Mr.

Martin Dinham Chair of the Board The Global Fund to Fight AIDS, Tuberculosis and Malaria The Global Fund to Fight AIDS, Tuberculosis and Malaria Board Members

We, the undersigned leaders and activists representing affected communities and nongovernmental organisations working in the field of HIV/AIDS prevention, care and treatment around the world, address you with this letter in advance of the Global Funds 4th Partnership Forum which will take place on 28 - 30 June 2011 in Sao Paulo, Brazil. We ask you to consider at the Forum the development and introduction of a formal strategy and its implementation plan aimed to address the vulnerabilities and the needs of injection drug users. During the meeting in Brazil, we will also urge participants at the Partnership Forum to identify the introduction of such a strategy to the Global Fund Board as one of its priority recommendations. Of the estimated 15.9 million people who inject drugs globally, around 3 million are living with HIV1. Injecting drug use with unsterile equipment accounts for at least 10 percent of global HIV infections and around 30 percent of HIV infections outside of sub-Saharan Africa2. Drug injecting has been formally documented in 151 countries and 120 countries report HIV infections among people who inject. In some Eastern European and Central Asian countries, up to 37% of injecting drug users live with HIV.3 The Global Fund plays a key role in HIV prevention, treatment, care and support for people who inject drugs in low and middle-income countries and has become a major source of international funding for these activities. Between 2004 and 2009, it invested around US$ 180 million in harm reduction interventions in 42 countries4. Thanks to the Global Fund, 3 million people living with HIV around the world, including drug users, have gained access to antiretroviral drugs.5 Despite these significant advances people who inject drugs have consistently less equitable access to HIV prevention, treatment, care and support6, even in countries where HIV programs supported by the Global Fund have been implemented. Access to these services is often limited by stigma, discrimination and the denial of human rights. As their behavior is criminalized in most countries, people who inject drugs often face incarceration (or, in some countries, extrajudicial detention) further limiting access to comprehensive HIV services.7 In spite of all of
1

Mathers B, et al (2008) Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review http://www.thelancet.com/journals/lancet/article/PIIS0140673608613112/abstract
2

Cook C, Kanaef N (2008) Global State of Harm Reduction 2008: Mapping the response to drug-related HIV and hepatitis C epidemics. http://www.ihra.net/GlobalState2008
3

World Drug Report.UNODC, 2009. p. 57.

Atun R, Kazatchkine M (2010). The Global Funds leadership on harm reduction: 20022009. International Journal of Drug Policy, 21, DOI:10.1016/j.drugpo.2010.01.002
5

The Global Fund to fight AIDS, http://www.theglobalfund.org/en/fighting/?lang=en

6

tuberculosis

and

malaria.

Data

from

the

official

website.

Mathers B et al (2010). HIV prevention, treatment, and care services for people who inject drugs: A systematic review of global, regional, and national coverage. Lancet, 375, DOI:10.1016/S0140-6736(10)60232-2.
7

WHO, UNODC, UNAIDS (2007). Evidence for Action Technical Papers: Effectiveness of Interventions to Address HIV in Prisons. www.who.int/hiv/pub/idu/prisons_effective/en/index.html

these challenges in their proposals to the Global Fund many countries request significantly less resources than they require to adequately address the needs of people who inject drugs. Only 3% of Global Fund HIV portfolio funds were allocated for harm reduction activities within Rounds 7, 8 and 9 budgets.8 Harm Reduction International (formerly known as the International Harm Reduction Association) estimates that US$ 160 million was spent on harm reduction in 2007 in low- and middle-income countries less than US$ 13 per person who injects drugs9. Other harms related to drug use include hepatitis C (HCV) which is becoming the leading cause of death amongst people living with HIV in Western Europe, and overdose which is the leading cause of death for injecting drug users in the region of Eastern Europe and Central Asia.10 Past initiatives and strategies introduced by the Global Fund have been effective in meeting the needs of other marginalized key affected populations including: women and young women11; men who have sex with men; sex workers; transgender people12; and pregnant women living with HIV. To address the needs and vulnerabilities of people who inject drugs, a formal strategy and implementation plan needs to be introduced as a matter of urgency. It should outline concrete actions that the Global Fund can take, as a major international funding entity addressing health challenges based on scientific evidence, human rights principles, and measurable outcomes, to encourage countries to address the vulnerabilities and the needs of people who inject drugs. We wish to emphasise our continued commitment to promoting for equitable access to HIV prevention, treatment and care for people who use drugs. Yours sincerely, David Otiashvili Steering Committee Chair Eurasian Harm Reduction Network (EHRN) Rick Lines Executive Director Harm Reduction International (Formerly known as The International Harm Reduction Association

On behalf of

Alvaro Bermejo Executive Director International HIV/AIDS Alliance

Koen Block Executive Director European Aids Treatment Group (EATG)

Presentation Global Fund Investments in Harm Reduction. Latest Data and Trends Dr Ade Fakoya, Senior HIV Adviser, Global Fund. Beirut, April 2011
9

