Today of the estimated 16 million people world wide who inject drugs—3 million are HIV positive. Any discussion on drugs cannot ignore their needs and human rights.
Credit: UNAIDS

In 1998, the UN General Assembly held a Special Session on the world drug problem. At the time there was little discussion on the linkage between HIV and drugs. Today of the estimated 16 million people world wide who inject drugs—3 million are HIV positive. Any discussion on drugs cannot ignore their needs and human rights.

Over the years the issue of HIV and drug use (especially injecting drug use) has grown. However, the global response has not followed the scientific evidence and harm reduction has been largely excluded.

Harm reduction programmes include access to sterile injecting equipment, opioid substitution therapies, condoms, STI treatment, information on sexual transmission of HIV 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.

Too often countries have taken the one dimensional approach of reducing drug demand or supply. The word “only” hasn’t worked for HIV prevention, treatment, care and support programmes. And the evidence shows that programmes that “only” focus on one area of drug use will not work either.

Countries that have adopted a comprehensive approach to HIV and drug use have seen a slowing and reversal in the spread of HIV among people who inject drugs. This includes countries such as Australia, UK, France, Italy, Spain, and Brazil, and in some cities in Bangladesh, the Russian Federation, and Ukraine. In recent years countries such as Indonesia and China are scaling up access to harm reduction programmes for injecting drug users.

No evidence has been found of unintended negative consequences such as increased initiation, duration or frequency of injecting drug use. On the contrary it has been found that countries which have adopted this public health approach to HIV prevention among people who inject drugs have been the most successful in reversing the HIV epidemic.

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. Drug laws may make possessing and distributing sterile needles and syringes an offence, and opioid substitutes may be classified as illegal, despite both methadone and buprenorphine being on the WHO model list of essential medicines.

These measures reinforce stigma against people who inject drugs, create disincentives to accessing services (including treatment for drug dependence or HIV) and may make health and welfare professionals wary of offering services to people who use drugs. But when law enforcement and public health efforts come together, the outcomes are very successful– for example in Britain and Australia where drug action teams police focus on the crime fighting and successfully refer drug users to health and welfare services. It is time to come together, not work against each other.

It should not be a crime to access clean needles. It should not be a crime to access substitution therapy. The global drug problem is complex and cannot be solved in isolation. A coming together of organizations working on drug control and AIDS is urgently needed. Working together the world has a better chance to employ solutions that save lives.

The largest numbers of HIV positive people who inject drugs are in Eastern Europe, East and Southeast Asia and Latin America. HIV prevalence among some groups in these regions is estimated at over 40%. New epidemics of injecting drug use are also emerging in sub-Saharan Africa. HIV can spread extremely quickly once it enters a population of people who inject drugs. Increases in HIV prevalence from 5% to 50% in one year have been observed among people who inject drugs in some settings, and HIV can also spread from people who inject drugs to their sexual partners and other populations at higher risk of HIV exposure.

A consultation on the progress, gaps and next steps towards achieving universal access to HIV prevention in the Russian Federation took place in Moscow on 25-26 February.
Credit: UNAIDS

A consultation on the progress, gaps and next steps towards achieving universal access to HIV prevention in the Russian Federation took place in Moscow on 25-26 February. The meeting was convened by the Russian Ministry of Health and Social Development, the Federal Service for Surveillance on Consumer Rights Protection and Human Well-being, the Federal AIDS Centre and UNAIDS. Around 100 health care professionals took part in the conference including representatives of the All-Russia Association of People Living with HIV/AIDS, and members of civil society from 23 Russian regions.

Russia has made significant progress towards achieving their universal access to HIV prevention, treatment, care and support targets endorsed by the 2006 Political Declaration on HIV/AIDS. In 2008, 55,000 people received HIV treatment, and 24 million people were screened for HIV. This year for the first time ever 400 million roubles (about US$ 14 million) of federal budget were earmarked for HIV prevention, which is a doubling of the previous years’ budget.

The number of new HIV infections in Russia has not reduced and accounts for almost 40,000 people a year. This is in spite of increased spending and widening coverage of HIV prevention programmes among populations at higher risk including people who inject drugs, sex workers, prisoners and men who have sex with men as well as young people and the general population. These numbers confirm the need to increase the coverage of key populations through establishing evidence-informed prevention methods and by ensuring the provision of quality services.

