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Aids Alert International: Global HIV epidemic fueled by UN policies
Study says major funding, changes needed soon
New HIV epidemics in Eastern Europe, Central Asia, and China are spreading fast due to injection drug use (IDU) transmission, and these epidemics will continue to escalate unless the United Nations and individual countries make major policy changes, a new report charges.
"Our 20 years of experience in how to address [HIV prevention among] vulnerable populations are not at all being put to use among drug users," says Kasia Malinowska-Sempruch, director of the International Harm Reduction Development Program at the Open Society Institute in New York City.
"The U.N. convention criminalizes possession of drugs even for personal use," she says.
This approach marginalizes IDU communities, pushing their drug use underground, which facilitates the sharing of needles and spread of HIV, Malinowska-Sempruch explains.
The result is the situation now at hand, according to the report Illicit Drug Policies and the Global HIV Epidemic:
Instead of tackling the epidemic head-on with harm-reduction strategies, such as providing drug treatment and clean needles, which would prevent it from spreading to the general population, these nations have followed the U.N.’s lead in treating drug users like criminals, Malinowska-Sempruch says.
"Many people are hostile to drug use as a principle . . . and do not put into place harm reduction programs," she notes. "The U.N. has not spoken in favor of harm reduction, so it provides cover to people who are not sympathetic."
Without harm-reduction programs, which were used very successfully in Australia, the United Kingdom, Poland, Canada, and some Western European nations, it’s likely HIV epidemics will grow in many of these countries where the epidemics are relatively new, Malinowska-Sempruch says.
Although organizations like the Open Society Institute are doing what they can to introduce harm reduction programs to Russia and other countries, these efforts provide only a small amount of coverage and cannot stop HIV from spreading, she explains.
For instance, the Open Society along with the British Development Agency have funded nearly four dozen harm-reduction programs in Russia, but even at that number, the programs reach only 5% to 7% of the people who need assistance, she says. "Unless the government steps in and uses its own clinics and AIDS centers to spread information out to people, we’re not stopping the epidemic, and we only have a large-scale pilot program," Malinowska-Sempruch says.
So it will be crucial for nations to change their policies regarding IDUs and to fund programs that help stop the HIV epidemic rather than worsening the problem. With these goals in mind, the Open Society report makes very specific recommendations for the United Nations, including the following:
Government funding for harm reduction programs is crucial if there is any hope of stopping the spread of HIV among IDUs and others, Malinowska-Sempruch says.
The magic number that has shown to stop HIV among IDUs in other countries is 60%, she notes.
"Sixty percent of the drug users need to be offered services if you are going to stop the HIV epidemic," Malinowska-Sempruch says. "If you have one or two harm-reduction programs, and the coverage is 1% — that simply is not going to stop an epidemic; it’s a gesture that shows good will, but it won’t make a difference."
1. Wolfe D, Malinowska-Sempruch K. Illicit drug policies and the global HIV epidemic: Effects of U.N. and national government approaches. Published on-line by the International Harm Reduction Development, the Open Society Institute. New York City; March 2004. Web site: www.soros.org.