Gerry V Stimson, Catherine Cook, Jamie Bridge, Javier Rio-Navarro, Rick Lines and Damon Barrett. Three cents a day is not enough, International Harm Reduction Association, 2010.
10

Overdose: A Major Cause of Preventable Death in Central and Eastern Europe in Central Asia: Recommendations and Overview of the Situation in Latvia, Kyrgyzstan, Romania, Russia and Tajikistan. Eurasian Harm Reduction Network (EHRN), August 2008
11

The Global Fund Gender equality strategy The Global Fund Strategy in Relation to Sexual Orientation and Gender Identities

12

Kieran Daly Executive Director International Council of Organizations (ICASO) Volodymyr Zhovtyak AIDS

Anita Krug International Coordinator Service Youth RISE Richard Elliott

Head of the Coordination Council of the Executive Director All-Ukrainian Network of PLWH, Ukraine Canadian HIV/AIDS Legal Network President of the International charitable organization "East Europe and Central Asia Union of people Living with HV" Anya Sarang Allan Clear President Andrey Rylkov Foundation for Health and Social Justice, Secretariat of the Initiative group on Substitution Treatment Advocacy in Russia Dave Burrows Director AIDS Projects Management Group/ The HIV Foundation, Australia Niamh Eastwood Acting Director Release, UK Irina Teplinskaya Coordinator Eurasian Network of People who Use Drugs Olga Belyaeva President Public organization Association Substitution Treatment Advocates Ukraine Aleksandrs Molokovskis Board Chairman Society "Association HIV..LV", Latvia Executive Director Harm Reduction Coalition

Karyn Kaplan Policy and Development Director THAI AIDS TREATMENT ACTION GROUP (TTAG), Thailand Valentin Simionov Executive Director Romanian Harm Reduction Network Alexandr Curashov Executive Director Regional Center for Community Policies, Moldova Jozsef Racz, MD Director

of Blue Point Drug Counselling and of Outpatient Centre Foundation, Hungary Andrey Klepikov Executive Director International HIV/AIDS Alliance in Ukraine

Sergey Uchayev Director "PLH Community" in Uzbekistan Monique Doolittle-Romas Executive Director The Canadian AIDS Society Giorgio Bignami President Forum Droghe, Italy Jason Farrell CEO

RICHTER Ji Executive Director o.s. SANANIM, Czech Republic Ruta Kaupe Board Chair DIA+LOGS NGO, Latvia Aram Barra Drug Policy Programme Director Espolea, Mexico Konstantine Labartkava Head of Organization

Harm Reduction Consulting Services, Inc., NGO "New Vector", Georgia The Netherlands Parvina Giyasova Ken Clement Director PO Apeyron, Tajikistan Vyacheslav Samarin Head of the Board Republican NGO Belarusian Community of PLHIV, Belarus Yelena Rastokina Public Foundation "Answer", Kazakhstan Khatuna Bechvaia Chairperson Chief Executive Officer Canadian Aboriginal AIDS Network Zoya Ruzhnikova Vice-chairman Public Charitable Foundation in support of PLH and their relatives "Shapagat", Kazakhstan Emil Kirboe The Street Lawyers, Denmark Walter Cavalieri Director

Rehabilitation and Development Charity The Canadian Harm Reduction Network Center Tanaziari, Georgia Ala Iatco President Union for HIV prevention Reduction from Moldova and David Ananiashvili Director Harm "Georgian Plus Group"

Nelli Kalikova The Member of the Board

Angela Moiseenko Director

NGO AIDS Information and Support Center Chernigov regional affiliate of All-Ukrainian Network of PLWH, Ukraine (AIDS-i Tugikeskus), Estonia Tsukerman Olena Maria Georgescu Chairman of the Board Charitable organization League "LEGALIFE" Pye Jakobsson International spokesperson Executive Director "All-Ukrainian Romanian Association (ARAS) Nataliya Kitsenko Director HIV/AIDS Department and Against AIDS

Drugs

Issues

Rose Alliance (The National Organisation for sex- and erotic workers in Sweden) Odessa Charity Fund "The Way Home", Ukraine David Cox Evgeniy Krivosheev Chief Administrative Officer Canadian HIV Trials Network Dilfuza Kulganova Director Tajikistan Network of Women HIV+ Catherine Van Huyck Directrice Modus Vivendi asbl, Belgium Veronica Zorila Monitoring and Evaluation Specialist CEO NGO Club Eney, Ukraine Sagyngali Yelkeev President Kazakh association "Equal to Equal" Jaborov Azim Director "Akson", Tajikistan Nofal Sharifov Head of organization

Soros Foundation Moldova, Harm Public Union Against AIDS, Azerbaijan Reduction Program, Republic of Moldova Burulbubu Isaeva Zulfiyya Mustafayeva President Chairwoman

Union of PLH Association, Kazakhstan NGO "Legal Development and Democracy", Azerbaijan Svetlana Moroz Elena Borzunova Head of the Board Director Foundation Tomsk-Anti-Aids,

Charitable organization Club "Svitanok", Charity Ukraine Russia

Nikolai Kuznetsov Chairperson AntiAIDS, Kazakhstan Anna Dubrovskaya President Non-government foundation " ", Kazakhstan Ivan Vodnev Head of the Board

