Preparing for PrEP (Part 2)

(Note: PrEP – see part 1 -is an experimental HIV prevention strategy that, if proven effective, would reduce the chance of HIV infection in HIV negative people, provided individuals take a single drug, (or combination) daily. Also discussed are i-PrEP, or intermittent PrEP, where someone takes the medication intermittently, and topical PrEP, known as Caprisa, a gel microbicide also undergoing trials, used vaginally to avoid infection from HIV.)

Glion at the Swiss riveria

The weather has been perfection here in Glion. The air is crisp and still and while the sun sweeps across the riveria from high above the mountains, the landscape splits and erupts with a forest that burns brightly with the reds, yellows and limes of autumn.

I’m writing this from the top of the mountains here, thinking about our discussions on PrEP over the last few days. It has been a fascinating discussion, if at times frustrating. I watched and listened as the divide between the sciences and the humanities fought to create to a bridge that would unite their ideas, only to, at times, be speaking in a different language, and exchanging ideas in alternate currencies. People want to see the drugs work, the HIV/AIDS world are immersed in prevention and treatment measures 24/7 and although some of the discourse seemed a world away from life on the street with HIV, a bridge was being built to bring thread the various strands of PrEP together.

The Missing Link

The big questions seemed to be around data – there just isn’t any yet. While the studies on animals have been promising, on humans – the data just isn’t in yet. The desire for everyone to try and find new and emerging solutions to the current HIV epidemic is clear – and it is behind the reason we are all here today. Looking at PrEP, i-PrEP, and Caprisa, -( a topical PrEP)– are the issues, and thoughts of how to manage the implentation of this when the data is out, is what the workshops here are based around.

Yet, from my perspective, I see all the people involved here at quite different stages of how to manage the next steps. There are still too many variables.

I can certainly see the importance of finding a drug that people in high risk

overlooking Montreux

environments can take that will prevent them from becoming infected with HIV. Yet even if the results are good, asking people – even if they are in high risk environments – to take a strong drug, every day for 2, 3, 4 or more years – so they ‘probably’ won’t get HIV, seems a long shot, especcially knowing just how hard it can be just to start taking HIV meds, let alone taking them every day!

The Contraceptive Debate

It is true to say however, that people do take contraception. Women do take the pill, and they did and do understand that they have to take it EVERY day for it to be effective, just as the PrEP regime expects. So there was a discussion about looking into how the pill was introduced, and there will be a deeper look into this when the time comes for implementation. However, I heard of a Dr who had researched the contraceptive pill for decades, and has now given up on the idea of a daily pill – that monthly or more injections are the only way forward as being an acceptable offering for women today. And perhaps she is right. How many of us miss a pill? How many pregnancies have occurred because of it?

We don’t currently know the data on intermittant PrEP, (an HIV pill that you would take intermittantly), and they are looking at injectable options for this as well. This could be the way forward, although it order to get there, we may have to traverse some rather rocky road.

Where could PrEP be useful?

view from the mountain above Glion

For me, and these are my thoughts, there seems to be the strongest case for PrEP in a few areas. It seems that currently, we need to match up a few areas for PrEP to be really useful. Combining factors like; 1) high risk environments 2) ability to adhere to drug regime (due to the need for further testing of PrEP and its ability to work), and 3) low ‘collateral damage’ – which basically means ensuring people won’t be abused or targeted, such as with hate crimes or violence for taking drugs which may be stigmatising.

If so, then perhaps the first is for women in high risk environments, such as parts of Africa and India where the rates of HIV are extremely high and, where the levels of sexual oppression of women is high. Where women may be unable to negotiate safer sex, yet may still have fairly stable routines around raising their families (their husbands may work away for weeks at a time and have sex outside the relationship). If novel ways are thought of to ensure PrEP reaches these women, (through health clinics, outreach etc) it could prevent HIV infection to women and then transmission to their infants if they became pregnant. NOTE: PrEP is not advocated at this stage for pregnant women, or adolesants.

It was unfortunate that I didn’t hear prisons mentioned, as I quietly thought this could be a good way to address the factors I mentioned beforehand. High risk environments (the rates of HCV and HIV in many prisons are truely awful), ability to adhere (you’d take them at the medication hatch as you would with any other medication), and low collateral damage. If, say, all prisoners were offered the opportunity to receive these meds, those exposed to IV drug use and sex could be protecting themselves effectively.

Of course, the 3rd group is serodiscordant couples – where one is HIV positive and the other is not. But perhaps PEP is of better use here? Taking the drug directly AFTER exposure – for the PEP limit of 4-6 weeks only. Now that’s fine as long as you know your partner is HIV positive. Some people don’t.

People Who Inject Drugs

Where does that leave people who inject drugs? Although to expect people who

meeting room in Victoria Hotel

are in very challenging, high risk environments already, to take a pill that needs routine – I know is difficult – but that certainly dosent mean they should be ruled out. In fact, in 2010, the 2nd PrEP trial to bring results will be a study of 2,400 Thai intravenous drug users – despite the fact that the there was some dispute about what the findings would be (so few were expected to sero convert – that studying PrEPs efficacy is expected to be hard.) It could be useful for our community, dispensed alongside methadone or syringes for example, but many of us may well prefer to have enough sterile syringes, or opiate replacement treatments first. Would some governments take monies away from these interventions to trial or introduce PrEP?

So where did that leave the discussions? I’ve just written a few thoughts of my own. To be honest, tracking the complex structures of scientists and researchers was difficult, and each time I felt I had something to say, something kept telling me to wait because there would be something else around the corner that would complicate things again! Often it did, other times someone would just say what I was thinking, so perhaps for the first time in a while, I was unusually quiet!

Drug Resistance?

Drug resistance was not an issue apparently, and it has been overestimated. And, because overall, rates of new HIV infections are estimated to decrease with PrEP, so will drug resistant strains of HIV decrease. Thus it is unlikely new resistant strains will increase, but it is likely, in the smaller group of new infections, there will be slight increase in drug resistant strains. If that makes sense! A 0.2% increase over 10 years using PrEP, versus 0.9% increase without using PrEP (-of drug-resistant strains).

Trying to summerise the complexities here is very hard. But I’ll try…

In Summery…

This is Montreux, on the Swiss Riviera

Poorly run programes are often worse than no programmes at all. People are going to die if they dont get HIV treatments, but they COULD die if they don’t get PrEP. Countries like South Africa are broke – they already have to pick from a ‘shopping list’ that gives them the ‘best bang for their buck’ so recently that has seen them take on male circumcision as a prevention measure (it increases your protection from HIV). Other countries are in the same boat. Can we afford for them to take from the treatment budget the already scarce resources for HIV positive people – to spend on negative ones?

Four statements emerged that best summed up the approach to implementing PrEP, if it proves to be effective in the next few years. We will need to:

Know your target audience – Know your epidemic.

