Harm reduction is easy: Put your money where your mouth is
By, Pascal Tanguay, HDN, January, 2008
"Aren’t you ashamed of yourselves?" demanded a European couple stumbling on the opening ceremony festivities here in Goa. "You should be, enjoying parties and conferences that cost millions, while people living with HIV can’t even afford to buy their medication!”
“We pay our taxes and when we get home we are going to contact our member of parliament.”
While many probably share their views about the costs of HIV-related conferences in general, the tirade points to a deep-seated misconception: that taxes in rich nations provide for high quality and comprehensive HIV prevention, care, treatment and support for people living with HIV (PLHIV) throughout the world. The fact is, they don't.
Sources of support for HIV work get even more muddy in relation to the needs of marginalized populations, such as drug users. Injection drug use is driving the HIV epidemic in Asia, and while harm reduction approaches have proven effective at reducing the spread and impact of the epidemic among injecting drug users (IDUs), progress in addressing IDU's needs and priorities moves at glacial pace.
According to Swarup Sakar, senior regional HIV adviser to the Asian Development Bank, only about one-fifth of the resources needed to achieve the agreed target of 80% at-risk population coverage by 2010 has been made available. That means something in the order of 100 million USD is needed every year in the Asia region alone for the so-called 'universal access' targets to be reached.
A similar scale of funding requirements was echoed by the UNAIDS regional chief, JVR Prasada Rao, who told the meeting that over 200 million USD per year is needed for harm reduction approaches to be effectively deployed on a global scale.
In 2006, less than half of that amount found its way into harm reduction programmes across the world – about 0.5% of the total resources invested in curbing the HIV epidemic. That lack of investment translates directly into the sobering figures being repeated in just about every session here in Goa: Outside of Africa, about 30% of new HIV infections are found among drug users; an estimated 18% of drug users have access to harm reduction services (2005 data); and less than 5% of injecting drug users have access to comprehensive HIV prevention, treatment, care and support services.
It is a case of 'one step forward, two steps back' with harm reduction in Asia, where service coverage is even lower than global averages, and falling: from 5.4% in 2003 to an estimated 3% in 2005. This is while across the region, between 30 and 50% new HIV infections are found among IDU communities and in some countries that rises as high as up to nearly 90%.
Although resources to address HIV have been significantly increasing overall, there is a mis-match between where resources are being spent and where they are needed. In Asia, the epidemic is continuing to accelerate and even in countries where the epidemic is showing signs of slowing or leveling off, HIV levels remain high among IDU communities.
Stigma, discrimination and criminalization of drug use contribute to the overall lack of action and practical thinking of governments and high level officials when it comes to drugs and associated issues. The common approach to drug use and drug users is from the public safety perspective instead of health and human rights. Even funds that are destined for harm reduction services may be diverted to other programmes that are deemed more socially desirable and deserving.
There are also specific donor restrictions in place that limit the flexibility of non-governmental organizations (NGOs) and community based organizations (CBOs) in providing effective services to IDUs. "Multilateral agencies have operational costs that constitute 20-30% of their budgets," said Shiba Phurailatpam, regional coordinator of the Asia Pacific Network of People Living with HIV (APN+). "Yet civil society organizations are told to cut their organizational costs below 10% and service delivery suffers as a result."
Although guidelines for effective harm reduction includes a 10% budget allocation for creating 'enabling environments', this investment is usually neglected. NGOs are often prevented from using donor funds to advocate for policy change and the creation of enabling environments for drug users.
The bottom line is that sustainable harm reduction needs political buy-in and commitment, and yet few Asian governments have committed to harm reduction policies and programmes. In fact, most have active legislation that criminalizes harm reduction activities as well as drug use. Where those commitments have been made, drug users are often not involved in the design, deployment and evaluation of such programmes in order to make sure they are appropriate. Further, high-level political commitment rarely translates into implementation at the provincial or community levels. As most of the harm reduction funding comes from external sources, governments do not have the incentive for genuine commitment.
Despite the challenges, there are champions for harm reduction in the Asia region. Launched in July 2007, the HIV/AIDS Regional Project (HAARP) spreads its eight-year budget (56 million Australian dollars) fairly thinly over six countries. But HAARP promotes harm reduction as a key approach to respond to HIV in Asia. It is mainly funded by the Australian government (AusAID) with contributions from the Netherlands government (for Vietnam-based activities). These two donor countries are field leaders in progressive policy-making founded on evidence; as opposed to stigma, discrimination and marginalization of drug users. The HAARP programme draws on comprehensive reviews of current evidence, and is being developed in consultation with civil society including drug users, as well as governments in programme countries.
According to Bijaya Pandey, a drug user activist based in Nepal, "HAARP's donors are putting their money where their mouth is."
