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HIV and Harm Reduction Winning on policy front : Faltering on Implementation

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

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HIV and Harm Reduction Winning on policy front : Faltering on Implementation

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  1. HIV and Harm Reduction Winning on policy front : Faltering on Implementation JVR Prasada Rao, UNAIDS XVIII International Harm Reduction Conference Warsaw, 13th May 2007

  2. 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

  3. HIV Epidemic Among IDUs Fastest Growing

  4. More countries and territories in which drug injecting and associated HIV infection is reported

  5. The Global View of HIV, End 2006 Recent trends in HIV infection, 2003–2005 + 55% 80% of all HIV positive IDUs are in developing countries Eastern Europe faces the most growing epidemic + 6% + 17% + 34% + 21% + 11% + 21% + 5% + 23% Source:UNAIDS/WHO July 2006 outside region

  6. The Global View of HIV, End 2006 Recent trends in HIV infection, 2003–2005 Kenya: 22.9% to 50% South Africa: 19.4% Africa is facing a second epidemic of IDUs Source:UNAIDS/WHO July 2006 outside region

  7. Major Initiatives at Global Level: Winning on the Policy Front

  8. 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

  9. 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

  10. 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 Winning on the Global Front: Resources Scale Up Signing of DOC

  11. Countries and Regions Small Victories

  12. Country and Regional Scenario Small 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 • Baltic countries introduce prison program with UNODC • Central Asian countries scale up

  13. Number of Countries with Harm Reduction Programs Global Needle Syringe Programmes Global Substitution Treatment 39 to 67 43 to 53

  14. Country and Regional Scenario Small Victories • Brazil, China, Malaysia – national programming • Viet Nam Government and Party endorses Harm Reduction • Baltic countries introduce prison program • Central Asian countries scale up • Baltic countries introduce prison program • Central Asian countries scale up

  15. Regional 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

  16. Sub-Optimal Level of Services

  17. Sub-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

  18. Resource Need for Prevention among IDU Low spending on IDUs even in Thailand Total Prevention resource need: 11 billion Annual IDU prevention need: 200 million

  19. Funding : Largely External What % of Resources are Domestic ? No. of countries Source: UNAIDS, RSTAP. Unpublished, (Result from a nine country survey, 2007)

  20. Major Challenges Ahead

  21. 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

  22. Most Important Global Challenges Global Warming AIDS

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