Know your environment. Manage expectations.

Stay tuned to the emerging research over the next few years. I expect that PrEP will be implemented – if the data emerges to prove its efficacy – but on a very small scale in very targeted environments, at least until we find an injectable or intermittant variety. The lack of data, costs and complications of PrEP is currently hindering its future. We will, as they say, have to wait and see.

The papers we were given to read state: Because PrEP is unlikely to be 100% effective, it would not replace other proven prevention strategies and would likely be most cost effective when used in combination with current HIV prevention methods including safer sex practices, use of male and female condoms, treatment of STIs, clean needles, circumcision etc. PrEP would not replace any of these strategies but it could be a powerful tool in the fight against AIDS.

Thank you

Thanks to everyone who puts in their time and passion into treatments and prevention measures for HIV. Special thanks Afrah AlDoori for her coordination in getting us all there, and to Georgina Caswell, who was so utterly lovely and helpful, and Jorge Beloqui both brilliant and such marvelous dinner guests! I’m glad that INPUD was invited to take part in discussions about our futures, it seems we are turning a corner and I look forward to our involvement in the future. If PrEP is implemented, the drugs community will most certainly need to be there on the road ahead.

Au Revoir!

Erin O’Mara

Preparing for PrEP

Hi from Switzerland!

The journey to Switzerland to report for INPUD had been a tiring one. After presenting a session in Glasgow at the National Conference on Injecting Drug Use, it was straight back to London and out the door for a flight to Geneva airport. I had been asked by INPUD to attend a consultation staged by the World Health Organisation, to report on a topic I have to admit to being unfamiliar with – ‘PrEP’ – or Pre Exposure Prophylaxis.

My first thoughts were of the HIV vaccine. Many of us may remember hearing of the recent breakthrough in the HIV vaccine trials, news which appeared out of the blue after many years of research of seeming dead ends and disappointments. However, while I was in the right ball park thinking vaccines, this was a very diferent game. PrEP you could say was more like PEP’s (Post Exposure Prophylaxis) newest cousin.

Instead of PEP – and its use as the short sharp shock of HIV treatments (anti retrovirals) for, most commonly, health professionals exposed to the virus via occupational related incidents such as needle stick injuries etc, PrEP is about taking things much further.

It is an experimental HIV prevention strategy that, if proven, would use anti retrovirals (ARVs) to reduce the risk of HIV infection in HIV negative people. Could PrEP, through the ingestion of a single drug (or combination) taken daily, reduce the chance of HIV infection – in HIV negative people? If found to be effective, how would such a prevention approach be rolled out? And to whom? In combination with what other prevention measures? And would HIV negative people even adhere to such a potentially uncomfortable drug regime with no immediately tangible benefit? And what about drug resistance – could we be making a rod for our own backs?

One of the potential advantages of PrEP is that those who are unable to negotiate condom use with their sex partners, would still be able to reduce their risk of infection. People who inject drugs may still be able to protect themselves despite being in higher risk environments such as without access to sterile needles and syringes.

There is however, a worrying lack of data, although current trials are well underway. These are looking at a range of transmission routes in diverse populations such as; Serodiscordant couples (one postive, the other negative); hetrosexual men and women in high prevalence areas; people who inject drugs; gay men and other men who have sex with men.

Yet there is an optimism about PrEP. Despite the fears and concerns of diverting potentially scarce resources away from positive people to negative ones when we still have not achieved the UNAIDS goals of universal access by a long shot, over 20,000 people are currently in PrEP trials, and the data will be emerging over the next few years. If, as hoped the results prove as encouraging as some believe, substantial preparation is needed to effectively scale up and implement such an intervention. In order to avoid unnecessary delays, additional research questions must be asked, and priorities decided upon.

Setting The Stage –

Scientist Kevin O’Reilly (Prevention in the Health Sector) has picked a fairytale setting for the meeting. An hour and a half from Geneva itself, the tiny town of Glion is picture perfect. A rickety little tram ascended up the mountainside from Montreux, taking me to Glion’s only hotel, sitting like a magnificent wedding cake, lodged firmly into the mountainside and overlooking the Swiss Riviera. After being given the key to my room I don’t mind admitting I launched into a mini boogaloo, before throwing myself on the big double bed, my eyes bulging at the view from my very own balcony! So this is how the other half live! After coming from the grey envelope of London, this was nothing short of breathtaking.

But there was no way this was any sort of a holiday; the huge array of complex issues involved in the emerging PrEP discussion was phenomenal, as I realised reading up on the materials I had been sent, en route to Glion this week. And after the first day of discussions, it was proving a very complex task with a massive amount of variables, and very little data to base decisions on.

The Cast.

It was great to meet up with my INPUD colleague Jason Farrell, who had trekked over from Amsterdam and members will be pleased to know he was both reflective and vocal during the ensuing consultation, raising the issues that related to our using community with clarity and emotion. Mixing the personal with the practical is often what is missing at meetings where so much is about data and health systems, and it was one of Jasons personal experiences that brought a touch of reality back into discussions. Which is, after all, why we are here. To ensure the discussions and hopes for PrEP, encompass the reality of peoples lives, in particular, for Jason and myself representing INPUD in relation to people who inject drugs. We want to ensure any guidelines created by WHO on PrEP, take user issues into account, particularly since 2,400 thai people who inject drugs (PUDs) are due to emerge from a trial in 2010, and being a government endorsed programme it is possible any rolling out of PrEP, may continue there. By WHO and UNAIDS collaborating on this issue and bringing together civil society, trialists, academics, investors, researchers, statisticians, and scientists to who PrEP is pertinent, discussion will focus on the research needed to conduct and prepare for implentation of PrEP, and what issues will have the highest priority?

Alas, it is now late and I am about to turn out the light and snuggle up in the wedding cakes puffball of a bed, to blog again tomorrow on the rest of todays discussion as we move past setting the scene and towards hearing more from the cast, to thinking about the strands involved in the story ahead.

Til tomorrow night, Bon soir!

Erin O’Mara

INPUD Communicating Globally

Hi everyone,

Yesterday, INPUD communications team held a teleconference, enlisting the help of its worldwide communications team, and bringing together a range of expertise in campaigning, IT , the ever changing realm of the internet, as well as journalism and knowledge of the User Press, to forward to goals of INPUD.