Source: http://www.healthdev.net/site/post.php?s=1233
"Aren’t you ashamed of yourselves?" demanded a European couple stumbling on the opening ceremony festivities here in Goa. "You should be, enjoying parties and conferences that cost millions, while people living with HIV can’t even afford to buy their medication!”
“We pay our taxes and when we get home we are going to contact our member of parliament.”
While many probably share their views about the costs of HIV-related conferences in general, the tirade points to a deep-seated misconception: that taxes in rich nations provide for high quality and comprehensive HIV prevention, care, treatment and support for people living with HIV (PLHIV) throughout the world. The fact is, they don't.
Sources of support for HIV work get even more muddy in relation to the needs of marginalized populations, such as drug users. Injection drug use is driving the HIV epidemic in Asia, and while harm reduction approaches have proven effective at reducing the spread and impact of the epidemic among injecting drug users (IDUs), progress in addressing IDU's needs and priorities moves at glacial pace.
According to Swarup Sakar, senior regional HIV adviser to the Asian Development Bank, only about one-fifth of the resources needed to achieve the agreed target of 80% at-risk population coverage by 2010 has been made available. That means something in the order of 100 million USD is needed every year in the Asia region alone for the so-called 'universal access' targets to be reached.
A similar scale of funding requirements was echoed by the UNAIDS regional chief, JVR Prasada Rao, who told the meeting that over 200 million USD per year is needed for harm reduction approaches to be effectively deployed on a global scale.
In 2006, less than half of that amount found its way into harm reduction programmes across the world – about 0.5% of the total resources invested in curbing the HIV epidemic. That lack of investment translates directly into the sobering figures being repeated in just about every session here in Goa: Outside of Africa, about 30% of new HIV infections are found among drug users; an estimated 18% of drug users have access to harm reduction services (2005 data); and less than 5% of injecting drug users have access to comprehensive HIV prevention, treatment, care and support services.
It is a case of 'one step forward, two steps back' with harm reduction in Asia, where service coverage is even lower than global averages, and falling: from 5.4% in 2003 to an estimated 3% in 2005. This is while across the region, between 30 and 50% new HIV infections are found among IDU communities and in some countries that rises as high as up to nearly 90%.
Although resources to address HIV have been significantly increasing overall, there is a mis-match between where resources are being spent and where they are needed. In Asia, the epidemic is continuing to accelerate and even in countries where the epidemic is showing signs of slowing or leveling off, HIV levels remain high among IDU communities.
Stigma, discrimination and criminalization of drug use contribute to the overall lack of action and practical thinking of governments and high level officials when it comes to drugs and associated issues. The common approach to drug use and drug users is from the public safety perspective instead of health and human rights. Even funds that are destined for harm reduction services may be diverted to other programmes that are deemed more socially desirable and deserving.
There are also specific donor restrictions in place that limit the flexibility of non-governmental organizations (NGOs) and community based organizations (CBOs) in providing effective services to IDUs. "Multilateral agencies have operational costs that constitute 20-30% of their budgets," said Shiba Phurailatpam, regional coordinator of the Asia Pacific Network of People Living with HIV (APN+). "Yet civil society organizations are told to cut their organizational costs below 10% and service delivery suffers as a result."
Although guidelines for effective harm reduction includes a 10% budget allocation for creating 'enabling environments', this investment is usually neglected. NGOs are often prevented from using donor funds to advocate for policy change and the creation of enabling environments for drug users.
The bottom line is that sustainable harm reduction needs political buy-in and commitment, and yet few Asian governments have committed to harm reduction policies and programmes. In fact, most have active legislation that criminalizes harm reduction activities as well as drug use. Where those commitments have been made, drug users are often not involved in the design, deployment and evaluation of such programmes in order to make sure they are appropriate. Further, high-level political commitment rarely translates into implementation at the provincial or community levels. As most of the harm reduction funding comes from external sources, governments do not have the incentive for genuine commitment.
Despite the challenges, there are champions for harm reduction in the Asia region. Launched in July 2007, the HIV/AIDS Regional Project (HAARP) spreads its eight-year budget (56 million Australian dollars) fairly thinly over six countries. But HAARP promotes harm reduction as a key approach to respond to HIV in Asia. It is mainly funded by the Australian government (AusAID) with contributions from the Netherlands government (for Vietnam-based activities). These two donor countries are field leaders in progressive policy-making founded on evidence; as opposed to stigma, discrimination and marginalization of drug users. The HAARP programme draws on comprehensive reviews of current evidence, and is being developed in consultation with civil society including drug users, as well as governments in programme countries.
According to Bijaya Pandey, a drug user activist based in Nepal, "HAARP's donors are putting their money where their mouth is."
Source: http://www.healthdev.net/site/post.php?s=1233
posted by AIDS-Care-Watch at 10:20 am
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