal Highness Princess Bajrakitiyabha of Thailand.

The UNiTE Asia-Pacific campaign aims to rally governments, civil society, the private sector, the media and the United Nations family around the joint goal to eliminate gender based violence in the region.

“Neither gender equality, nor development can be fully realized if violence against women and girls is allowed to take place, unabated and unresolved,” Prime Minister of Thailand, Mr Abhisit Vejjajiva said in his statement at the launch.

Women’s heightened risk of HIV infection through violence was highlighted at the launch as a central concern for the campaign. According to population based studies carried out in the region, women who have experienced physical as well as sexual violence were four times more likely to be infected with HIV than the women who reported no such experiences.  

“To realize UNAIDS vision of zero new infections, zero discrimination and zero AIDS-related deaths, tackling violence against women is critical,” Steve Kraus, Director of the UNAIDS Regional Support Team for Asia and the Pacific, who participated in the launch ceremony.  

The UNAIDS Regional Support Team for Asia and the Pacific, and UNFPA Asia Pacific Regional Office are working closely with campaign hosts UNIFEM and the UN Economic and Social Commission for Asia and the Pacific (ESCAP) in the roll out and implementation of the campaign in the region.

Launched in 2008, the United Nations Secretary-General Ban Ki-moon’s UNiTE to End Violence against Women campaign aims to prevent and eliminate violence against women and girls in all parts of the world.

Sex workers, government officials and UN representatives joined the first-ever Asia-Pacific regional consultation on HIV and sex work. Credit: APNSW

HIV transmission via sex work accounts for many new HIV infections  in the Asia-Pacific region. Yet in many countries HIV prevention, treatment and care services for sex workers are lacking. At the first consultation of its kind in the region, sex workers, government officials and United Nations participants emphasized the urgent need for action to increase focus on sex work within national HIV responses.

“I was arrested when the police saw I had condoms.” “Sex workers’ rights are being violated.” “Sex workers are going underground now. We don’t know where they are.”

These are just some of the experiences shared at the first-ever Asia-Pacific consultation on HIV and sex work, held in Pattaya, Thailand, from 12-15 October. Some 150 participants from eight countries* in the region—including sex workers, government officials, representatives from civil society and the United Nations—came together to call for a greater emphasis on ensuring universal access to HIV prevention, treatment, care and support services for sex workers.

Hosted by the Royal Government of Thailand and co-organized by UNAIDS and UNFPA, in collaboration with the Asia-Pacific Network of Sex Workers (APNSW), meeting participants shared strategies and developed national action plans to be carried forward.

Sex work accounts for a significant number of new HIV infections in the Asia–Pacific region. An estimated 10 million Asian women sell sex to 75 million men who, in turn, have intimate relations with an additional 50 million people. In some countries in the region, HIV prevalence among sex workers is nearly 20%. Meet participants stressed that spending on HIV services is falling, despite evidence of their cost-effective impact and that only about one third of sex workers in the region are able to access HIV prevention programmes.

Khartini Slamah of APNSW moderates a discussion on legal and policy barriers. Credit: APNSW

Meeting participants also pointed to numerous punitive laws and policies that can prevent sex workers from accessing HIV services. “Sex workers experience firsthand the effects of laws and harmful enforcement practices that violate their human rights and hamper progress in the HIV response,” said Jan Beagle, UNAIDS Deputy-Executive Director, Management and External Relations, who attended the consultation. “Listening to sex workers is crucial.”

Participants in the consultation heard how sex workers are frequently subjected to violence and harassment, and often face criminal charges and detention. Participants said enforcement of elements within new anti-trafficking and other related laws in some countries including Cambodia, Fiji and Thailand had exacerbated this situation, citing recent cases where carrying condoms had led to arrests.

“Every day we confront brutal realities—arrest, violence, discrimination,” said Kay Thi Win, Chair of APNSW and programme manager of a successful and long-running outreach programme in Myanmar that is largely run by sex workers or former sex workers. “We want to turn the tide by demanding that initiatives designed ‘for’ us be designed ‘with’ us,” she said.

*Cambodia, China, Fiji, Indonesia, Myanmar, Pakistan, Papua New Guinea and Thailand

Asia-Pacific Year of Youth launch roundtable panel. Credit: UNAIDS

HIV and sexual and reproductive health has been identified as a central theme for discussion as part of the International Year of Youth, a United Nations (UN)-led initiative launched this month by the Secretary General Ban Ki-moon.