The global INPUD Communications Team stands at:

>New York (Les) – Better World Advertising
>UK : (Mat, Erin & Rupert ) – Mat INPUD, Erin, Black Poppy UK, Rupert at RELEASE
>France (Pierre) – ASUD France
>Macedonia (Vito) – INPUD and Comms Team Leader
Netherlands (Denis) – World Aids Campaign
>Bangkok (Greg & Dean) – World Aids Campaign

An all round approach to communications means various things; branding – to ensure the name INPUD is instantly recognisable and that what it stands for is universally understood , the overarching message succinct and translatable. Campaigning is another branch to the Comms Team as after the success of The Drug Users Peace Initiative, there will be many more campaigns, protests, petitions and lobbying to tackle. Networking – using Blogging, Facebook, Twitter, campaigning will be essential in bringing new members to INPUD as will reporting on the various important issues and concerns that affect the Drugs community every day around the world. As of yesterday, we are certainly getting another step closer to these goals.

Les Pappas from Better World Advertising, a socially conscious advertising agency told us they are keen to share their campaigning expertise and resources. ‘Better World are committed to INPUD and looking for ways they can be a part of things’, he said. Designers of the artwork, website and collaborators on the media campaign for INPUD’s 2009 Vienna Drug Peace campaign, Les talked about how important marketing was as a whole for INPUD in order to put its messages across. It was clear for the team that the INPUD Logo also needed re-branding and BWA will now go ahead with this and put forward its ideas to the Comms Team for final a decision.

Rupert from Release, the Drugs Law and Human Rights Charity, will be looking at the technical side of things and told us that their Talking Drugs site would act as an ‘Incubator’ until a website is up and functioning. This would mean that the much needed E-Forums could now exist on the TD site, taking on the different memberships types and operating in up to 23 languages (10 languages are currently functioning well). Using one of the new models of website programmes called ‘Droople’, the Talking Drugs website will ‘incubate’ INPUD’s E-Forums until such time as an INPUD website is fully launched and the various strands pulled together onto one site.

Currently of course, there is the Google group that is operating as a discussion list for the board and membership, and the website that was a basis for the Vienna Drug Users Peace Initiative, and currently still holds the link to INPUD’s International Diaries blog, here on WordPress. Erin, who has been overseeing the blog, has been pleased with its progress. “It has been a really good way to let INPUD members and others see what INPUD has been doing around the world, and it has meant people feel a bit more involved in what’s going on”. Twitter is also being used in order to alert people to the latest blogs. However, an international calender of important events for INPUD was requested, and will be added to the Talking Drugs site temporarily, so Bloggers can keep abreast of what events people attend on behalf of INPUD and to write up their work and experiences during/after attending.

Mat talked about the funding for the expansion and development of INPUD communications as being looked at and he feels very hopeful that we will see some support forthcoming in this crucial area. Facebook is also another useful tool and Mat has been experimenting with this in his own area in the West Country of England, bringing together a wide range of people who use drugs for campaigning and networking. This will be monitored closely and could be yet another tool for INPUD’s networking.

It has been clear for some time that we need a fairly adaptable and powerful website / database programme to ensure INPUD online is able to cope with an international membership  and utilise the variety of cyber networking technologies. Developments are currently underway to ensure  we will soon have a varied and a fully functioning website – to be accessible in different languages but until then, we will be strengthening the different arms of INPUD, to finally be brought together in one place.

Interviews held with the media, gathering a list of quality and sympathetic journalists to the cause, letters to editors, writing up articles in the worlds User Press, and an online INPUD newsletter, will also be looked as issues to focus on in the foreseeable future.

Thanks to everyone in the Comms Team, please forward any ideas on comments below as we would love to hear what you think.

Erin O’Mara Black Poppy Magazine UK

Remembrance Day Diaries…

Germany

The white rose is a symbol used widely in Germany for IRD, although some towns vary this such as here in Bonn, where they use red roses.

Dirk Schaeffer from Deutsche AIDS-Hilfe writes about what happened in Germany to mark International Remembrance Day on July 21st this year. Germany has been doing events across the country to mark this day for many years now and has been an inspiration for many other countries to begin their own events to mark

Dirk from Dirk Schaeffer – Deutsche AIDS-Hilfe writes about what happened in Germany to mark International Remembrance Day on July 21st this year. Germany has been doing events across the country to mark this day for many years now and has been an inspiration for many other countries to begin their own events to mark International Remembrance Day each year.

“In Germany we are celebrating the 12^th International Remembrance Day. With events in 40 cities and with more than 100 organizations involved, we have had the highest attendance ever.

The day was founded by parents and other supporters who fight for more liberal drug policies, heroin prescribing, substitution treatment etc , although now, many user groups (JES) arrange events together with drug service and aids organisations.

The Remembrance Day has many “different faces” in Germany. The overall motto this year was “legalization – our goal”., but the participating cities and organizations are completely free whether they follow this motto or not.

The character of the Remembrance Day has changed over the years. It changed from a day of mourning into a day of political discussion and demonstrations, but of course, if you take a look at the pictures you´ll see that it is still about grieving for those who have died.

Just on July 21 2009, the new German law for the diamorphine prescribing comes into effect- so that was a very good opportunity for us to talk about the importance of this new treatment.

We’ve also got different stakeholders for the 21st July but it is important that we hold the remembrance day in our hands.

It is so important that the 21juli is arranged in many countries, Switzerland has also been celebrating this day.

For us in Germany the 21juli is the best chance to get in contact to the media, and the regional and German wide press to characterize our goals and our views for a human life with drugs- without criminalization and prohibition.

IRD in Frankfurt

IRD in Leipzig

IRD, Berlin

Amsterdam, Netherlands

- Jason Farrell

Greetings INPUD members:

I am happy to report that International Remembrance Day in Amsterdam was a huge success. We had about 80 people

The flyer for the Remembrance Day in Amsterdam this year

show up including press. It appears that International Remembrance Day has become a day to be honored again with pride and dignity in Amsterdam. What was most surprising was that the event received significant media attention; on TV news, radio and local newspapers.

The International Remembrance Day event was sponsored by MDHG, Amsterdam’s and I think the world’s oldest, user union, and Drugspastoraat, an NGO that provides funerals and spiritual support services including, counseling, referrals and emergency shelter for drug users.

Upon the event closing a few participants were interviewed including myself, the 2 directors of MDHG, and Nelly Versteeg from Drugspastoraat, who lead the group in spiritual remembrance. When interviewed they asked me how long has this day been honored in America, I said unfortunately never. ‘Didn’t you know that in America drug users are criminals, and it is unlikely that America will agree to have a nationally acknowledged day remembering people who died from drugs?’ Although in the US they do honor World AIDS Day, which has become more of a prevention / education day than a remembrance day for those who died from AIDS.

International Remembrance Day is acknowledged amongst a growing number of European countries, as well as Canada and Australia. The reporters added they were surprised that an American suggested this. However a colleague of mine from the UK, an INPUD member, brought this annual International Remembrance Day event to my attention. The International Network of People Who Use Drugs (INPUD) has encouraged as many user groups as possible participate in this important day of remembrance.

