Norwegian Ambassador HE Kjersti E Andersen: By 2030, the aim is to have sterile injection sets for all people. It is important that needle and syringe programs are included in broader harm reduction programmes. The 2003 WHO guidance on harm reduction highlights opioid substitution therapy, overdose prevention, and management and needle syringe programs. There is very strong evidence for us to make recommendations for these programs; systematic review shows that high coverage in low level of support areas can reduce intervention by 90%. There have also been studies demonstrating the success of harm reduction measures; with a 5-fold increase between 2012 – 2017. The high impact interventions baseline recommendations set out by WHO in 2015 has not been met. The progress made in achieving safer use of injecting equipment has also not been met; there needs to be a 10-fold increase in coverage for us to be able to achieve these targets. The majority of countries still fall within very low coverage and a lot of countries do not even have the basic of NSP and OST programs. There is now a cure for hepatitis C and we are still a long was off from achieving the coverage that we really need, and the coverage of treatment is even poorer amongst the prison population. In reality, the treatment for hepatitis c is affordable and we can see with the introduction of generic medicine the cost is even lower. Some countries have reported that the hepatitis C treatment is available from $35.00 per cure. Harm reduction measures need to be upscaled; everyone diagnosed with hepatitis c should be treated irrespective of their disease status. We need to recognise that these interventions can only be delivered if there are structural interventions in law and in policy and there is support from the community. The WHO strategy is to ensure that no one is left behind, including people who use drugs.
Monica Beg, Chief, UNODC HIV/AIDS Section: Globally, there are 11 million people who inject drugs and 30 million people who are held in prisons annually. 1.3 million are living with HIV. A recent study showed that with high coverage of hepatitis c treatment there is a significant reduction that can come below 10%. NSP program coverage is too low to have an impact on the HIV and hepatitis C epidemic. In prisons, only 52 countries have an OST site. The UNODC global program is helping countries to develop and disseminate normative guidance; we are helping countries to review, adapt and implement legislation; we are building the capacity of our counterparts – including community organisations and civil society. In Myanmar, we have supported the revision and amendment of the 1993 drug law to a public health approach. In 2018, in 10 high priority countries, we trained service providers with the help of community organisations. We have also trained service providers on reacting to women who use drugs. In Kenya, to narrow the gap in HIV and hepatitis services in the community and in prisons we have helped the government to provide 4000 clients with OST. We are about to start a pilot OST site in Mombasa. In Vietnam, we have scaled up the current project. With further support, we can enhance these programs a lot more amongst people in prison and people with hepatitis c and HIV. Focusing on priority populations and locations we must understand that these interventions are value for money, so we need to intervene now.
Ronny Bjørnestad, from proLAR Nett: Hepatitis C is a highly potent virus that needs to be addressed. It is creating more sickness and problems. We need to act strongly. More and more countries need to have better access to treatment. National strategies are needed and people who use drugs need to be involved in these strategies. 5 years ago, there was a lack of general information and knowledge and prevention was at a low level. There is still a need for better prevention tools, but the situation is getting better. We have begun disseminating flyers to our group; our latest project is a hepatitis C bus. People who use drugs have to be involved. We have to understand that they are the key players for us to reach our goal by 2030.
Wangari Wa Kimemia, Médecins du Monde France: The treatment pilot in Kenya is now transforming into a national programme. Part of our treatment project is building awareness and testing; we have been running this programme since 2013. We have created a one-stop shop in the drop-in centre to cover all areas of diagnoses and treatment. Homelessness is not a reason not to give treatment to people who use drugs. As a result, we have had a 95% success rate; the positive impact means that the initial pilot is now becoming a national response. We do recognise that policy is still a major challenge; in our country possession is still illegal. our main concern right now is prevention. The key message we trying to get across is that the peer-led approach is important and the availability of harm reduction services is important.
Kunal Kishore, India HIV/AIDS Alliance: There are still challenge in policy developments that need to be made, but things are moving in the right direction. India has been guided by the WHO on these programmes, the components of which are in sync with the response. The programme is under the ministry of health and is fully funded by the government of India. We don’t know the number of people who use drugs in India, there is a lack of data here and it is very important that to have this. We know this is a big problem. There are an estimated 40 million people living with hepatitis C. two weeks ago we launched our drug user survey. The aim is to eliminate hepatitis C by 2030.