The meeting provided an opportunity to address the most urgent issues around HIV prevention in Russia. Participants analysed the need to identify weak components in the HIV prevention work and stepping up its efficiency by introducing specific measures. Alexander Goliusov, head of HIV/AIDS department of Federal Service for Surveillance on Consumer Rights Protection and Human Well-being, said:

L to R: Dr. Vadim Pokrovsky, Head of Federal AIDS Centre, Dr. Alexander Goliusov, Head of HIV/AIDS Department of Federal Service for Surveillance on Consumer Rights, Protection and Human Well-Being, Fritz Lherisson, a.i. Regional Director, Regional Support Group, Eastern Europe and Central Asia
Credit: UNAIDS

"There are about 400 prevention projects carried out within the framework of the National Priority Health Project. However the HIV epidemic keeps on spreading. While progress has been made in HIV treatment, screening and prevention of mother-to-child transmission other HIV prevention interventions need improvement.”

Currently 45% of all country’s HIV prevention efforts are aimed at most-at-risk populations and 55% of the projects focus on various kind of support for people living with HIV. Russia implements different successful innovative programmes. However the conference emphasized that most of the projects do not go beyond the stage of pilot efforts, thus the population exposed to HIV prevention measures remains insufficient. For example, the needs of young people are not adequately addressed by HIV prevention work. In 2007 only 33.8% of young people of aged 15-24 had correct understanding of HIV infection. The Russian government set the goal for 2010 at 95%.

“Russia has made substantial progress towards a number of universal access indicators, mainly in the field of HIV treatment. Regretfully, as it is in many other countries, achievements in widening HIV prevention programmes especially among most-at-risk populations and the youth are lagging behind the advances in treatment,” said Marina Semenchenko, acting team leader of the UNAIDS office in Russia. “At the meeting, Russian experts discussed various viewpoints of efficient and not efficient measures of HIV prevention, and what could be done to achieve tangible results in HIV prevention.”

The discussion also addressed the issue of introducing a sustainable HIV prevention programme in the secondary school education system. Currently, HIV information - the ways of transmission and prevention - is included in school subjects as Biology, and Health and Safety; however they do not provide an adequate and up-to-date understanding of the disease.

Participants at the meeting also highlighted that one of the main obstacles to effective HIV prevention programmes was the lack of interagency collaboration and the limited engagement of the Drug Service in addressing the needs of injecting drug users.

The debates resulted in a resolution with recommendations on a range of required measures, in particular the need to elaborate a National HIV Prevention Concept. The final resolution will be submitted to the Governmental Commission on the Issues of Prevention, Diagnostics and Treatment of Decease Caused by Human Immunodeficiency Virus.

On 7 March 2009, the Minister of Foreign Affairs of the Russian Federation hosted a meeting of UN Heads of Agencies in Geneva to focus on the impact of the global financial crisis.

On 7 March 2009, Minister of Foreign Affairs of the Russian Federation, Mr Sergei Lavrov, hosted a meeting of UN Heads of Agencies in Geneva to focus on the impact of the global financial crisis.

This was the first meeting of UNAIDS Executive Director Michel Sidibé. At the discussion, Michel Sidibé expressed his concern that the impact of the global financial crisis threatens to roll-back the hard-won progress made in the global response to AIDS if it results in donors not fulfilling their global commitments to increase funding for AIDS to reach universal access goals, and, if governments are less able to afford to buy essentials such as HIV testing kits and life-saving antiretroviral drugs.

The UNAIDS Executive Director articulated his vision of how the financial crisis also represents an opportunity for countries and international organizations to pursue much needed reforms, to refocus on results at country level, and to deliver more with less. He also cited UNAIDS as model of UN reform, being a joint programme across 10 United Nations agencies and programmes, delivering coordinated results at global and country level.

