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ADVOCATING
FOR RESULTS
Tuesday 27 April 2010 – DAY TWO –
Daily Update
– 5
‘THERE IS NOT ENOUGH MONEY
out there for harm reduction’ says
Urban Weber, The Global Fund to Fight AIDS, Tuberculosis and Malaria’s
interim director for Eastern Europe, Central Asia, Middle East, North Africa,
Latin America and the Caribbean. ‘The Global Fund works through
countries and therefore people need to engage in the countries that are
recipients, so that more applications reach the Global Fund.’
Advocacy for demand creation is key, therefore, he stresses, and so far
Global Fund money remains unaffected by the financial crisis. ‘Countries
apply for programmes for a duration of up to five years and all the amounts
approved by the Global Fund are secured at the time of approval.’
Replenishment of that money occurs this year, with a pledging conference
in October with Ban Ki-moon. ‘The Global Fund will not get replenished
because of harm reduction,’ says Weber. ‘It’s because we’re contributing to
Millennium Development Goal number six – fighting HIV and malaria – as
well as four and five, child mortality and maternal health. Harm reduction
won’t be prominent on the agenda, so it’s piggy-backing harm reduction
onto the larger picture.’
Is that a deliberate strategic move? ‘I wouldn’t say donors would
disregard harm reduction, it’s just that we’re talking of an amount between
$13-20bn for the next three years. What’s important is that the Global Fund
fights the epidemic where it is, and 30 per cent of all HIV infections outside
of sub-Saharan Africa occur because of the non-sterile use of injection
material.’
This problem remains acute in Eastern Europe and Central Asia, he says.
‘They have largely IDU-driven epidemics. Sexual transmission is increasing,
but only because a huge cohort of drug users are infected and they’re
transmitting it sexually to their sexual networks. We can see the beginning
of a spillover effect into the ‘mainstream population’, let’s say, through
sexual contact, but if people were to say the nature of the epidemic was
changing they would be wrong. It simply means that instead of having one
problem, we have two – the sexualisation of the epidemic doesn’t mean the
underlying problem is going away.’
He’s adamant that key players – NGOs and the developmental
community – engage within countries, and says it’s crucial to remember that
the conservative culture and politics of many developing nations mean it’s
unlikely that spending would come from domestic sources, making
international donors vital. ‘There’s no other way to get money into these
countries,’ he says. But this money, he stresses, can lead to genuine policy
change, citing the Balkan countries and substitution treatment in Kyrgyzstan
and Tajikistan. ‘Once money is in the countries it starts to talk. Money from
international donors can have a catalytic effect in changing policy.’
HARM REDUCTION HAD STARTED AS A
‘COUNTER MOVEMENT’
in the Netherlands
and the UK but was now part of the EU
mainstream, Franz Trautmann of the
Netherlands-based Trimbos Institute told
delegates. ‘It went from being bottom up to
being promoted top down,’ he said. ‘It’s still
controversial, but it’s an element in the global
trend of convergence of drug policies.’
Drug policy expenditure had increased
substantially in the last decade in many
countries, he said, with harm reduction
measures expanding to more nations. Opioid
substitution therapy was now even spreading
to ‘unlikely’ countries such as China and Iran,
while on the supply side, convergence of
policies meant increasing toughness towards
traffickers and sellers. Use and possession still
accounted for the majority of arrests in most
countries, even if they didn’t lead to
imprisonment, he said, and overall, most drug
expenditure still went on supply reduction. ‘In
all countries – even the famous Netherlands –
it’s the same trend,’ he said.
Harm reduction was now more widely
accepted as a guiding principle of demand
reduction, he told the conference. ‘It’s losing its
revolutionary aura, moving from “Che
Guevara” to “Florence Nightingale”. But this
also risks turning it into technical management
of drug-related health problems with more of a
“9 to 5” mentality, moving away from
humanitarian commitment.’
‘The paradigm that drug use is an illness
and not a crime is patronising,’ he said. ‘We’ve
changed it to something that’s a little bit
better, but it’s still keeping people under.’
From ‘Che Guevara to
Florence Nightingale’
‘What’s important is that the Global
Fund fights the epidemic where it is, and
30 per cent of all HIV infections outside
of sub-Saharan Africa occur because of
the non-sterile use of injectionmaterial.’