Under the overarching theme of “dialogue and mutual understanding,” the Year of Youth aims to promote peace, respect for human rights and solidarity across generations through activities that highlight issues of increasing importance for youth—including HIV, the environment, hunger and employment. Young people are encouraged to participate in local and global efforts to achieve internationally-agreed targets, such as the Millennium Development Goals.

With young people aged 15-24 accounting for 40% of all new HIV infections, increased youth engagement in the AIDS response is critical. Empowering young people to protect themselves from HIV is one of ten UNAIDS priority areas, with the overall goal of a 30% reduction in new HIV infections by 2015. UNAIDS has committed to achieving three ‘bold results’ in at least nine of the 17 high-burden countries. These include:

• ensuring at least 80% of young people in and out of school have comprehensive knowledge of HIV;
• doubling young people’s use of condoms;
• doubling young people’s use of HIV testing and counselling services.

Youth in Asia-Pacific call for open dialogue on HIV

UNAIDS National Goodwill Ambassador for China, CCTV presenter and moderator of the Asia-Pacific Year of Youth launch James Chau listens to interventions from young people. Credit: UNAIDS

At the Asia-Pacific launch of the Year of Youth in Bangkok, Thailand, young people from across the region underlined limited access to sex education and HIV-related information as key areas of concern. During the launch event—a roundtable dialogue between youth representatives, heads of UN agencies and government officials, moderated by UNAIDS Goodwill Ambassador for China and television presenter James Chau—young participants highlighted the need for parents and others to “get outside their comfort zones” in order to better reach youth with information on sex and HIV.

“My parents have talked to me openly about sex and HIV for as long as I can remember,” said Benya, a 14-year-old high school student from Bangkok. “I think this helps me make good choices in my life.”

Young participants emphasized that greater access to evidence-based information on HIV and sexual and reproductive health, through both traditional and new media channels, was critical for youth empowerment on HIV-related issues.

Steve Kraus, Director of the UNAIDS Regional Support Team for Asia and the Pacific, underscored that evidence shows that when young people are given accurate information about sex and HIV, they choose to have sex later, with fewer partners and increased use of condoms.

Steve Kraus, Director of the UNAIDS Regional Support Team, underlines that young people are “leading the prevention revolution.” Credit: UNAIDS

“Young people are leading the prevention revolution. Recent data show that HIV prevalence has dropped by 25% among youth in 15 of the highest-burden countries. We have to continue this momentum,” said Mr Kraus. “The International Year of Youth provides a key opportunity for us to massively increase our emphasis on bringing young people to the table and ensuring their voices are heard in the important debates on HIV.”

For the Asia-Pacific region—and across the world—the Year of Youth launches will be followed by a series of targeted activities to showcase youth contributions to development, encourage dialogue and highlight the benefits and significance of youth participation in all aspects of society.

A HIV outreach peer worker chats with a transgendered person in Pattaya, Thailand. Credit: UNAIDS/Vinai Dithajoh

Across the world sex workers, men who have sex with men, transgender people, and other sexual minority groups are disproportionally affected by HIV yet often face considerable challenges in accessing healthcare and other services.

To address the technical and political challenges of securing resources for these key populations while also supporting strong country ownership, the Global Fund to fight AIDS, TB and Malaria (Global Fund), UNAIDS and the Coalition of Asia Pacific Regional Networks on HIV/AIDS is hosting a global expert consultation in Bangkok, 5-7 October 2009.

Mr Prasada Rao, UNAIDS Director for Regional Support Team Asia and the Pacific, earlier opened the Global expert consultation on gender and sexual diversity, emphasising the importance of effective programming for key groups at higher risk of HIV drawing on examples from UNAIDS work in the Asia Pacific region.

“Both UNAIDS and Global Fund, by sharpening their policies and priorities with regard to most at risk populations can influence countries to prioritise high impact prevention in their national plans.

UNAIDS has identified sexual transmission and removal of punitive laws as priorities in its Outcome Framework 2009-2011. The Global Fund is increasingly moving to funding National Strategic Applications (NSAs) rather than individual proposals. Both these policy shifts will immensely benefit MSM and transgender populations by resource availability for high impact programs,” said Mr Rao.

Mr Prasada Rao, UNAIDS Director for Regional Support Team Asia and the Pacific, spoke of the importance of effective programming for people at higher risk if HIV when he opened the meeting in Bangkok, 5 October 2009
Credit: UNAIDS

Mr Rao was joined by David Winters, Country Coordinating Mechanism Manager of the Global Fund; and, Vince Crisostomo Regional Coordinator of the Coalition of Asia Pacific Regional Networks on HIV/AIDS as well as representatives of sexual minority groups from around the world. The meeting brings together experts to discuss the implementation of the Global Fund’s Sexual Orientation and Gender Identities Strategy.