At the meeting with Mr Lavrov, Michel Sidibé encouraged Russia’s continued leadership to ensure stable financing for AIDS, health and development. The Russian government has become the primary funder of the national AIDS response and has made significant progress towards achieving its universal access targets in the following areas: prevention of mother to child transmission, scaling up HIV testing and counselling, expanding the coverage of medical supervision, and providing access to treatment (which has increased from 15,000 people in 2006 to 55,000 in 2008).

Despite a growing number of HIV prevention activities in the country, Russian and international experts agree that coverage of most prevention programme especially for vulnerable groups is insufficient. HIV prevention services are reaching only 39% of sex workers, 17% of men who have sex with men, and 24% of people who inject drugs. In addition, high levels of stigma prevent those most-at-risk and marginalized in society actively seeking AIDS services.

However, the Government of Russia has recently pledged additional financing for HIV programmes, including prevention. Under the leadership of the Minister of Health and Social Development of the Russian Federation Ms Tatiyana Golikova, the government’s HIV Commission formally adopted Russia’s universal access targets in March 2008.

UNAIDS looks forward to continuing work with the government of Russia on national and regional initiatives and on strengthening partnerships across the region.

The new study, Vulnerabilities of Migrant Women: from Asia to the Arab Statessays that Asian women migrating to Arab countries often face circumstances which leave them highly vulnerable to factors leading to HIV infection.

Asian women migrating to the Arab states often do so under unsafe conditions, are targets of sexual exploitation and violence and are highly vulnerable to factors that lead to HIV infection, according to a study launched today, produced in collaboration by UNDP, UNAIDS, CARAM Asia, IOM,UNIFEM, and Caritas Migrant Centre in Lebanon.

HIV Vulnerabilities of Migrant Women: from Asia to the Arab States examines the health, social and economic toll that migrant women often face, particularly those who are low-skilled. In the current global economic crisis, with rising unemployment, their situation can become precarious as they tend to be in a weak bargaining position and are more likely to accept poor conditions to secure or keep a job.

Migration itself is not a risk factor for HIV infection, but it is the conditions under which people migrate, and the working and living conditions they find themselves in that make them highly vulnerable to HIV.

Based on some 600 interviews in four Asian countries and three Arab states (Bahrain, Lebanon and United Arab Emirates), the study reveals that migrant women, many of whom become domestic workers, often lack legal coverage, suffer duress and sexual exploitation in the workplace, and have limited or no access to health and social services.

The Arab States are the primary destination for many migrant workers from Asia, including the four countries which are the focus of research; Bangladesh, Pakistan, the Philippines and Sri Lanka.

The movement of women and money between the countries studied is considerable. The report estimates that 70-80 percent of migrants from Sri Lanka and the Philippines to the Arab States are female. Between 1991 and 2007, 60 percent of women migrants from Bangladesh left to find employment in these countries and remittances from Filipinos working in the Arab States in 2007 amounted to US$ 2.17 billion. In Bangladesh, migrant workers sent back close to US$ 637 million from the UAE. Current remittances by migrant workers from Sri Lanka amount to US$ 3 billion.

HIV Vulnerabilities of Migrant Women: from Asia to the Arab States charts a way forward. According to the report, host countries and countries of origin share equal responsibility to provide protective policies and programmes for women who seek a better life away from home. Recommendations include:

• Migrants who have a medical condition that does not impair their ability to work, such as living with HIV, should not be denied the right to work
• Health insurance schemes for migrant workers should cover all aspects of health, including HIV
• Hiring agents and employer blacklists need to be created, monitored and shared
• Embassy and consular staff in host countries should be trained on the special needs and vulnerabilities of migrant women
• Existing labour laws should be changed/reformed to cover migrant workers in the domestic sector

The Islamic Conference of Health Ministers (ICHM) brought together representatives from 57 member countries from 1 – 4 March in the I.R. of Iran. Credit: ICHM

The Islamic Republic of Iran hosted the second session of the Islamic Conference of Health Ministers (ICHM) bringing together representatives from 57 member countries from 1 – 4 March to discuss health issues facing the Islamic community under the theme "Health Equity in the Islamic Ummah."

The aim of the conference was to formulate concrete proposals in addressing health issues through initiating a “Health Vision” for the Organization of the Islamic Conference (OIC), as well as to review the implementation and progress made on the decisions and recommendations of the First Islamic conference of Ministers of Health held in Kuala Lumpur, Malaysia in 2007.

