hiv and harm reduction winning on policy front : faltering on implementation jvr prasada rao, unaids...
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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