One of the first videos we received at the Here I Am campaign was from a young man named Yevhen Selin who lives in the Ukraine (see below). Yevhen begins by telling us that his risk to contracting HIV infection increased because he injected drugs. Like many others who are at risk of contracting HIV or are living with HIV, people who inject drugs (PWID) too often face stigma and increased discrimination.
Yevhen's video is a story of hope: a story of a man who received treatment that has helped him find hope, love and a future. To help me and my readers understand a little more about the issues facing Yevhen, and why the Global Fund must continue to pay particular attention to this community, I invited Serge Votyagov of the Eurasian Harm Reduction Network to make a guest appearance here on my blog this week.
I asked Serge to tell us a little more about what thousands other people like Yevhen face, the role the Global Fund has played in addressing the HIV epidemic among people who inject drugs (PWID) and what the future looks like for PWID and the Global Fund.
Here are some of the highlights:
On why the Global Fund is important to the community of people who inject drugs (PWID):
HIV and PWID advocates in the region agree that the Global Fund's importance to PWID in the region cannot be overstated. In Eastern Europe and Central Asia (EECA) where national government are still either reluctant or outright resistant to investing in harm reduction programs, the Global Fund has played a unique and indispensable role in responding to the HIV epidemic among people who inject drugs. From 2002 to 2009, the Global Fund provided more than all other international sources combined ($263 million) for harm reduction in EECA.
Harm reduction programs that include needle-syringe exchange, opioid substitution therapy (OST) e.g. with methadone, and peer outreach and counselling are seen as critical to curbing the spread of HIV in this highly vulnerable population.
In EECA, frequent political opposition to harm reduction, along with laws that directly or indirectly criminalise people who inject drugs, makes it imperative to provide support for community strengthening, advocacy capacity, and work toward the inclusion and human rights of people who use drugs. In addition to providing funds for commodities such as clean needles and syringes, some Global Fund HIV/AIDS grants have provided funding for stigma reduction, community mobilization, strengthening civil society and policy advocacy and has helped to facilitate real dialogue on harm reduction within countries e.g. within Country Coordinating Mechanisms (CCMs).
On what specific actions the Global Fund has taken to ensure harm reduction is available to people who inject drugs and why that's important:
The Global Fund has enabled the steady expansion of harm reduction programs in the region. The Global Fund's direct involvement is a key reason that the number of needle-syringe programs increased steadily after 2002. In 2003, a total of 213 needle-syringe exchange programs reportedly existed across 25 EECA countries (1), and just seven years later there were more than eight times that number in Ukraine alone (2).
One of the most important actions the Global Fund has taken was during the last Round of proposals in 2010 (Round 10) when the Global Fund announced a dedicated funding reserve for most-at-risk populations including people who inject drugs ("MARPs reserve"), and a further $152 million was approved for PWID -- including $109 million (64 percent) for new grants in five EECA countries (3).
The Global Fund's beneficial influence has often been very clear: in several EECA countries (e.g. Belarus, Kazakhstan and Tajikistan), OST pilots were first introduced within the implementation of the HIV prevention programs supported by the Global Fund.
In a region where people who use drugs have traditionally been criminalized and excluded, the Global Fund has been seen as a key player in the push for their human rights and full inclusion.
On what the future holds for the Global Fund and the community of people who inject drugs:
Within the community of harm reductionists and people who inject drugs, many of us were optimistic up until Round 11 that the heightened emphasis on the human rights of marginalized, HIV-affected groups in the new 2012-2016 Global Fund Strategy will lead to an increase in support and, ideally, help overcome some of the resistance of national governments to harm reduction programming.
As the Global Fund seeks to replenish in 2013, the community of PWID and its advocates are naturally following developments quite closely. Eurasian Harm Reduction Network and Eurasian Network of People who Use Drugs organized regional drug user forums -- watch here --
in July and September 2012 to bring the voices of drug users to decision-makers so that the impact of decisions on their lives would be heard and considered in addressing their needs.
The following quote sums up the hopes and concerns of the community:
"Now, OST is available [in the Kyrgyz Republic]. Social and psychological help also is provided, but unfortunately due to lack of finances it is limited. There is methadone till 2015, but we don't know what will happen next. All OST clients are in fear. Nobody wants to go back to their past life [without these services]," said Irina from Kyrgyzstan, a country where HIV and drug dependence treatment is secured only until 2015, when the existing Global Fund program ends.
Citations:
(1) Aceijas C, Hickman M, Donogoe MC, Burrows D, Stuikyte R. Access and coverage of needle and syringe programmes (NSP) in Central and Eastern Europe and Central Asia. Addiction 2007; 102(8):1244-50.
(2) Ministry of Health of Ukraine, Ukraine harmonized AIDS response progress report. Reporting period: January 2010- December 2011", Kyiv - 2012.
(3) Bridge J, Hunter BM, Atun R, Lazarus A. Global Fund investments in harm reduction from 2002 to 2009. Int J Drug Policy 2012.
Note to readers: if you would like more information on the Eurasian Harm Reduction Network, the forums held recently and harm reduction as prevention generally please visit www.harm-reduction.org
Lucy Chesire: TB-HIV advocate from Kenya, Alternate Board Member of the Global Fund Board Communities Delegation
About the Here I Am campaign: The Here I Am campaign is a global call on world leaders to save millions of lives by supporting a fully funded Global Fund to Fight AIDS, Tuberculosis and Malaria. Here I Am brings the voices of people that are directly affected by AIDS, TB and malaria into dialogue about decisions that affect their lives and the lives of millions of others in their countries. Through video testimonies from all over the world, campaign ambassador advocacy, online actions and on-the-ground mobilizations, the Here I Am campaign is building collective power to end three of the world's most deadly diseases. www.hereiamcampaign.org