“Policy makers in the area of health should adopt a comprehensive strategy towards health issues. A strategy which considers health as the focus of development, where health is evaluated in a broad sense from physical to psychological, social, and spiritual health,” said H.E Professor Lankarani Minister of Health and Medical Education of I.R. Iran, during the opening of the meeting.

In relation to combating communicable diseases, it was noted with deep concern in the resolution adopted by the ministers on this subject, that AIDS is a crisis with disastrous consequences for the social and economic progress of all nations, including Muslim countries. The resolution urged OIC member states to foster HIV prevention programmes in cooperation with, among others, UNAIDS, WHO and the Global Fund. Such programs shall be formulated and implemented with full respect for Islamic, Cultural, Ethical and Social values of OIC member states.

There is no single HIV epidemic among the 57 OIC member countries. While the number of reported infections is on the rise in some countries and stable in others, higher HIV prevalence rates are documented among specific populations and settings within a number of countries. This is compounded by wider socioeconomic dynamics, such as changing lifestyles of young people, socio-political instability and conflict, gender inequality and mobility, factors that can increase vulnerability to HIV infection.

“Ensuring universal access to HIV prevention, treatment, care and support is the cornerstone to reverse the HIV epidemic,” said Renu Chahil-Graf, Director, UNAIDS Regional Support Team for Middle East and North Africa. “The opportunities afforded by the drive to universal access must be seized to ensure access to all essential commodities, gender equality, human rights, progress on all Millennium Development Goals and primary health care for all.”

The final resolution adopted by the OIC invites its member states and the OIC General Secretariat to contribute to the global response to AIDS in the context of international cooperation and partnership, and by actively sharing and disseminating the common Islamic vision and approach in responding to the HIV epidemic.

The OIC brings together 57 Member States inhabited by almost 1.5 billion people and spread over four continents in Asia, Africa, Europe and South America. The efforts of the OIC are mainly aimed at crystallizing a Joint Islamic Action to ensure, safeguard and protect the interests of the Muslim world. Since the 3rd Extraordinary Summit in Makkah Al-Mukarramah in 2005, whereby a Ten-Year Programme of Action was formulated, developmental targets in various domains including Health were set. For example, the Summit strongly called for combating pandemics and eradicating diseases and epidemics such as AIDS, Malaria, Polio and Tuberculosis.

This story was first published on UNICEF.org

Clementine, 18, and her sister, both HIV-tested and safe in eastern Rwanda.
Credit: UNICEF/2009/Frejd

Bamporeze is a non-governmental organization that started a community-based protection programme for children orphaned by AIDS in Rwanda soon after the genocide in 1995. Around 150,000 people live with HIV in Rwanda; 19,000 of them are children.

Clementine, 18, lives in eastern Rwanda and has been deeply affected by the AIDS epidemic.

“My parents died from an AIDS-related illness a few years ago,” she said, “but no one told us what they had or that we, too, should be tested.”

Clementine and her siblings were tested and now have a larger group they can rely on – an extended ‘family’ consisting of members of the community, mobilised by Bamporeze, who found out about Clementine and her siblings after their parents died.

Community support for orphans

While working with orphans, Bamporeze realised that foster families were not sustainable for all the orphans.

“There were just too many orphans,” said Bamporeze founder and coordinator Jeanne D’Arc Muhongayire. “So we decided to see how we could work with the whole community to try to rebuild children’s lives to create a feeling of a common responsibility for orphans.”

To create this larger family, Bamporeze, with support from UNICEF, helped orphaned children continue their education, learn skills and access information on reproductive health and life skills. Children in Clementine’s area also started their own agricultural cooperative to earn income to buy books, medicines and clothes. Bamporeze helped them find mentors who could be like parents to them.

A mentor to serve as parent

Clementine’s home in Rwanda; both of her parents died of AIDS-related illnesses several years ago.
Credit: UNICEF/2009/Frejd

“When Clementine and her siblings lost their parents, they were initially isolated from the other families,” said Patrick, who works with Bamporeze. “This happens to other children as well, and as their homes are spread out, it is hard to reach all of them to tell them that they are not alone.