It was really nice for MDHG and Drugspastoraat to acknowledge International Remembrance Day by offering a service for drug users here in Amsterdam. The 3 hour event started with a walk from the MDHG office to the meeting space in the Red Light District known to many as the Crypt, a short service was then led by Nelly Versteeg, memories of deceased friends/family members and loved ones were shared by participants, and then drinks and sandwiches for everyone. It was sad to learn that this day was never honored here before, let alone to my knowledge never even discussed or conceptualized in the US.

This day showed the importance and the emotional value for people who had loved ones who died from drugs and/or AIDS to mourn and grieve. Although when speaking with people who attended today, many have said that they themselves, including their family members have tried to mourn and have been told to stuff their feelings, deal with it (tough love crap) or not pay attention to the death because it was disrespectful and brought shame to the family. Therefore many attending today were being misled into believing that disowning the person who died because it was related to drugs or AIDS is acceptable. Unfortunately the culture of today’s society sets a precedent that people, because they have died from drugs and/or AIDS, are worthless and expendable when in fact they are human beings, family members, brothers, sisters, mothers, fathers, friends, lovers, etc. They count and it hurts. This day allows us to feel the pain and mourn along with others on the same day throughout Europe. Next year we will do it again and I hope to read about all the new participating countries and cities experiences acknowledging International Remembrance Day.

Here’s to you Johnny and Joey, hey ho lets go

Be safe and stay healthy – Jason Farrell email Jason at: jason@hrcsny.com

Copenhagen – Denmark.

Written by Eliot Albert. Copenhagen, 21st July 2009

Flowers placed at the Memorial Stone, under the Remembrance Tree

Six years ago the Danish Drug Users’ Union (BrugerForeningen) established a memorial site at which to mark International Drug Users’ Remembrance Day: An inscribed stone and a tree on the corner of a small, triangular piece of grass, on a street parallel to Copenhagen’s main open drug scene.

I’ve attended all but one of these ceremonies and every year a new visual device is used to indicate the number of officially recorded ‘overdoses’ in Denmark in the preceding year. This year the grass was covered with rows of small white crosses, 275 of them. Each marking a sad, utterly gratuitous loss of life.

Sitting amidst the crosses before the ceremony trying to think of what to say I was struck by the sheer obscenity of the spectacle and what it represented. 275 victims of the utterly immoral, pointless, war on drugs. Each of these crosses didn’t represent a drug related death but a prohibition caused death – collateral damage.

I imagined the day sometime in the future when the International Court of

The white crosses, one for each drug related death.

Justice in The Hague will convene a session to try war criminals from the war on drugs which celebrates its grisly centenary this year (marking one hundred years since the 1909 Opium Convention in Shanghai). Antonio Maria da Costa will be denounced as a war criminal, Thaksin Shinawatra will be denounced as a war criminal, as will Richard Nixon, Ronald Reagan, George Bush I and II, and so many other nameless bureaucrats ‘just following orders’ whilst they destabilize states, drive peasants from their lands, pump countless billions into the hands of organized crime, all the time driving an epidemic of blood borne viruses.

Billions that could be used to provide clean needles to all those who need them, treatment to those who want it, and cheap, clean heroin, cocaine, and stimulants to those of us who want them. I tried to speak of these things but words failed me.

Vito Georgievski the Macedonian General Secretary of INPUD and Mikael Johanesson from the Swedish Drug Users’ Union each spoke of the plight of drug users in countries with particularly harsh drug control regimes and Jørgen, President of BrugerForeningen spoke of the imbecilic politicking surrounding the upcoming heroin trial in Denmark.

The people who came to remember in Copenhagen this year.

Johnny Cash’s great onslaught on prisons, ‘San Quentin’ was given a rousing rendition, and the day was wound up by a communal, and sometimes less than tuneful, singing of a song popular amongst the Danish Resistance (to the Nazis); its final verse is especially poignant and appropriate as we, out, proud, drug users continue our resistance to the war that is being waged upon us. The lyrics are:

Fight for all that you hold dear,

Fight to the death if necessary

Then neither life nor death will seem too hard.

(If you did something you would like to share on remembrance day, please do get in touch, comment below).

United Kingdom:

The poster utilised in the UK to raise awareness of the day, the dove theme is one that we hope may be picked up globally as a symbol for the day

Erin O’Mara

International Remembrance Day is held in many cities and countries around the world, and although the day only began in the UK one year ago, when it was hosted by Black Poppy, members from Lambeth Service User Council and GLADA Womens Voices, this year it has been picked up by numerous groups and services around the country. Black Poppy sent out via mass emailing, a basic DIY kit that contained 4 simple items; a poster that could be printed out and pinned up, a statement to print out that said what IRD was for and about, national statistics for informing press releases, and a small document that outlined ideas people could implement on the day – from lighting a candle at home, putting a remembrance book in a local drug service, to holding an event.

It seemed to be an excellent way to raise the profile of the day and many services and groups across the country took up the opportunity to pay respects and remember.

Birmingham drug/service users and local services held a range of commemorative events and activities to remember friends and colleagues who have passed away. Reception areas in clinics were redesigned, one clinic put up a symbolic branch, where people could hang their remembrance message on it. Another scattered black poppy seeds to pay tribute to those who died. Overdose prevention messages were employed, training other users to save lives. Birmingham’s service user and drug using community unveiled a plaque to remember loved ones and a one minute silence was held at midday by all staff within the Birmingham Drug & Alcohol Action Team, and by the treatment services across the city.

Across the country, lunches were held, memorial gardens produced, art was created, messages were written, wristbands produced in memory, events staged and candles were lit in loungerooms, churches and clinics. It has been wonderful to see it take off with such care and commitment across the UK, it is clear people need and want to remember. There is a need to give these often forgotten and hurried deaths, the proper time and dignity they each deserve, for one of us – for all of us.

Thanks to Black Poppy, Steve Freer and Si and Sue from Morph, who really pushed the day forward and did wonderful work in their regions.

Did you do something on remembrance day? Please let us know and we can post what your country did on our INPUD blog site.

International Remembrance Day 21st July,2009

21st July; Remembering the Fallen

The names and incidents of the many casualties of the War on Drugs will never really be known.

International Remembrance Day is dedicated to those people, known and unknown, who have died in the war against drugs and drug users. It is a time when the drug using community can remember and pay tribute to our friends and loved ones; for the funerals we couldn’t attend, for the deaths that no one acknowledged, for the moment we never got to say goodbye.

It is to remember those we know, and those we don’t – from our villages, towns and cities across the world. The vast majority of these deaths are not just deaths from drugs, but from the laws of prohibition and the pervasive ignorance and stigma that blindly follows.

July 21st is a Day to Remember.

Those who have died from unregulated, adulterated drugs as a result of today’s black market.

