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amfAR releases report on HIV programs for drug users
Special to the online edition of Windy City Times
by Margo Anderson
2015-10-06

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The American Foundation for AIDS Research ( amfAR ) recently released a report entitled "Harm Reduction and the Global HIV Epidemic." The goals of the brief were to establish the efficacy of HIV prevention programs for people who inject drugs ( PWID ) in five selectively chosen countries around the world.

amfAR undertook case studies in Kenya, Kyrgyzstan, Nigeria, Ukraine and Vietnam to obtain a better understanding of their HIV-prevention programs for PWID. Selection of countries was based on geographic diversity, funder interest, and demographics of local HIV epidemics.

Drug use via injection is a major factor in the spread of HIV. Kali Lindsey, deputy director of Public Policy at amfAR, told Windy City Times, "HIV, as an infectious disease, is a virus that infects CB4 [white blood] cells … and turns them into HIV cells … so, of course, injection drug use, because the needle goes directly into the blood stream, is an incredibly efficient way to transmit HIV." Recently, in Scott County, Indiana—an area with fewer than 3,000 inhabitants—the use of injecting drugs was linked to 120 HIV infections in six months.

In 2009, the World Health Organization ( WHO ) collaborated with the United Nations Office on Drugs and Crime ( UNODC ) as well as the Joint United Nations Programme on HIV/AIDS ( UNAIDS ) to endorse a comprehensive package of harm-reduction services for PWID. The coalition urged countries to prioritize the implementation of needle and syringe programs ( NSPs ) and opioid substitution therapy ( OST ), along with HIV counseling and testing ( HCT ) and antiretroviral therapy ( ART ). All of these recommendations have been scientifically shown to be effective. In Vietnam, these policy changes led to a sharp decline in HIV cases among PWID. But, in 2014, only 56 percent of countries that reported injecting drug use had some form of NSP and only 50 percent provided OST.

The stigmatization of drug users is a significant barrier for many HIV-prevention programs. As stated in the report, PWID who are HIV positive are often denied care by health-care providers who feel that they are unable to use ART effectively. In addition, drug users are often subject to arbitrary detention, unfair trials, torture, or other harassment. Said Lindsey, "Individuals [who] are injecting drugs … are not going to get access to those clean syringes to prevent the spread of HIV if they risk arrest or if they risk stigmatization or discrimination."

And this criminalization can even extend to health-care providers and service workers. In Kenya, health-care professionals often avoid areas where drugs are prevalent out of fear of being arrested. In Ukraine, outreach workers can be held liable for the residue found in a syringe. Lindsey said, "Countries that want to control drug use have to focus more on drug trade and drug trafficking within their borders. … We [also] have to retrain law enforcement to, instead of taking [drug users] to jail, take them to treatment or harm-reduction programs."

The issue of funding has also become an obstacle to PWID-specific prevention programs. Most often, the majority of funding for prevention programs comes from international donors rather than the national government. The U.S. President's Emergency Plan for AIDS Relief ( PEPFAR ) is the largest supplier of HIV services in the world. But the United States currently holds a Congressional ban on federal funding for needle and syringe programs.

To date, the Global Fund to Fight AIDS, Tuberculosis and Malaria has been the largest funder of harm-reduction services in the world. But the Global Fund's new model, which uses the gross domestic product to allocate funding, may not account for a country's existing public health infrastructure, wealth inequalities, or current political climate. Lindsey said, "If those societies, which are now newly developing societies, have not developed their infrastructure … they're not going to be able to do anything to take care of their population." In addition, several Global Fund grants expire in 2015 and 2016 and may not be renewed.

Another obstacle to effective HIV-prevention programming may be a lack of civil society representation. The five countries chosen for the brief differed in their level of community engagement for these programs. Said Lindsey, "The individuals that are empowered to demand the changes that are necessary … are civil society. They are individuals who are in those communities."

The United States also plays a role in the HIV epidemic, Lindsey added: "We have serious problems here at home. Even parts of Illinois have experienced recent outbreaks of opioid drug use. [The] U.S. needs to really play a leadership role in this. We have to change our laws and policies. If we're going to really resolve the drug epidemic around the world, it starts here at home.

The full report is available at www.amfAR.org/uploadedFiles/_amfARorg/Articles/On_The_Hill/2015/DC-PWID-Policy-Report_08-31-15v205.pdf .


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