Evgenia Maron, Russian Federation: June 2011
Currently, the Global Fund to fight AIDS, Tuberculosis and Malaria (The Global Fund) has strategies for supporting people of different sexual orientations and gender identities, and promoting gender equality. However, there is no such strategy for improving HIV and hepatitis C responses among injecting drug users (IDUs).
According to Ivan Varentsov, coordinator of Civil Society Action Team (CSAT), Eurasian Harm Reduction Network (EHRN), “We know that in many regions, not only gender inequality fuels the HIV epidemic, but also injection drug use. IDUs face no less stigma and discrimination, [and] suffer because of lack of access to prevention and treatment services.”
CSAT was established in 2007 by the International Council of AIDS Service Organizations (ICASO), to support the involvement of civil society representatives and organisations – including most-at-risk populations (MARPs) – in the preparation and implementation of Global Fund grants.
Gaps in the Global Fund
For Varentsov, “In our opinion, the Global Fund should develop a strategy of working with IDUs.”
He continues, “Hepatitis C, overdose prevention and opioid substitution therapy (OST) should be a key focus in this strategy document. Presently, the Global Fund does seem to support programmes preventing and treating hepatitis C, but in applications for the Global Fund 10th round from the Kyrgyz Republic and Ukraine, the Technical Review Panel (TRP) refused to support implementation of activities combating hepatitis C.”
Varentsov’s comments confirm that representatives of MARPs, including IDUs, must be meaningfully involved in Global Fund work at all levels. The voice of the community should be central in shaping local and national policies.
Health and community systems
For Varentsov, “Co-infection of hepatitis C and HIV among IDU is ubiquitous. In some countries, complications of hepatitis C are a major cause of mortality [in this group]. Global Fund programmes provide HIV treatment for IDUs, but do not yet provide universal access to hepatitis C treatment. As part of the 4th Global Fund round in Russia, some sub-recipients closely working with IDU wanted to include this treatment, but this was not possible as it was not targeted funding. Though their primary problem may be hepatitis C, not HIV, IDUs cannot access this treatment.”
In addition, overdose prevention and opioid substitution therapy (OST) are other components that receive little attention in Eastern Europe and Central Asia. “There are OST programmes, but they are only pilots. Also, in most countries, OST programmes are implemented only at the expense of the Global Fund. If the funding stops, then it’s all over,” said Varentsov.
IDUs are also at high risk of TB, and for Varentsov, lack of effective overlap and integration in health systems, between TB, HIV and hepatitis C, is a serious problem. “It is not taken into account that people may have ‘three-in-one’. They often die because they cannot get treatment. When they receive TB treatment, they are not treated for withdrawal symptoms; [when treated for] HIV they cannot have an inpatient substance abuse treatment; and while in the drug clinic, they cannot receive ARVs,” said Varentsov.
Another key point is strengthening community systems. “We must adapt the concept of Community Systems Strengthening (CSS) for each region, and make the concept easy to understand and accessible to community-based organizations,” said Varentsov.
Punitive legislation
Speaking about legal reforms in Russia, Varentsov says that the current anti-drugs policy will be in place till 2020, continuing the situation where there is a clampdown on IDU rather than the coordinated provision of care and support. “A law on compulsory testing for drugs is currently being discussed, and this will further criminalise drug use, and introduce compulsory treatment as an alternative punishment,” says Varentsov.
Let’s hope with genuine community engagement, developing a strategy to improve health responses for IDUs becomes a reality in Eastern Europe and Central Asia.
Disclaimer: The views expressed in this note are those of the Key Correspondent and the persons interviewed by them. Whilst the material will contribute to information shared in Sao Paulo at the in-person consultation on the 2011 Partnership Forum, the material is not published as an official communication of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