Those who have been criminalized or incarcerated because of their addiction only to overdose upon release;

Those who have died from drug related infections through poverty or discrimination in our hospitals;

To those who die in prisons from disease, violence and the many state sanctioned executions (such as Singapore, Burma and China), or from vigilante death squads like in Thailand and Brazil;

Those who have died from the viruses transmitted due to a Drug War mentality which actively discourages and even criminalizes needle exchange and drug treatment programs such as in the Sweden and Russia.

To those who defy the laws to obtain their medicine or drug of choice, who get caught in the crossfire of heavily armed drug raids or gang wars due to the profit motive of illegal drugs,

To those who give up hope or who gave up the struggle, to those who couldn’t fight anymore. To those who died in poverty, and alone.

July 21st is the day when all across the world,we will carry our torch of dignity and hope and remember our friends.

Scenarios for Global Drug Use

Scenarios for Global Drug Use & Policing Practices & HIV/AIDS in Eastern Europe/Central Asia.

Jason & Masia at Erin's In London after the meeting

Brief Update: So here we are in London, Masia and Jason have just joined me at my flat to update readers on the last couple of days their meeting. I was really mad that I couldn’t attend but came down with a shocking cold that came on me like a hurricane and that is only just starting to lift! Although you will get a fuller briefing from both Masia and Jason shortly, here is a very brief rundown on what the meeting was about.

Based on a 2 year project, these round table discussions were to examine and identify key factors that will affect the hiv epidemic in the next 25 years, how it relates to drug use and law enforcement issues, as well as what actions should be considered in order to overcome the anticipated problems.

The aim was to envision what universal access – to prevention, treatment, care and support – would mean for postive people who use drugs in 2031. This date is particularly meaningful because it will be 50 years since HIV was first reported – 2031 is supposed to be about not what we should be doing in 2031 – but what we should be doing differently now to change the face of the pandemic by 2031. It is response that involves a whole consortium of partners to create an Agenda for the Future, a document that will be launched late in 2009.

Interestingly, this meeting although quite small, involved a variety of experts from the world of policing, UNODC, UNAIDS, and other areas health, as well as positive people and users of drugs, and focused specifically on global drug use, the policing of groups and certain activities and how this relates to the HIV epidemic.

The workhorse

It was clear, Masia and Jason noted, that we can support INPUD to access and work with these roadmaps to 2031 as we are going to have to start to make law makers and legislators accountable to achieving these goals. Long term inpud can look to 2031 to tie in and support other things we are aiming to achieve such as UNAIDS directives regarding HIV and drug use, plus the UNODC and their drug treatment recommendations/research. It is one more way to find allies, share knowledge and insights, gain skills, lobby and achieve global policy change where its needed.

Jason and Masia leave London today. It was really great to see them. One of the best things about international networks is seeing each other after months or years, and being inspired all over again, and then there’s always the chance to party! But I’m Siiiick! You will hear their thoughts and comments on this, following this blog . If you want to know more about the campaign of 2031 click here www.aids2031.org

More updates soon, Erin.

Sex Workers and Junkies Networking in Porto

Mat Southwell gives us his impressions of CLAT 5, the Latin European Harm Reduction Conference. Here he talks to the sex workers and finds some fascinating views and more common ground.

Only Rights will Right the Wrongs -Sex Workers & Junkies Network in Porto

Coffee 'n' chat in Porto

When Erin and I were at the UNAIDS PCB we networked with other community organisations. Organisations of men who have sex with men and people living with HIV/AIDS have organisations which they own and control. However, the situation with sex workers is much less clear. Networks of sex workers include both professionals and sex workers. Sex workers don’t have strong organisations and this creates a climate within which professionals often speak ‘on behalf’ of sex workers.

I was therefore pleased to attend a session at the CLAT conference to hear Pye Jakobson from Rose Alliance in Stockholm speak from a sex workers organisation. Pye described her own journey into sex work and also presented the views of other sex workers who she had interviewed (see PowerPoint Presentation in file store). Her survey, in and of itself, challenged the view that it was impossible to capture the views of sex workers, which legitimises professionals speaking on their behalf.

I was very struck by the parallel struggles of our two communities. Like us, sex workers struggle to make their own unique voices heard above those of the professionals who seek to ‘represent’ them. The lack of self-determination among sex workers and the pattern of professionals speaking on their behalf, leaves sex workers feeling alienated from international advocacy processes. It makes me appreciate the hard fought for progress that we have made with our professional partners in the harm reduction movement.

Additionally, struggles for sex workers is to liberate themselves from the imposition of a victim identity. I was impressed by Pye’s ability to describe the human rights abuses faced by sex workers while still rejecting the victim identity. This is particularly challenging given the current debates around the ‘trafficking‘ of women to take part in the sex trade. This provides an avenue for professionals to assert that sex workers are really victims after all. Once again, I was saw parallels with our community’s experience. In the UK, we are facing problems with Vietnamese gangs bringing in child migrants to work as effective slaves in the houses that are converted into mini-cannabis growing centres. As an older cannabis smoker, I have the choice to source my cannabis from dealers who buy whole crops so they can control the production qualities. However, this is not a choice open to many cannabis users and we once again face the discomfort of buying drugs that fund organised crime and their inhumane practices. However, the ‘trafficking’ problem is created by prohibition in both cases even if the people who use drugs or sell sex are blamed or framed as victims.

Interestingly, sex workers also struggle with the sense of community. The term ‘sex work‘ covers prostitution, stripping, sex call centre workers, porn actors etc and the different groups have varying levels of comfort with the term sex worker. Many groups fear being viewed as prostitutes who are seen as the lowest class of sex workers. The parallels with the internal discourse between different groups of people who use drugs is clear.

I went out for dinner with Pye, an academic ally called Laura Agustin who has written a book looking as the ‘rescuing industry‘. Laura has some interesting and challenging views about the process of helping and rescuing. She asks professionals to reflect on what they get out of their role as ‘helpers’ and challenges the view that only the ‘helped’ gain from the rescuing industry.

Also with us were Satxa Rossello and Jordi Parramon from Plataforma Drogologica which is a coalition of drug users organisations in Barcelona. This includes ASUT, APDO, FAUDAS, AUPAM, and ASUT ORENSE. It was fascinating talking about the different ways our communities are perceived and our networks operate.

We all spent time discussing the challenges of promoting work between sex worker and drug user organisations. We both acknowledged the difficulties of taking up each others agendas because we already face enough stigma of our own. As such, issues for sex workers who use drugs can get missed and people affected by both issues can feel unclear whether they are welcome in either network.

In a great piece of synchronicity, Pye had been at the Swedish Drug User Union Conference (see earlier blogs from Erin) and the Rose Alliance has recently formed an alliance with Svenskabrukarforeningen. In fact, the last meeting that Pye had had in Stockholm was with Kikki from the Swedish Drug Users Union. This is clearly the beginning of a conversation between two marginalised communities fighting for our respective voices to be heard.