The Strategy, agreed by the Global Fund Board in May 2009, recognizes that key populations at higher risk of HIV face considerable challenges in being able to access or benefit from grants and face social and structural barriers in the realization of their health and rights. The consultation aims to continue collaboration between key partners on work towards resource allocation for activities related to sexual orientation and gender identities. It is also a forum to exchange experiences and practices on these activities in order to achieve a more harmonized AIDS response.

Andy Seale, Senior Adviser for Sexual and Gender Diversity at the Global Fund, said: “Progress in securing greater investment in HIV programming for sex workers, men who have sex with men, transgender people, and other sexual minority groups requires a strong partnership approach. We need to ensure that the same diverse partners that helped develop the Global Fund’s sexual orientation and gender identities strategy are now active in demonstrating leadership in addressing the technical and political challenges of its implementation. This meeting brings together a number of key partners in this effort.”

The consultation, is jointly organised by UNAIDS, the Global Fund and the Coalition of Asia Pacific Regional Networks on HIV/AIDS. The Global Fund finances nearly a quarter of all international spending on AIDS and two-thirds of global spending on malaria and TB. UNAIDS plays a unique link role in this effort by strengthening partnerships across sectors, including within civil society and communities.   

The Coalition of Asia Pacific Regional Networks on HIV/AIDS is a broad-based alliance that brings together seven regional networks that have experience and expertise in initiating and implementing programmes dealing with affected communities and vulnerable populations. The Network builds upon partnerships to ensure effective responses at grassroots level.

Geneva, 24 September 2009 – The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) are optimistic about the results, announced today, of the largest ever HIV vaccine clinical trial held to date.

The study results, representing a significant scientific advance, are the first demonstration that a vaccine can prevent HIV infection in a general adult population and are of great importance.

The two UN agencies congratulate both the principal investigators, sponsors and the trial volunteers who have made this encouraging result possible.

The RV144 HIV vaccine study results, revealing a 31.2% vaccine efficacy in preventing HIV infections are characterized as modestly protective. However, these results have instilled new hope in the HIV vaccine research field and promise that a safe and highly effective HIV vaccine may become available  for  populations throughout the world who are most in need of such a vaccine. No vaccine safety issues were observed in the trial.

Much more work, though, has to be done by the principal investigators and a large group of international collaborators to analyse the trial data, understand the protective mechanism, determine the duration of protection, and map next steps. Licensure at this point in time may not be possible solely on the basis of this study's results, and it remains to be seen if the two specific vaccine components in this particular regimen would be applicable to other parts of the world with diverse host genetic backgrounds and different HIV subtypes driving different regional sub-epidemics. Once an HIV vaccine does become available, it will need to be universally accessible by all persons at risk.

In addition, early HIV vaccines with modest levels of efficacy would most likely have to be used as complementary tools in combination with strategies to promote changes in behavioural and social norms, promotion of correct and consistent condom use, access to safe injection equipment, as well as male circumcision.

The Phase III trial, involving 16 395 adult male and female volunteers in Thailand, was a test- of-concept of a novel HIV vaccine regimen with two different candidate vaccines developed by Sanofi-Pasteur and the non-profit organization Global Solutions for Infectious Diseases. The trial was performed by the Thai Ministry of Public Health, sponsored by the United States Army Surgeon General and received funding from the United States National Institute for Allergy and Infectious Diseases and the United States Army Medical Research and Materiel Command, Department of Defense. 

WHO and UNAIDS began supportive work for this trial 18 years ago, in 1991, when Thailand was recommended as one of the WHO-sponsored countries in preparation for HIV vaccine trials and the development of the National AIDS Vaccine Plan. In particular, WHO and UNAIDS through their HIV Vaccine Advisory Committee (VAC) provided continuous technical guidance and advice for review, approval and implementation of the RV144 trial protocol. In 2006, VAC performed an external evaluation of the trial examining various ethical and community-related issues: this evaluation showed that the trial was being conducted at the highest scientific and ethical standards and with active community participation.

Moreover, WHO and UNAIDS, in collaboration with partners, such as the Global HIV Vaccine Enterprise have jointly developed numerous policy documents relating to access to care and treatment for trial participants, design and purpose of test of concept HIV vaccine trials as well as scientific parameters.

WHO and UNAIDS will work with the global HIV stakeholder community to further understand and resolve a range of questions related to the potential introduction of an HIV vaccine of moderate protective efficacy. This includes additional, in-depth trials in different populations with diverse host and virus genetic backgrounds.

