More than two billion people in middle-income countries (MICs) lack access to essential medicines. Medicines are expensive, and consume 25 to 65 percent of the total private and public spending on health, and 60 to 90 percent of household expenditure in MICs. In the public sector, there is poor availability of medicines and patients are forced to purchase medicines from the private market. The Global Burden of Diseases 2010 study shows that MICs rather than experiencing a classic ‘epidemiological transition’ in which infectious diseases dissipate and non-communicable diseases (NCD) emerge, are facing a ‘dual burden’ in which infectious diseases are still prevalent, especially HIV, viral hepatitis and tuberculosis, while NCD rates are rising. Access to affordable medicines is therefore of central importance in ensuring universal access to health care in these countries.

Middle-income countries (MICs) are facing a crisis of containing costs for treating people living with HIV. These countries carry a high burden of HIV, and transmission of the virus is often concentrated amongst key populations: people who inject drug (PWID), men who have sex with men (MSM), sex workers (SW), transgender (TG), prisoners and migrants. The highest numbers and the highest prevalence of PWID with HIV are in East and Southeast Asia (17 percent), Eastern Europe (27 percent), and Latin America (29 percent). HIV prevalence is on average 13 times higher among MSM compared to the general population. In most parts of the world, sex workers experience higher prevalence of HIV than the general population. Access to treatment can be a challenge for key populations given the structural barriers such as laws and legislation that criminalize their behavior, stigma and discrimination, and lack of general acceptance in society. But even when such barriers are overcome, medicines including ARVs may not be available (‘stocked out’), largely because of the high costs as well as poor procurement and distribution system. The high cost of medicines are often the reasons governments claimed to have prevented them from including or limiting access to treatment as part of the public health insurance or social security system. Moreover, a country’s ability to pay is not always commensurate to
willingness to pay especially when it involves key populations.

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Access challenges for HIV treatment among people living with HIV and key populations in middle-income countries

This report is the second publication in a series where we examine funding shortages for TB and HIV programmes in Eastern Europe and Central Asia (EECA).The first publication, “Bridging the Gap: Whythe European Union must address the Global Fund’s funding crisis to tackle the escalating HIV and TB epidemics in Eastern Europe and Central Asia” explored the cancellation of the Global Fund to Fight AIDS, Tuberculosis and Malaria’s eleventh funding window in 2011 and how this left some countries without the financial support needed to aggressively combat their disease epidemics. This report builds on our previous publication by analysing three cases studies to demonstrate the continued impact of TB and HIV in the region and to show the effects of international donor aid diminishing in middle-income countries. The current situation for TB and HIV programmes in the region remains serious. These diseases urgently require sustained political and financial support from both domestic and international sources, including regional level aid from the European Union.

The Global Fund to Fight AIDS, TB and Malaria, historically the largest international donor for TB and HIV programmes in the EECA region, has adopted a New Funding Model (NFM) that will significantly reduce the amount of support available for middle-income countries. This includes support to civil society organisations that deliver TB and HIV services and are essential to creating environments where national governments are held accountable for properly addressing the health needs of their citizens. A Global Fund modelling of funding allocations under the NFM indicated that just three percent of total resources would be allocated to EECA. This represents a 50 percent decrease compared with what was previously available.

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Bridging the gap: How the EU can address the funding crisis for TB and HIV programmes in Eastern Europe Central Asia

Injection drug users who take measures to reduce the risk of contracting hepatitis C are not always motivated by messages about preventing transmission of the disease, according to research published in 

Instead, health services should use messages appealing to pragmatic concerns, such as vein care, preventing painful injections, and avoiding risk of withdrawal.

Researchers from the London School of Hygiene & Tropical Medicine’s Staying Safe project interviewed 37 long-term injection drug users in London to discover those practices which may prevent exposure to hepatitis C and other blood-borne pathogens.

Approximately 216,000 people in the UK are living with hepatitis C. It is estimated that up to nine out of 10 cases in England are caused by injecting illegal drugs, and that nearly half of people who inject drugs in England may be living with the virus.

All participants engaged in protective practices irrespective of serostatus. It is important to consider the relative importance of different motivations framing protective practices in order to formulate harm reduction interventions which appeal to the situated concerns of PWID, especially given that these protective practices may also help protect against HIV and other blood borne infections.

- See more at: http://blogs.lshtm.ac.uk/news/2013/10/31/reducing-the-risk-of-hepatitis-c-among-people-who-inject-drugs/#sthash.h1DhTr6r.dpuf

Hepatitis C avoidance in injection drug users: A typology of possible protective practices

The epidemiological reality of HIV infection in Egypt favours prioritizing efforts to the high risk groups rather than the general population. Hence, harm reduction should be at the core of interventions targeting HIV.

The current study revealed that there is still a long way to go to enhance the role of these interventions in influencing a significant behaviour change among target group.

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Harm reduction in Egypt: The insight of injecting drug users

A report published at the end of the third year of the study showed four distinct findings in relation to higher likelihood of drug use and binge drinking, higher likelihood of substance dependency and barriers to help-seeking in relation to substance use among LGB people.

