People who use drugs left behind by global funding gap

The fight to defeat HIV among those most at risk of infection may not be achieved as soon as hoped unless harm reduction services for people who use drugs receive appropriate funding.

The fight to defeat HIV among those most at risk of infection may not be achieved as soon as hoped unless harm reduction services for people who use drugs receive appropriate funding.

Due to stigma, discrimination and criminalisation, millions of people don’t have access to vital services which reduce the harmful consequences of drug use, such as needle exchange programmes and tailored healthcare.

A report launched by International HIV/AIDS Alliance and partner organisations during July’s AIDS 2014 conference in Melbourne, Australia, highlighted the need to invest more in HIV-related harm reduction programmes for people who inject drugs in low and middle income countries. According to the report, this is imperative to ensure a future HIV-free generation. The report stated: “Throughout the HIV epidemic, the investment to prevent and treat HIV among marginalised and criminalised populations has not met the need.”

In a heated plenary session HIV leaders and activists collectively called for the “globalisation of the global funds” to include all those most at risk from HIV infection. Following the Global Fund’s launch of a new funding model in April, there were high expectations that prevention would still be a key priority.

The Global Fund

The Global Fund is an international financing institution which supports vulnerable communities around the world in fighting HIV, tuberculosis and malaria. Most of its funds come from donor governments, with the private sector and non-governmental organisations also contributing.

The new funding model has received mixed reactions. Some organisations responsible for implementing HIV programmes argue that by focusing on treatment, the model overlooks prevention and so is jeopardising key issues such as harm reduction.

“This means we are moving one step ahead and leaping two steps backward,” observed an officer from an implementing organisation, who sought anonymity. However, those in favour of the new model argue that it will allow more strategic investments and will engage implementers and partners more effectively to achieve greater global impact.

During the session, Mark Dybul, executive director of the Global Fund, pointed out that focusing on the most vulnerable people would be a massive leap towards ending HIV, saying: “If all partners worked together toward this common goal, HIV would no longer be a high-level epidemic.” He also observed that science has given the world an opportunity to end HIV while calling upon all stakeholders to grab the chance and eliminate the epidemic.

Budget cuts

In Ukraine, for example, the national HIV budget has substantially decreased and the Global Fund has cut its budget for people who inject drugs by more than half. As a result, the International HIV/AIDS Alliance report argues there is a dire need for more funding to save lives among this vulnerable group. Prevention is imperative to avoid an explosion of new HIV infections.

Far from being unique, the situation in Ukraine is reflected in many countries, as people who inject drugs have been excluded by the withdrawal of donor funding and cuts in national budgets for harm reduction programmes.

Vietnam has also experienced this scenario, with the national budget for HIV cut by 65 per cent. All HIV programmes are affected, but harm reduction services are among those hardest hit by the cuts, because the number of injecting drug users is increasing. According to Khuat Thi Hai Oanh, leader of the Centre for Supportive Community Development Initiatives in Vietnam, these cuts could lead to similar problems to those in Ukraine.

No one should be left behind

If pledges and subsequent contributions to the Global Fund in 2013 were anything to go by, an end to AIDS, tuberculosis and malaria should be in sight. During its fourth replenishment, in Washington DC in 2013, speakers unanimously voiced their optimism that the fight against HIV would soon be won, using the funds contributed.

An initial US$12 billion was pledged in contributions from 25 countries, as well as the European Commission, private foundations, corporations and non-governmental organisations.

But while treatment is fundamental, the fight against AIDS will never be won unless a budget that prioritises people most at risk, through harm reduction programmes, is put in place. This will ensure no one is left behind in both prevention and treatment. In the decade since the Global Fund was founded, not enough has been done to address harm reduction as a prevention measure.

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