Regional Civil Society Organization IPA Independent Social Support, Belarus "VoiceAntiAIDS", Bashkortostan Republic, Russia Svetlana Plavsuk Valentina Turluk Head of the Board Director

National Youth Non-Governmental Republican NGO "Probujdeniye", Belarus Organisation "Yana", Belarus Alexander Grin' Anatoliy Volik Director BF the Rehabilitation narcodependent the West Ukraine Maram Azizmamadov Chairman of board of Directors Harm Reduction Association, Tajikistan Ruslan Poverga Chairperson NGO "Viaa Nou", Republic of Moldova Elvira Demyanenko CEO Altay NGO "Anti AIDS Siberia", Russia Center of Psychosocial Information and Counseling New way, Georgia Harm Reduction Project Coordinator center Poltava regional charitable Chance, "Public health", Ukraine Slavica Gajdadzis-Knezevik Director Private Helath Organization HELIO MEDIKA 2, Macedonia Olga Itskovich Director Autonomous NGO "Luch", Russia Dali Usharidze foundation

The list of individuals and organizations who supported the letter online on http://www.itpcorg.ru/petitions/690.html

Aleksandras Slatvickis / Marina Chokheli, Tbilisi, Georgia , Klaipeda, Lithuania

Vitalie SLOBOZIAN, Chisinau, Moldova

Ekaterina Stepanova / , Kazan, Russia

Inna Vishemirskaya / , Oksana Yarosh / , Kharkov, Kaliningrad, Russia Ukraine

Nicolay Flora / , Odessa, Sasha Gurinova, Berlin, Germany Ukraine

Ivtodi Cristina, Chisinau, Moldova

Janna Ataiants / Pennington, NJ, USA

Viktor Malchikov / , Almaty, Khazakhstan

Umed Ibragimov, Dushanbe, Tajikistan

Ina Tcaci, Chisinau, Moldova

Victoria Lintsova / , Kirivigrad, Ukraine Liudmila Trukhan, Minsk, Belarus

Emily Hamblin

Gvantsa Piralishvili, Tbilisi, Georgia

Radu Luminita, Balti, Moldova

Marina Shegay, Moscow, Russia

Larisa Solovyeva / Kaliningrad, Russia

Elena Podmazko /

Jalal Amanov, Social Research Public Union Progress", Baku, Azerbaijan

Olesya Muntianu / , Cahul, Moldova

Alena Asaeva, Orsk, Russia

Iurii, Cahul, Moldova

Ciobanu Svetlana, Cahul, Moldova

Haibullin Ruslan, Cahul, Moldova

Eduard Caladare, Kishinev, Moldova

Tatiana, Togliatti, Russia

Maria Jacovleva, Saint-Petersburg, Russia

Nadezhda Baranova / , Denis Efremov / , Omsk, Kemerovo, Russia Russia

Aditi Sharma, New Delhi, India

Kurmanaevskiy / , Kazan, Russia

Tolik Alekseenko / , Anastasia Poliakova / Simferopol, Crimea, Ukraine , Tyumen, Russia

Oksana Vaschenchuk / , Albert Zaripov / , Kazan, Kiev, Ukraine Russia

Vitaly Kurbanov / , Nicolay Baranov Ryazan, Russia Perm, Russia

Alisher Latypov, Dushanbe, Tajikistan

Anastasia Sibiriakova / , Perm, Russia

Svitlana Gurevych, SAAPF, Kyiv, Ukraine Anahit Harutyunyan, Soc. NGO People Armenian Network", Armenia

"Positive Yerevan,

Konstantin Zverkov / , Odessa, Ukraine NGO Age of mercy ( )

Pavlo Skala, Kiev, Ukraine

Victor Isakov, Kiev, Ukraine

Dasha Bernhardt, Chicago, USA

Galyna Naduta, Kyiv, Ukraine

Hanna Nazarava, Minsk, Belarus

Maria Bondarenko, Volgograd, Russia

Farid Shagiakhmetov

Valery Epov / Petersburg, Russia

St. Alexandr Ezdakov / , Perm, Russia

Andrei Golosov / Svetlogorsk, Belarus

Oleg Kozub / , Nikolayev, Ukraine

Igor Voytenko

Tatiana Safronova / , Kaluga, Russia

Yuliya Bogdanova, Krivoy Rog, Ukraine

Svietlana Osipova, Krivoy Rog, Ukraine

Elena Levicheva / , Krivoy Natalia Gvay / , Krivoy Rog, Rog, Ukraine Ukraine

Evgenia Maron, St. Petersburg, Russia

Olexandr Voronov / , ASTAU, Chernigov, Ukraine

Anastasia Solovyeva, International Treatment Preparedness Coalition (ITPCRU) in Eastern Europe and Central Asia, Saint-Petersburg, Russia
Anna Komarova / , Abakan, Russia

Yulia Palagniuk / Association of Substitution Treatment Advocates of Ukraine (ASTAU), Chernigov, Ukraine