When world leaders meet in New York at the United Nations General Assembly High Level Meeting on HIV/AIDS (June 8–10, 2011), they will review progress and chart the future of the global AIDS response. The meeting marks three decades of the HIV epidemic, ten years since the landmark adoption at the UN of time-bound, measurable goals and targets, and five years since the commitment was made by world leaders to achieve universal access for all to comprehensive HIV programmes by 2010.
In the past ten years, there have been fewer new HIV infections globally, significantly fewer infections among newborns and improved access to HIV treatment. As a result AIDS-related deaths have decreased by more than 20% since 2006. But thirty years into the global HIV epidemic, we have not come far enough. Progress towards universal access has proven to be selective.
People who inject drugs have little to celebrate. Accounting for 30% of HIV infections outside of sub-Saharan Africa, and up to 80% of infections in Eastern Europe, Central Asia and parts of South East Asia, the proportion of new HIV cases in people who use drugs is increasing. 33.3 million people live with HIV across the globe, and an estimated three million of this group are people who inject drugs. A further 16 million are at risk of infection through injecting drug use. For people who inject drugs, access to HIV prevention, treatment, care and support has been inadequate. Stigma, discrimination and punitive policies associated with the failed, U.S.-promoted ‘war on drugs’ approach have exacerbated the risk of HIV infection.
Funding for harm reduction works out to three US cents a day per person injecting drugs, and accounts for less than 10% of estimated 2009 and 2010 UNAIDS targets for harm reduction financing globally. In order to mount a response commensurate with the magnitude of the epidemic among people who inject drugs, a 2009 economic analysis by Harm Reduction International estimated that at least 20% of total global funds allocated for HIV prevention in low and middle-income countries must go toward harm reduction programs.
The new draft declaration on HIV/AIDS set to emerge out of the UN Meeting in June, tentatively titled “Zero New Infections – Zero Discrimination – Zero AIDS Related Deaths,” provides little hope of significant movement. The document contains weak, indecisive references to these issues, and an aversion to naming explicit harm reduction interventions and policies that we know work. There is no mention at all of opioid substitution therapy, a proven, effective intervention for treating opioid dependence, preventing HIV transmission, improving adherence to HIV treatment and reducing overdose-related deaths (a leading killer of people who use drugs living with HIV).
There are further weaknesses. Despite bearing a disproportionate burden of HIV infections, stigma and human rights violations, and experiencing limited or no access to gender-specific harm reduction and reproductive health services, the needs of women are only addressed in reference to heterosexual transmission. Unacceptably, “abstinence and fidelity” make it into the draft text despite significant scientific evidence of the failure of abstinence-based HIV prevention measures for young people. Meanwhile, there is no strong acknowledgment that young people, who are increasingly affected by HIV as a result of drug injecting and drug use in several countries, are being left behind against the global trend of reduced HIV incidence. Thirty years into the AIDS epidemic, the draft UN document provides evidence that governments are still evading the disastrous impact that HIV has had on the lives of people who inject drugs, their families, friends and communities.
A new call to action led by Harm Reduction International (formerly the International Harm Reduction Association), the Beirut Declaration on HIV and Injecting Drug Use, addresses these gaps directly, and sets out action points for governments and the international community at the UN Meeting in June.
The Beirut Declaration, launched in April 2011 at the 22nd International Harm Reduction Conference in Beirut, Lebanon, calls for the implementation, scale-up and financing of evidence-based harm reduction programmes, including needle and syringe exchange programmes and opioid substitution therapy, in both communities and detention settings. One hundred and fifty-eight countries and territories report injecting drug use yet almost half of these still lack these essential services, and with poor coverage in the majority of countries that do implement them, the world is far from ‘universal access’. Instead, people who use drugs face stigma, discrimination and human rights violations as law enforcement and abusive drug control measures continue to trump public health in country after country around the world.
Punitive responses to drugs have been proven to impede HIV prevention efforts. To facilitate a more intensified response to the HIV epidemic in the drug-using community, the Beirut Declaration calls for a comprehensive review and reform of ineffective, expensive, drug policies, from a punitive criminal justice approach to one rooted in public health and human rights-based principles. Specifically, it calls for the amendment of laws criminalising the possession of drugs for personal use and the carrying of paraphernalia such as sterile needles.
Over 300 organisations from around the world and from a range of disciplines, as well as high profile decision-makers, have endorsed the Beirut Declaration since its launch. Among them is Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the America Foundation for AIDS Research (amFAR), Medicins du Monde, International Federation of Red Cross and Red Crescent Societies, International Network of People who Use Drugs, Canadian HIV/AIDS Legal Network, International HIV/AIDS Alliance, Open Society Foundations, Catholic Overseas Development Agency (CAFOD), Save the Children UK and many others. In their April 9th editorial, the respected international medical journal The Lancet featured the Beirut Declaration as a key document for informing UN High Level Meeting priorities, echoing its calls for evidence-based harm reduction programmes and drug policy reform to be “explicitly included in the new global declaration on HIV/AIDS that will be drafted at the June meeting with measurable targets to hold governments accountable,” adding that “millions of lives are at stake”.
The Beirut Declaration on HIV and Injecting Drug Use is an urgent call to action for states and the international community to respond to HIV and AIDS with evidence-based, cost-effective programs and policies founded on public health and human rights. A strong acknowledgement of the role of injecting drug use in the AIDS epidemic and the programmatic and policy actions the world must take to address its impacts is crucial if we aim to achieve zero new infections, zero discrimination and zero AIDS-related deaths. Thirty years into the HIV epidemic, it’s about time, and it’s still not too late.
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View the April 9th Lancet editorial: http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611604753.pdf
For media inquiries, please contact Michael Kessler: [email protected] +34 655 792 699
 US$2.13 billion.
 $3.2 billion.