On the 21st August 2009, UNODC and UNAIDS circulated the following letter to clarify their common understanding of harm reduction initiatives.

Dear colleagues,
With this email, we would like to make you aware of some recent developments in the field of harm reduction, and request you to disseminate this information to your partners in your country, particularly to the members of the Country Coordinating Mechanisms (CCM), the National AIDS Commissions and civil society.

The sharing and use of contaminated injection equipment among injecting drug users remains one of the most devastating modes of HIV transmission—outside sub-Saharan Africa it accounts for approximately one third of all HIV infections.

Hence it has been identified as a priority area by the UNAIDS Executive Director in the UNAIDS Outcome Framework 2009-2011. In his PCB June 2009 speech, he stressed ‘…we have evidence that effective programmes for harm reduction and substitution therapy can save billions of dollars. During this crisis, UNAIDS will champion these and other evidence informed prevention programmes as smart investments for saving money, saving lives and restoring health and dignity to people.’

Although the Global Fund is the leading multilateral donor of harm-reduction initiatives worldwide, the total allocation for harm reduction interventions is disproportionately low compared to the needs on the ground. Therefore, in countries where injecting drug use is one of the major routes of HIV transmission, it is absolutely critical that the CCMs are properly briefed and assisted in ‘knowing their epidemic’ and in the development and submission of Global Fund proposals – the next Round 10 - having strong focus on harm reduction. 

Often, it is the UNAIDS Country Coordinators who represent the UNAIDS family in the CCMs, therefore, we felt it is important that you are aware of the recent decisions taken by various intergovernmental bodies (Commission on Narcotic Drugs (CND), UNAIDS Programme Coordinating Board and Economic and Social Council of the United Nations) concerning injecting drug use and HIV.

Please note that the CND political declaration, the PCB report and the ECOSOC resolution contain critical language on this issue. The decisions (please see annex) of these three UN entities indicate that there is a common understanding in the UN on what is a comprehensive package of HIV services for injecting drug users, namely ‘harm reduction’. For the first time in history, the UN system has clearly defined what harm reduction in relation to HIV is - the nine interventions as enumerated in the WHO, UNODC, UNAIDS Target setting guide.
 
That is a huge leap forward, and now it is time for us to help translate that common understanding into cohesive ‘practical’ programmatic and policy actions at the country level.
 
Thank you, and with best regards,
 
Christian Kroll
Global Coordinator for HIV
United Nations Office on Drugs and Crime
 
Paul de Lay
Deputy Executive Director, Programme
UNAIDS
 
Annex:
CND:
On 12 March 2009, the Commission on Narcotic Drugs, at its high-level segment adopted the “Political Declaration and Plan of Action on International Cooperation towards an Integrated and Balanced Strategy to Counter the World Drug Problem”, where it stated, in paragraph 19, that “… also note with great concern the alarming rise in the incidence of HIV/AIDS and other blood borne diseases among injecting drug users, reaffirm our commitment to work towards the goal of universal access to comprehensive prevention programmes and treatment, care and related support services, in full compliance with the international drug control conventions and in accordance with national legislation, taking into account all relevant General Assembly resolutions and, when applicable, the WHO, UNODC, UNAIDS Technical Guide, and request the United Nations Office on Drugs and Crime to carry out its mandate in this area in close cooperation with relevant organizations and programmes in the United Nations system, such as the World Health Organization, the United Nations Development Programme and the Joint United Nations Programme on HIV/AIDS;” (Commission on Narcotic Drugs Report on the fifty-second session (14 March 2008 and 11-20 March 2009) Economic and Social Council Official Records, 2009, Supplement No. 8)

UNAIDS PCB:
On 24 June 2009, a little more than three months later, the UNAIDS Programme Coordinating Board discussed issues related to HIV among injecting drug users, and decided, in paragraph 8.5, among others, to request “the UNAIDS Secretariat and the Cosponsors, in particular UNODC, to support national authorities to align policies, clarify roles and responsibilities of various national entities - including drug control, the penitentiary system, public health and civil society - and support increased capacity and resources for provision of a comprehensive package of services for injecting drug users including harm reduction programmes in relation to HIV as enumerated in the UNAIDS/UNODC/WHO “Technical Guide for countries to set targets for Universal Access to HIV prevention, treatment and care for injecting drug users” (24th Meeting of the UNAIDS Programme Coordinating Board Geneva, Switzerland, 22-24 June 2009, Decisions, Recommendations and Conclusions).

ECOSOC:
On 24 July 2009, exactly one month after the UNAIDS Programme Coordinating Board decisions on injecting drug use, the Council adopted a resolution on UNAIDS, where it stated in paragraph 19 “ Recognizes the need for UNAIDS to significantly expand and strengthen its work with national governments and to work with all groups of civil society to address the gap in access to services for injecting drug users in all settings, including prisons; to develop comprehensive models of appropriate service delivery for injecting drug users; to tackle the issues of stigmatization and discrimination; and to support increased capacity and resources for the provision of a comprehensive package of services for injecting drug users including harm reduction programmes in relation to HIV as elaborated in the WHO/UNODC/UNAIDS: “Technical Guide for countries to set targets for Universal Access to HIV prevention, treatment and care for injecting drug users”, in accordance with relevant national circumstances;” (Economic and Social Council resolution E/2009/L.23 adopted by the Council on 24 July 2009: Joint United Nations Programme on Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (UNAIDS))

WHO, UNODC, UNAIDS Technical Guide
The WHO, UNODC, UNAIDS Technical Guide on target setting spells out, what the UNAIDS family understands by comprehensive prevention programmes for injecting drug users, namely nine essential interventions:

  • Needle and syringe programmes
  • Opioid substitution therapy and other drug dependence treatment
  • HIV testing and counselling
  • Antiretroviral therapy
  • Prevention and treatment of sexually transmitted infections
  • Condom programmes for injecting drug users and their sexual partners
  • Targeted information, education and communication for injecting drug users and their sexual partners
  • Vaccination, diagnosis and treatment of viral hepatitis
  • Prevention, diagnosis and treatment of tuberculosis.