Mat Southwell

NOTE: If you would like to see a video of Pye talking about sex work in Sweden, click here

If you’d like to read more about Laura’s Agustin’s Book, Sex at the Margins: Migration, Labour Markets and the Rescue Industry, you’ll find it on Laura’s blog, which she writes as a lifelong migrant and sometime worker in both nongovernmental and academic projects about sex, travel and work. (click here).

The Latin European Harm Reduction Conference

What happened when INPUD and members got together in Portugal for CLAT 5; (the harm reduction conference for Latin countries of Europe)

CLAT is the harm reduction conference for the Latin countries in Europe. Given the historic, language and cultural

Fabrice Olivet (ASUD) Chairing session for CLAT 5

connections between the Latin European countries and Latin and South America, the conference also attracts participants from this region. This year the conference takes place in the beautiful port of Porto in Portugal, a town proud of its heritage as a produce of fine red wine and port. Portugal still had a dictator up until 1968, which makes the current system of democracy and progressive drug policy all the more impressive. The conference is held somewhat appropriately in an old Customs House, which has been beautifully restored. The CLAT Conference arose after Latin countries became frustrated with the inaccessibility of the Harm Reduction Conference to non-English speakers.

The Latin Flow

I had been warned that the CLAT conference was a chaotic event, however, I now realize that this is a very Anglo-Saxon perspective. To take part in CLAT you have to get into the Latin flow. Firstly, you have to understand that session start and finish times are only a very rough guides and speakers take allocated speaking slots pretty loosely. I chaired a session which started three quarters of an hour late so I asked speakers to stick to time, agreed an end time for the session, and then brought the session to close at this time. The conference organizer thanked me for chairing the session and noted my ‘interesting, Anglo-Saxon approach to chairing

The Latin Groove

The coffee room and display area is also an integral parts of the conference and CLAT recognizes and creates a space for the informal dialogue that is an important function of these types of specialist gatherings. In the coffee breaks, the Anglo-Saxons (Germans, Dutch and English) gather in slightly bemused groups acknowledging our initial discomfort with such a fluid approach to conferencing. One UK participant quipped that while Portugal is actually on the same time zone as the UK, the Portuguese people tend to operate on Spanish time (which is an hour later). However, as the event has gone one, we are slowly learning to chill out and get into the Latin groove. We now realize that the event is actually working very well and somehow we are getting to hear the right speakers and take part in right sessions even if they don’t always happen exactly when scheduled. It’s a good experience to come to this conference and to see the different way, different cultures do their work.

Vive la difference!

Mat Southwell Friday, 3 July 2009

A Seat at the Table with US AIDS Ambassador

Dear readers – this was another momentous moment for the PUDs history book. As previously mentioned, the new US HIV/AIDS ambassador was at UNAIDS, and Mat Southwell sat down to chat…here’s what happened.

Dr. Eric Goosby, CEO and Chief Medical Officer of Pangaea Global AIDS Foundation, takes a seat for his confirmation hearing before the Senate Foreign Relations Committee to be President Obama's Director of the Office of the Global AIDS Coordinator, on Capitol Hill on June 9, 2009 in Washington, DC. Goosby has been involved in the fight against HIV/AIDS for over 25 years, beginning with his treatment of petients at San Francisco General Hospital when AIDS first emerged. (Photo by Jonathan Ernst/Getty Images)

Meeting between Harm Reduction NGOs and the new US Delegation at UNAIDS PCB

In his inaugural speech to the UNAIDS PCB yesterday, Michel Sibide, the UNAIDS Executive Director, reminded us how even after Pandoras box was opened, and many miseries were inflicted on the world, there remained hope.

Along with many other marginalised populations, the drug using community has held its breath as first President Obama stood for office and was then elected as the first black President of the United States of America. I remember getting up at 7 am to hear the results and finding myself in tears filled with hope that a country that had opposed harm reduction was changing.

The Commission on Narcotic Drugs (CND) was a coming of age event for INPUD. We showed the depth of expertise in our community as 30 people who use drugs from around the world came together to call for a peace in the War on Drugs. However, the US Delegation at CND didn’t become overnight champions for harm reduction and we wondered whether this was just the unavoidable confusion that comes with the changing of the guard or whether our hopes had been overinflated.

During his speech, Michel notified the meeting that the new US administration had worked hard to ensure that the new US AIDS Ambassador, Dr Goosby, would be in post in time to take part in the meeting. When Dr Goosby subsequently arrived, the welcoming applause highlighted the sense of expectation that exists more broadly in the AIDS community.

Over lunch I was invited to attend a meeting that had been arranged with Dr Goosby and his team by Allan Clear from the US Harm Reduction Coalition. Vitaly Djuma from the Russian Harm Reduction Alliance and few other NGO representatives were also present. We met with the full US team including representatives from PEPFAR and other parts of the Department of State.

The meeting was wide ranging covering the US approach to harm reduction generally and in particular Dr Goosby recognition of needle exchange and opiate substitution therapies as science-based HIV prevention interventions. We discussed the US’s historic concerns surrounding the use of the term harm reduction and the misperception that it is equivalent to legalisation. Dr Goosby identified the limits of the US position; clarifying that the US did not support heroin prescribing or consumption rooms.

We talked about the limitations placed on compliance with ARV treatments when OST are not present.

We further discussed the need to include the voices of people who use drugs in the discussion of policy and practice. Dr Goosby acknowledged the importance of engaging people who use drugs in order to inform and guide the implementation and review of interventions with our community.

After the official meeting, we had an informal discussion with members of the US delegation. This included a frank conversation about the role of drug user organisations. While the US accept the need to engage people who use drugs, they have been more hesitant about engaging drug user organisations. The perception for some is that we are hard core legalisers who don’t reflect the wider diversity within our community. I clarified that we had been working very hard to reflect the pluralism within our community. I stated my own position as a legaliser and acknowledged that these views are held by many of our community. However, I highlighted that our movement includes people who inject drugs, drug treatment advocates and ex-drug users.

I highlighted the important role that people who use drugs can play in championing the cause of HIV prevention and harm reduction services. I particularly highlighted the challenges faced by people who use drugs living in the USA who do not receive financial support to engage in international advocacy because they are from the leading developed world country. I stressed that people who use in drugs in the US often live in marginalised situations that can be equivalent to situations faced by some in the developing world.

We concluded by agreeing to establish a communication channel between the harm reduction movement and the US delegation when problems or points of difference arise. This won’t limit our ability to speak out publicly in the interests of our community but it reflects the normal diplomatic practice that exists between NGOs and progressive countries.