Until a highly effective HIV vaccine becomes available UNAIDS and WHO underline the importance of effective and proven HIV prevention methods for all people. A comprehensive HIV prevention package includes, but is not limited to, behavioural interventions to reduce sexual risk practices, including correct and consistent male and female condom use, early and effective treatment for sexually transmitted infections, male circumcision in high HIV prevalence settings, harm reduction for injecting drug users, post-exposure prophylaxis with antiretroviral drugs, and interventions to prevent HIV transmission in health care settings. 

By Michel Sidibé, Executive Director, Joint United Nations Programme on HIV/AIDS (UNAIDS) Geneva, Switzerland

(This article also appeared in the Bangkok Post on 20 April 2009)

At the Mitsamphan drug user harm reduction drop-in centre in Bangkok drug users are able to get clean needles, condoms and counselling. Access to these services allows them to stop HIV, look after their health and lead productive lives. The centre is run by community members, including ex-drug users, and has restored dignity and is giving hope to many. Thanks to many such centres worldwide, new HIV infections among drug users are being stopped. This is not a surprise for the delegates attending the 20th international conference on harm reduction in Bangkok this week. But for a majority of policy makers in national drug programmes, the term ‘harm reduction’ invokes silence and controversy. However nearly 16 million people inject drugs worldwide – 3 million of whom are estimated to be living with HIV – silence on harm reduction therefore is not an option.

National drug control and HIV programmes must work together. They must be informed by evidence and grounded in human rights. Drug issues are complex but they do not take away from the fact that people who inject drugs, just as everyone else, are entitled to the full spectrum of human rights. Evidence shows that harm reduction programmes save lives. Many countries are still not providing access to the harm reduction services. This is killing people as much as the drugs themselves.

Regrettably the 52nd session of the Commission on Narcotic Drugs in March of this year missed an occasion to make a bold political commitment to holistic harm reduction. Yet member states had committed to accelerating access to harm reduction efforts related to drug use in the Political Declaration on AIDS adopted at the UN High level meeting on AIDS in 2006.

But why are drug control authorities against harm reduction? Harm reduction programmes include access to sterile injecting equipment, opioid substitution therapies, and community-based outreach. These are the most cost effective means of reducing HIV-related risk behaviors. They not only prevent transmission of HIV but also of hepatitis C and other blood borne viruses. In Australia, the return on investment of a decade of needle and syringe programmes was estimated at one and half billion US dollars. And in Ukraine, for $0.10 cents per day one drug user can be protected against HIV through the provision of comprehensive harm reduction services.

Countries that have adopted a comprehensive approach to HIV and drug use have seen a decline in the spread of HIV among people who inject drugs. This includes Australia, United Kingdom, France, Italy, Spain, and Brazil, and in some cities in Bangladesh, the Russian Federation, and Ukraine.

We can protect drug users from becoming infected with HIV. China is doing its part. In 2004, there were only 50 needle and syringe programmes. Today there are more than a thousand such programmes in all priority provinces. By achieving universal access targets for 2010, nearly 10 million drug users will be able to access such life saving harm reduction programmes worldwide.

Harm reduction is not an obstacle in reaching the goal of a drug-free world. Drug control authorities need not fear a rise in drug use simply because people are taking steps to protect themselves from HIV and reduce their drug dependency.

There is no evidence that providing harm reduction services has led to more people becoming drug users. There is also no proof that current drug users increase their intake of drugs or choose to use them longer. In contrast to the overwhelmingly beneficial effects of harm reduction, law enforcement approaches alone do little to reduce drug use and drug-related crime and are often associated with serious human rights abuses and poor health outcomes for people who use drugs. They include arbitrary arrests, prolonged detention, compulsory drug registration and unwarranted use of force and harassment by law enforcement officers.

Many drug laws make possessing and distributing sterile needles and syringes an offence, and opioid substitutes such as methadone and buprenorphine are classified as illegal despite being on the WHO list of essential medicines.

When law enforcement and public health efforts come together, the outcomes are very successful – for example in Britain and Australia where drug action teams and police focus on crime fighting and successfully refer drug users to health and welfare services.

The Supreme Court in Indonesia rightly ruled that drug users should not be sent to prison; instead they should have access to treatment. It should not be a crime to access clean needles. It should not be a crime to access substitution therapy.

We need to get rid of drug laws that block the response to AIDS and drug use. HIV and injecting drug use are two epidemics but need a combined strategy. We cannot leave it to the next generation to reconcile the separate approaches to HIV and drug control.