“In fact,” Patrick continued, “I spend a lot of my time walking from one children’s household to another to ensure that all are registered with us and have access to the services. I then selected a mentor from the village – a person they trust and think can give them the support they need.”

“Our mentor comes to visit us every day,” said Clementine. “I talk to her about anything and she has introduced me to other children like us. It is good to know that we are not alone.”

Government bears responsibility

Bamporeze’s community-based programme for orphans has succeeded in registering every orphaned child with local authorities.

“This means that local government now also knows about these children and bears responsibility for their well-being,” said the Head of UNICEF Rwanda’s HIV and AIDS Section, Bernardine Mukakizima.

“Bamporeze has helped initiate a programme that serves as an example to other communities in this country,” she added. “We don’t have to wait for foster families or adoptions or even rely on them, if a community is mobilised and feels a sense of ownership for ‘its’ children, then orphaned children around this country will know that they are not alone.”

(from left) Ambassador Susan Rice, U.S. Permanent Representative to the United Nations and UNAIDS Executive Director Michel Sidibé, UN HQ New York, 2 March 2009.
Credit: USUN

On 2 March 2009 UNAIDS Executive Director Michel Sidibé met with Ambassador Susan Rice, U.S. Permanent Representative to the United Nations.

During their meeting Mr Sidibé thanked Ambassador Rice and the US Government for their continued support to UNAIDS and shared his thoughts on how an effective HIV response will support the achievement of the other Millennium Development Goals (MDGs).

Mr Sidibé also spoke on the need to address the obstacles to universal access to HIV prevention, treatment, care and support services. These include addressing stigma and discrimination, human rights and gender inequality as well as specific support for key populations including people who inject drugs and men who have sex with men.

Permanent U.S. Representative to the United Nations, Ambassador Susan E. Rice, shared her Government’s priorities and reaffirmed its continued commitment to the global AIDS response.

Ambassador Susan Rice was confirmed to the position of U.S. Permanent Representative to the United Nations by the U.S. Senate on January 22, 2009.

L to R: Craig McClure, Executive Director of the International AIDS Society, Dr Gennady Onischenko, Head of the Federal Service for Surveillance of Consumer Rights Protection and Human Well-being, Chief State Sanitary Physician of the Russian Federation, Michel Sidibé UNAIDS Executive Director, Urban Weber, Team Leader Eastern Europe and Central Asia, The Global Fund to Fight AIDS, Tuberculosis and Malaria

The co-chairs of the 3rd Eastern Europe and Central Asia (EEAC) AIDS Conference gathered today in Geneva to discuss the forthcoming event to be held in Moscow, 28-30 October 2009.

The meeting took place at UNAIDS Secretariat and was hosted by Michel Sidibé UNAIDS Executive Director with the participation of Dr Gennady Onischenko, Head of the Federal Service for Surveillance of Consumer Rights Protection and Human Well-being, Chief State Sanitary Physician of the Russian Federation and Craig McClure, Executive Director of the International AIDS Society. The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) was represented by Urban Weber, Team Leader, Eastern Europe & Central Asia. Alena Peryshkina, Director, AIDS Infoshare, Russia also participated.

Discussions were held on key topics to be featured during the conference, the importance of regional collaboration and of building strong partnerships with civil society and others.

As conference co-chairs UNAIDS, the International AIDS Society and the Global Fund offered their support to the Government of Russia in the preparation of the event.

The October conference will be co-chaired by UNAIDS Executive Director Michel Sidibé, Dr Gennady G. Onishenko, Head of the Federal Service for Surveillance of Consumer Rights Protection and Human Well-being, Chief State Sanitary Physician of the Russian Federation, Craig McClure, Executive Director of the International AIDS Society and Dr Michel Kazatchkine, Executive Director of the Global Fund to fight AIDS, Tuberculosis and Malaria.