This report further explores problematic and dependent drug and alcohol use and help seeking behaviour, particularly among those who indicated substance dependency.

This is the penultimate year of the POTP study, and in 2014 we plan to publish comprehensive recommendations for commissioners and policy makers, drug and alcohol service providers, the LGB&T voluntary and community sector, and LGB communities themselves.

At present, we recommend implementation of the actions outlined in the Action Plan that was developed with key stakeholders in the substance use field following the launch of the 2009-11 report.

An accompanying report presents case studies based on the lived experiences of three LGB people with a history of substance use and/or current substance use. These three cases offer a useful contrast to the survey data, providing important biographical detail about the life processes and issues that inform decisions and actions around substance use.

Part of the picture: Lesbian, gay and bisexual people's alcohol and drug use in England

Injectable opioid treatments are more cost-effective than optimised oral methadone for chronic refractory heroin addiction. The choice between supervised injectable heroin and injectable methadone is less clear. There is currently evidence to suggest superior effectiveness of injectable heroin but at a cost that policy makers may find unacceptable. Future research should consider the use of decision analytic techniques to model expected costs and benefits of the treatments over the longer term.

Click here to read the full publication (restricted access)

Cost-effectiveness of injectable opioid treatment versus oral methadone for chronic heroin addiction

Cannabis dependence is a disorder primarily experienced by young adults, especially in higher income countries. It has not been shown to increase mortality as opioid and other forms of illicit drug dependence do. Our estimates suggest that cannabis use as a risk factor for schizophrenia is not a major contributor to population-level disease burden.

The global epidemiology and contribution of cannabis use and dependence to the global burden of disease

In the last few years, the debate on illicit drugs – long dominated by voices that favor repressive and punitive policies framed by prohibitionist strategies – has broadened and gained new momentum. This publication summarises the different drug law reform movements in the Latin American region.

From repression to regulation:  Proposals for drug policy reform

Responses to problematic drug use continue to improve in Scotland. Service provision is more coherent, waiting times are down and there is a clearer understanding that all steps in the recovery journey need to be supported.

Commissioners and services are focusing on raising standards at a time when resources are at a premium. SDF’s Big Lottery-funded National Quality Development Programme has helped in excess of 80 projects to implement changes aimed at improving recovery outcomes – often identifying ways to make better use of existing resources.

This is an evolving process. Needs identified by managers and frontline workers have led to the development of SDF’s well-received Sexual and Reproductive Health Initiative and intensified our focus on New Psychoactive Substances through training, events and collaborative working at local and strategic level.

We hope to attract further funding for our Quality Development initiative to help services implement the recommendations in the Opiate Replacement Therapies Review and the new Quality Improvement Framework, both of which underline the need for the wider psycho-social supports.

Scottish Drugs Forum: Annual report 2012/13

Latin America is confronted with astonishing levels of organised and interpersonal violence, much of it connected to illicit narcotics production and trafficking and the so-called “war on drugs”. There is evidence, however, of mounting resistance to the global drug control regime and its narrow emphasis on suppressing supply, chiefly through enforcement measures. This report considers how changes under way in Latin America are challenging the foundations of this regime. Over the past decade two independent commissions – the Latin American Commission on Drugs and Democracy and the Global Commission on Drug Policy – have broken the taboo on debating alternative drug policies. Both commissions have emphasised a paradigm shift from repressive approaches to more preventive interventions that focus on harm reduction and citizen security. Emboldened by these commissions’ recommendations, Latin American leaders from across the political spectrum are currently discussing a more balanced approach to drug policy. Some governments are experimenting with legislation and regulatory models that are tailored to their countries’ local realities and needs. These and other efforts have potentially dramatic implications not just for drug policy in Latin America, but globally.

Latin America awakes: A review of the new drug policy debate

The aim of the guide is to make practical information on prevention quality standards available outside the European Union. It includes a description of the eight stages involved in the drug prevention cycle, along with a self-reflection checklist that can be used when planning and implementing prevention activities. It has been designed for practitioners and those working in the field.

The European drug prevention quality standards, published as Manual No 7 by the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA), provide the first European framework on how to conduct high quality drug prevention.

The standards contained in the manual were developed during a two-year project with co-funding from the European Union under the Programme of Community Action in the field of Public Health (2003–08) (Project No 2007304). The project was carried out by the Prevention Standards Partnership, a multi-disciplinary and multi-sectoral collaboration of seven organisations across Europe, led by the Centre for Public Health at Liverpool John Moores University, UK. The EMCDDA supported the Partnership throughout the development process and has also funded the publication of the standards as a manual as well as the production of this quick guide.

European drug prevention quality standards: A quick guide

Inhalant misuse is one of many alcohol and drug problems that occur within Australia. Inhalants are easily obtained and are predominantly misused by young people and by people who are socially or economically marginalised. Inhalant misuse can result in impairment and death and can be very distressing for families and communities. This publication aims to assist local communities to address inhalant misuse.

The first edition of the booklet has been used by communities and community workers across Australia. This second edition contains updated advice. I recommend it to you and commend Sarah MacLean for her work.

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