It is important to understand that this is the beginning of a conversation. We need to be realistic that we will continue to have points of difference with the US. However, we do have clear areas where we share common interests and have common concerns. The major change is that the US are willing to talk to different stakeholders even where differences exist. I confirmed our ability to work with partners on areas of shared interests while respecting areas of difference. This is the beginning of a journey with a significant international partner. We need to continue demonstrating our ability to operate as a constructive, reflective and informed partner in international affairs.

Hope continues even if it is tempered by an awareness of how far the international community has to go to meaningfully engage our community and to address the impact of the AIDS and Hepatitis C pandemics within our community.

Mat Southwell

The Incredible Journey (Day 4 of PCB)

Hi Everyone,

The room where decisions are adopted

Back in smokey old London now, but wanted to update you with the happenings on the final, amazing day at the UNAIDS PCB in Geneva. Very recent blogs will give you the brief version on what the PCB does, and some of the issues that were raised over the few days the board meeting was convening.

Mat and I, as I mentioned, were there to input into an excellent document that a series of NGOs had put together, on HIV Prevention amongst Injecting Drug Users. (The paper is attached in the file box). Out of the document, which is an excellent read and a very useful resource for the drugs field, there had been a series of 8 recommendations brought to the fore that the NGO delegation were extremely keen to get passed by the member states – and so become a UNAIDS policy document.

The process itself was very interesting and I promised myself I would try and relay it to you as best as I could so here goes…How the UNAIDS comes to its decisions.

Much of the UN works in very similar ways apparently, except of course the UNODC which has no direct input or involved representation from NGOs and is much less transparent.

The HIV Prevention amongst IDUs report…

Firstly, the NGO delegations had produced a report to assist countries to scale up HIV prevention among IDUs – in line with the decisions of the PCB in its previous Policy Position Paper on Intensifying HIV prevention (another useful paper to refer from for all our work).

By utilising the global communications structures we have at our disposal in 2009, a concise, well researched report was compiled, though INPUD was brought in at a fairly late stage due to, primarily, the fairly recent collaboration and the partnerships being formed with the international HIV community. This is most welcome and certainly reflective of a wider recognition of INPUD and its affiliated groups and networks. But I would like to stress that when we were brought in, we felt fully involved in the work and believe this will only develop and strengthen ties with the global HIV community.

The world drug report just released

Anyway, before the paper was read out, Christian Kroll from the UNODC set the scene for the discussion by talking about some of the realities on the ground from the new World Drugs Report. He recognised many HIV positive drug users and women are going underground in Central Asia and Eastern Europe because of the intense stigma associated with drug use and pointed out the emerging injecting crisis in countries such as Tanzania and Kenya. He also stated that coverage of services are less than 5% in some places and there is still a lack of political will regarding Opiate Substitution Treatments/therapies (OSTs) and mentioned with concern the fact that he only just saw a letter that Uzbekistan who said OST is not effective! He also mentioned the need for better warning systems for emerging problems and stressed the need to focus also on drugs other than injected ones pointing to the massive stimulant problem China currently faces. See the UNODC’s policy papers in relation to HIV.

After Christian from the UN’s Office Of Drugs and Crime (UNODC) reported, round it went for all the member states to report their thoughts. As mentioned before, due to the huge number of affiliated member states, only 22 are ‘speakers’ yet they speak on behalf of a cluster of countries, usually 3 or 4.

Key messages from member states were:

Japan:

We had been tipped that Japan was going to be awkward, indeed its no secret as to the views they hold. The Japanese representative agreed that harm reduction came from the public health point of view and accepted it has been used in several key UN documents. But, in implementing harm reduction, Japan felt that countries should take in to account each country’s rates of HIV, the risk of promoting drug use from syringe and needle exchange programmes in case it encourages people to use drugs (!!) and that “because we have a very low rate of people using drugs…we also think that OST isnt always useful and can be harmful.” It regretted that Japan could not support the recommendations in this paper. Basically, they believed that they shouldn’t be made to toe the line because they have cultural and national differences that make harm reduction something they shouldn’t have to adhere too. See the final paper for the additional language Japan insisted on inserting.

Russia:

Another potential probelm, however Russia was rather coded in its language. The Gov Rep said “What we see happeing in our county is a clash between the moralists and the medicalists (sic) – they are talking past each other and not listening to each other…unless we get some agreements we wont be able to address these problems”. (Now you would think Russia might be coming on board with the paper here but, the gov rep continued)… “Therefore I fully support what Japan says that we need to take into account the particular nuances of every country”!

United Kingdom:

I must mention here that the UK were excellent on the floor and in supporting the statements and work of the NGO’s. Thank you Alison. “We have known for some years how to effectively prevent the spread the of HIV and serious health problems, harm reduction is indisputable, but it m dosent’t matter how much we know about the evidence or the laws – we need to address the stigma and discrimination. As long as they are stigmatized and criminalized in many countries they will continue to face many difficulties and this gets in the way of initiatives being rolled out. The World Drug Report out today leaves some worrying gaps about where drug use lies and its trends and unless we have better data we will not be equipped to plan. We need to look at what we have data wise and improve that data.”

USA
Now this was certainly awaited for. Dr Eric Goosby had apparently rushed in from the states

Work stations please...!

before he had even been sworn in (although some said he hurried through this procedure especially so he could be here for the PCB).
The US said they viewed needle exchange as a conduit to reach a difficult to reach community and it has been shown that it is possible to bring these people back not just into a medical frame “but to re-imbrace the person as a patient who has a disease that is treatable and that the history of addiction is full of recidivism” (oh dear!) He thinks the UNODC document and the difficulty around the term harm reduction has confounded the discussion. The US asked for explicitly defining the services that come under harm reduction as people think it means legalisation. (This is interesting readers because in a sense it could open up a can of worms, for example if drug consumption rooms come under the ‘defined’ term of harm reduction, would that mean the US would NOT then support the term? Scary – it could mean going backwards or forcing the HR lobby to exclude certain things from definitions of HR).

Finally, Ill wrap up here, as blogs are supposed to be short and I have a bit left to tell you regarding the final recommendations adopted. But let me say a few short quotes from member states:

France: When the care is given to users in must be comprehensive, they often suffer from other ailments. They said they support recommendations 8 and 9 from the NGOs very strongly.
Denmark; Supports the term harm reduction very strongly; reiterated the use of alcohol and it’s role in increasing HIV infections from unprotected sex, violence etc. (the first time I have heard it stated so far). The term harm reduction must be widely used and acknowledged.
Brazil: This Gov Rep was fabulous. Stating that she remembered a time when IDUs and harm reduction was not mentioned at all. It was approved in 2005 but it was not easily approved. She said crack use was by far the fastest growing group of drug users in her country and also asked Decision point 8.5 made even stronger.

So, the comments were passed from the member states, having had the chance to read the report and then although Vitaly Djuma spoke as our IDU representative after Russia spoke, (and he must be commended all his hard work, nice one Vitaly, huge thanks from all of us!) I have put his recommendations here however for the sake of clarity.