Dr Jean Ramjohn-Richards, wife of President George Maxwell Richards, presents Brent Benjamin, winner of the Caribbean Coalition on Women, Girls and Aids (CCWA) regional  Logo Competition, with a cheque of US $500 at the launch of CCWA launch on 4 March 2009, Port-of-Spain.
Credit: UNAIDS

Violence against women is increasing women and girls’ vulnerability to HIV in the Caribbean region. This is the stark message which emerged from the launch of the Caribbean Coalition on Women, Girls and AIDS (CCWA) hosted on 4 March by the UNAIDS Caribbean Regional Support Team at the National Library, in Port of Spain, Trinidad.

Sexual violence against women and girls in the Caribbean is pervasive. According to a regional study, 47% of adolescent girls’ first sexual experience was “forced” or “somewhat forced” (Halcon, L. Beuhring T and Blum, R.: 2000). Violence or the threat of violence increases women’s vulnerability to HIV by making it difficult or impossible to negotiate safer sex and condom use. It also affects women’s expectations in relationships and can also stop women from accessing HIV prevention, care and treatment services.

The CCWA, a broad coalition of women from a diversity of backgrounds pledged to vigorously challenge not just violence against women but all aspects of female vulnerability to HIV. The First Lady of the Republic of Trinidad and Tobago, Her Excellency, Dr. Jean Ramjohn-Richards, who is a member of the CCWA, was in attendance as well as Yolanda Simon, Director of Caribbean Regional Network of People Living with HIV/AIDS (CRN+), founding member and advocate of the CCWA.

According to Roberta Clarke, Regional Programme Director of UNIFEM, much more needs to be done to transform unequal and harmful gender relations between women, men, boys and girls; as this culture of inequality is a root cause of women’s vulnerability to HIV.

“We know that the Caribbean is an unsafe space for women. Several Caribbean countries have amongst the highest homicide rates and all have higher than global averages of sexual violence, with three countries having amongst the top ten highest rates,” said Ms Clarke.

The CCWA therefore has a role to play in drawing attention to the persistence of inequality and violence and in advocating societal transformations which are consistent with the full respect for human rights.

The launch event also saw the unveiling of a new logo for the Coalition. Young Trinidadian, Brent Benjamin, was the winner of the competition to design the logo and he was presented with his prize by her Excellency, Dr. Jean Ramjohn-Richards.

The CCWA has been supported by the UNAIDS Caribbean Regional Support Team, along with UNIFEM and regional civil society organizations including CRN+, Caribbean Association for Feminist Research and Action (CAFRA) and the Centre for Gender and Development Studies (CGDS) for 15 months leading up to the official launch. This support will continue in 2009 during which time the Coalition will be hosted by UNIFEM with continued assistance from UNAIDS.

The new publication, HIV and AIDS in South Asia: An Economic Development Risk, reports that the epidemic may pose a considerable danger to the socio-economic development of South Asian countries if prevention programmes are not scaled up.
Credit: World Bank

The AIDS epidemic may pose a considerable danger to the economic and social development of South Asian countries unless those at highest risk of infection are reached by scaled up prevention programmes, according to a new World Bank report.

The publication, HIV and AIDS in South Asia: An Economic Development Risk, contends that although overall HIV prevalence is low (up to 0.5%) there are concentrated epidemics among key population groups which may escalate if concerted action is not taken. These groups include sex workers and their clients, and injecting drug users and their partners who would benefit, the report says, from access to comprehensive harm reduction, including clean needle exchange, condom use, and treatment of sexually transmitted infections.

Threats to economic and social development in the region are emerging not only in the form of the escalation of these concentrated epidemics, the report says, but also in terms of the costs of welfare and of scaling up of AIDS treatment.

The publication highlights the fact that AIDS frequently results in and exacerbates poverty, with a significant number of affected household losing well over half of their income. The ability to cope with the financial effects of the epidemic is strongly linked to socio-economic factors such as gender, education and wealth. Investing in effective HIV prevention, the Bank says, has a clear effect on containing poverty.

HIV and AIDS in South Asia: An Economic Development Risk also stresses the “catastrophic” health expenses associated with antiretroviral therapy in a region where most people pay out of pocket for health services, making the case for a key role for the governments of the region to ensure quality and adherence in both public and private provision of treatment.

AIDS represents a significant burden in South Asia with about 2.6 million people living with HIV, the majority of them in India, with AIDS accounting for 1.5% of all deaths in the region.