Chair Aldo Lale Demoz

With the current data on harm redution, Con las estadisticas actuales de acceso a reduccion de dannos no estamos yendo muy lejos.

Monica Beg, UNODC

We organised in Viena a scientific consultation. The presentations and discussions were in consultation with civil society organisations and around seven topics (treatment, HIV drugs and legal environment, harm reduction in prisons, compulsory treatment…). Michel Kazatchkine chaired the session of the scientific community.  Based in six tematic papers, a scientific statement was produced. These scientific consultations were also peer reviewed. We are proud to launch this special issue in a special publication by the International Journal of Drug policy.

Dasha Ocheret, Deputy Director for Advocacy EHRN

I would like to present some data on Central Asia and the crisis of harm redcution programmes. These countries are in process of transition from regional to national programmes, and we see increasing investment in health in general.  On one hand it seems to be a great time to address this issues, but  on the other hand global donnors are leaving. There are new cases of HIV among people who inject drugs.  In 2011 the Global Fund stoped in Romania, and we saw how blood borne tranmitted disseases increased.

I am going to present some of the results of a project supported by the Global Fund.

Kazakhstan is the leader in the region of transition from regional to national budget. The funding includes specific funding for NPS programmes. At the same time, this funding stays wihin the state health system and does not necesary goes to civil society organisations, and according to PWID the quality of the state services has improve. There is not legal barriers for OSF funding, but there are barriers in practice.

Georgia A huge proportion of services provided in Georgia have to be paid. not a lot of people can afford to pay harm reduction or treatement programmes, so many drug users that enter drug treatment and harm reduction programmes abandon them after two months.

Moldova Does not provide the best practices in therm of harm reduction programmes.
Money could not be spent because there were some lack of proceedings…  but when policy makers from Moldova could learn from Estonia how programmes were funded and implemented, 300 patients with state insurance could attend methadone programmes.  The resource gap on harm reduction in Moldova is huge.  The actual coverage for harm reduction expeciture shows that the alocation for harm reduction programmes is only 10% on what is needed. The resource gap for methadone is also huge, 50%

We need to increase cross’countries cooperation. We will be happy to see European Union countries, and to discuss how the transition from regional to national funding is possible.

We are promoting iniatives to create a produce a strong CND draft resoltuion next year to support more harm reduction programmes, and allocate resources in this field.

Anna Lisa Paanuseke, Estonia

In 1997, we started the first NPS programme, after that we implemented OST programmes, HIV counselling, etc. in 1998 in 2003 the Global Fund came to help us and the activities started to be more systematic. In 2007 there was a big transition from the GF funding to the country based funding. In September 2013 we started a take home naloxone programme. It aims is to reduce the number of drug related overdoses. The aim of the programme was to educate drug users and families on how to use naloxone kits. The programme had 822 participants, 818 naloxone kits given out, 184 repeated prescription reported.

Fentanyl (?) is the main drug that is causing overdoses in Estonia. Since the naloxone programme, and also thanks to the police work, overdose deaths have fallen.

• 170 overdoses in 2012
• 111 overdoses in 2013
• 102 overdoses in 2014

What do we need to go from a regional model to a country’based model? Evidence, motivation, policy, money, a good team… The number of HIV infection among the number of people that inject drugs is dropping.  The used of shared syringes has dropped. Most of the people get the syringes from the harm reduction programmes and also from the farmacy.  In 2007, 76% of people who inject drugs have been tested, in 2012, this number was 90%.  The HIV prevalence has drop from 72% to 60%.

It is important to use money succesfully. We have an integrated planning for HIV, TB…, diversifing sources of income is also important. The ministry of social affairs is mainly responsible of this area, but we have other important partners as as the national health organisation for development.

Questions. Aldo What did you do in your country to persuade people. There was an economic argument?

Marie Phelan, HRI
Why PWID are marginalised in HIV prevention? She presents the Global State of Harm Reduction: NPS exist in 90 countries and OST programmes exist in 80 countries.  We are talking about ending epidemic by 2030 but I don’t know if it is possible. Only 8% of PWID has accesss to OST  and 4% of PWID has access to ART . The Funding Crisis of Harm redution a joing report of HRI, IDPC and HIV Alliance.

UNAIDS in 2011 tried to quantify how much need we need to end HIV: 2.3 billion US dollars by 2015. To achieve this we need community mobilisation, advocacy, inclusion and participation of PWID.  160 million dollars were invested in harm reduction from HIV donors. This is only 7% of what we need. Harm reduction is totally

90% of the harm reduction funding is received from international sources, there is a huge dependency.  The decision of GF has decided to move away its funding from middle income countries without proper transision. Donors that invest in HiV does not necesarily invest in key populations. In Asia no money from national sources is coming.

We have started thinking creatively around funding harm reduction in the current context of austerity.  Around 100 billion dollars are invested in law enforced, that are counter productive. This money could be much more expended in harm reduction programmes, so we are calling to invest 10% of this resources in harm reduction by 2020. We need to strengh the networks of people who use drugs, roll out naloxone, fill the gap on HIV prevention among PWID.

Questions

M. Katzatzine thanks the UNODC for working in the scientific document, because its participation has given importance to the document.

Harm reduction in Croatia. Our experiences is not to the best. When we talk on harm reduction, we need to be very flexible and we cannot generalised. We are the country with the lower prevalence of HIV. We implemented harm reduction in 1996. It is the only country in the world that has stablished in parliamentary way harm reduction programmes as part of public health.  When we are talking about raising money for harm reduction, nobody will give you money for harm reduction, although there is scientific evidence that is cost-effective.