Vitaly, having around 3 minutes to speak, (his speech is in the box file) noted and spoke of the report that was brought before the PCB, and put forward the 8 final recommendations with a few additonal tweaks that had gone on over the last few weeks and days.

Basically, due to the need for TOTAL CONSENSUS in UN policy, and because of the comments made by, in particular Japan, the US and Russia, it was suggested by the chief exec Sibide that the reports recommendations should go to the drafting room over lunch and any countries who wanted changes should be there to hammer it out.

The Drafting Room…

So off we all went, a dozen or so countries and ourselves (observers are are not permitted to speak, only our NGO reps, but we can whisper to the NGO reps!), to hammer out some of the wording.

In order to keep this brief, I’ll mention two of the main changes. Japan wasn’t happy with the fact that they should have to toe the line with initiatives/directives that stem from words like harm reduction etc, when they reckon they have very little illicit drug use or HIV infection. Therefore, they INSISTED on the wording…. “in accordance with relevant national circumstances”. Basically, a bit of a get out clause but Japan just WOULD NOT shift on the matter and it was either that, or potentially watch a series of things collapse – for discussion at a later date. See points 8.9, 8.4, and 8.1 for their inserts. It really is interesting, the power of a word, if not rather excruciating and annoying.

The recommendations were, after additional tweaking, comment, and drafting were;

Agenda item 3: HIV prevention among injecting drug users

Decision Points:

8.1 Requests the UNAIDS Secretariat and the Cosponsors, in particular UNODC, to significantly expand and strengthen the work with national governments to address the uneven and relatively low coverage of services among injecting drug users and to develop comprehensive models of appropriate service delivery for injecting drug users in line with relevant national circumstances and the UNAIDS/UNODC/WHO “Technical Guide for countries to set targets for Universal Access to HIV prevention, treatment and care for injecting drug users”; (in red text – Japans addition)

8.2 Recognizing that resources should be expanded for service delivery and capacity development to enable communities to provide prevention, care and support services to drug users living with HIV on a larger scale whilst, at the same time, tackling the issue of stigmatization and discrimination requests UNAIDS and its stakeholders to work with multilateral donors, and national governments, to facilitate greater resource mobilization on this issue, consistent with the level of identified need; (Japan (and I think Russia) inserted that bit.)

8.3 Requests UNAIDS to intensify its assistance to, and work with, all groups of civil society, including those affected by drug use and those that provide services to people who use drugs, aimed at advocating for anti-stigmatizing, anti- discriminating, and evidence-based approaches to HIV and Hepatitis C Virus(HCV) epidemics at national, regional and global levels;
The text in italics was a statement insisted upon by the US. Previously, the text had read ‘…intensify its assistance to, and work with, civil society including global, regional and national harm reduction associations, and associations of people who use drugs.It seemed that asking the US to openly agree to working with associations of people who use drugs was just a step to far. However, after much discussion in the drafting room, which was a fascinating process in itself, the final statement above was decided upon to everyone agreement, including ours. It really is often a case of compromise or get it thrown out all together.

8.4 Calls upon Member States to further harmonize national laws governing HIV and drug use, in accordance with relevant national circumstances both from a public health and a human rights perspective;

Previously this had read… “…harmonise laws governing HIV and drug use including the removal of legal barriers for possession of drug related paraphrenalia.” Sadly, Japan insisted on ‘relevant national circumstances’ appearing here as well.

8.5 Requests the UNAIDS Secretariat and the Cosponsors, in particular UNODC, to support national authorities to align policies, clarify roles and responsibilities of various national entities – including drug control, the penitentiary system, public health and civil society – and support increased capacity and resources for provision of a comprehensive package of services for injecting drug users including harm reduction programmes in relation to HIV as enumerated in the UNAIDS/UNODC/WHO “Technical Guide for countries to set targets for Universal Access to HIV prevention, treatment and care for injecting drug users”;

8.6 Calls upon UNAIDS, Member States and civil society organizations, in addition to specific interventions that target injecting drug users, to develop and implement guidance and programme models to respond to the needs of other sub-groups of drug users, including female drug users, drug users who also exchange sex for money or drugs, drug users who end up in prison settings, underage and young drug users, migrant drug users, drug users amongst refugees and other displaced populations, stimulant and poly-drug users and men who have sex with men who use drugs, spouses and partners of people who use drugs, as well as interventions that target broader health needs of people who use drugs;

8.7 Calls upon Member States, civil society organizations and UNAIDS to increase attention to certain groups of non-injecting drug users, especially those who use crack cocaine and amphetamine type stimulants, and those who abuse alcohol, and their link to increased risk of contracting HIV through high-risk sexual practices, as well as to responses to emerging epidemics of injecting drug use in many African countries;

8.8 Recognizing that existing data on HIV and drug use are far from adequate in both quality and quantity, requests UNAIDS to support greater investment in data collection required to inform the development of HIV prevention, treatment, care and support initiatives, resource allocation and comprehensive service delivery, including a system of regular and rapid assessments of the risk potential for new epidemics where anecdotal evidence indicates an emerging problem, and calls upon Member States to ensure accurate estimates are made of the size of IDU populations, while taking into consideration the shifting patterns of injection;

8.9 Encourages governments to reaffirm commitment to, and intensify harm reduction efforts in relation to HIV as enumerated in the UNAIDS/UNODC/WHO “Technical Guide for countries to set targets for Universal Access to HIV prevention, treatment and care for injecting drug users”; including needle and syringe programmes and opioid substitution programmes, essential for reaching universal access to comprehensive HIV prevention, care, treatment and support for people who use drugs in accordance with relevant national circumstances; (Japan again!)

8.10 Requests the UNAIDS Secretariat and WHO to support countries in the implementation and improved surveillance of hepatitis B and C including co-infection with HIV in all countries, and to develop the necessary guidelines for Member States to elaborate policies, strategies and other tools to prevent and control hepatitis co-infection in people living with HIV;

8.11 Recognizing that stimulant drug use is a rapidly growing health problem, requests UNAIDS to strengthen its work on HIV and stimulant drugs;

So there we have it readers. The final text is in the file box on the right (while the box isnt working files will be attached as links in the articles), do visit the UNAIDS website for further information. I haven’t even touched on the great success had by women around the issues of HIV and gender, which included sex work, perhaps Ill try and get a neat summery of what happened for you. Suffice to say, I would like to stress a big thank you to Kate Thompson, Greg Grey, Natalie Siniora, Sara Simon, Alan Brotherton and Alan Clear, Vitaly Djumas, Alison, and all the NGO reps and observers that put in so much work to support the harm reduction cause.

See chief Exec Michele Sibide’s opening speech here.

See Chief Exec Michele Sidibe’s closing speech here on video

written by Erin O’Mara