UK: hepatitis C diagnosis up by a third in two yearsback to top
30th Jul 2013
UK hepatitis C diagnoses have increased by a third between 2010 and 2012, according to a new report published by Public Health England. Figures from the report, released ahead of World Hepatitis Day (28th July), show hospital admissions for liver cancer and final stage liver disease to have also increased from 574 in 1998 to 2,266 in 2012.
Hepatitis C is a blood born infection primarily affecting the liver. It can lead to cirrhosis, cancer and other liver diseases that can be a major cause of hospitalisations for people living with HIV. Unlike hepatitis A and B, there is no vaccine to prevent hepatitis C, but it can be cured with a course of antiretroviral treatment. Yet, only 3 percent of patients are receiving treatment each year. This may be connected to the fact many people do not realise they are infected as the liver can still function when damaged which can delay the onset of symptoms for several years. This has led the World Health Organisation to dub the infection “a viral time bomb”.
It is therefore vital to raise public awareness on the condition so people can be promptly diagnosed and treated before the arrival of major liver complications. An epidomoligcal model showed that 6,000 hepatitis C-related deaths could be averted in the next 30 years by doubling the number of patients on treatment. Further to improving the health and well-being of an individual, evidence has also shown treatment to reduce to risk of transmission.
There has been much headway in prevention, especially among injecting drug users who remain the most at risk of hepatitis C, with rates between 33 percent and 49 percent across the UK. IDUs reporting sharing injecting equipment is falling, and is likely to follow a downward trajectory with needle and syringe programmes continuing to develop in the UK. However, as the authors of the report highlight, “there is much more that can and should be done” to improve the prevention, diagnosis, treatment and care of hepatitis C across the UK to reverse the rise in related morbidity and mortality. Recommendations to improve the UK response from the report include; encouraging primary care providers to receive awareness training on the condition, and for more up-to-date studies to inform targeted prevention campaigns.
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Resistance to male circumcision campaigns in Southern Africaback to top
22nd Jul 2013
Male circumcision campaigns are failing to reach many men in Southern African countries despite compelling evidence that it can reduce the risk of HIV. Speakers at the 2nd International Conference for Social Sciences and Humanities in HIV argued the scarce attention to the social meanings of circumcision for many men has lead to the low coverage rates.
Three large-scale randomised control studies in South Africa, Kenya and Uganda showed male circumcision to reduce heterosexual HIV transmission by 60 percent. In 2007, UNAIDS and the World Health Organisation (WHO) consequently introduced recommendations for male circumcisions in countries of Southern and Eastern Africa, where HIV prevalence rates are high.
Following these recommendations, Swaziland, which has the highest HIV prevalence in the world, launched a government-led campaign aimed at circumcising 150,000 adult men in 2009. However, by 2011 only 12 percent of target males had been circumcised. Interviews with Swazi men found the perceived threat to masculinity to attribute to the procedure's unpopularity. The notion of reduced masculinity came from the belief circumcision would reduce sexual functionality that will in-turn jeopardise men's ability to have a family.
Similar to Swaziland, the circumcision campaign in Botswana fell well short of its mark, reaching only 40 percent of target men. Initially well received among communities where circumcision was already a cultural norm, it quickly became ill-favoured because of the way the campaign was carried out – “In 2011, everything turned around – the public campaigns had breached traditional privacy” commented Masego Thamuku, who conducted the research in Botswana.
These findings highlight the need for further research into the cultural and social issues that effect men's decision to be circumcised, and for social aspects to be better integrated into policies on male circumcision as an HIV prevention tool.
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UNAIDS calls for accelerated action on treatment access back to top
15th Jul 2013
UNAIDS has released a new framework that offers countries “practical and innovative ways” to scale-up treatment access. The report was launched with less than 1,000 days before the 2015 global target of reaching 15 million people with antiretroviral (ARV) treatment, set in the United Nations 2011 Political Declaration on HIV and AIDS.
The report was developed in-line with the new guidelines set by the World Health Organisation (WHO), which recommends people living with HIV to start treatment earlier. Speaking of previous successes in treatment scale-up, Dr Margaret Chan, Director-General of WHO commented, "the scale-up of [ARV treatment] is an unprecedented global success story for public health", and emphasised the need for “substantial further scale-up of access to these medicines”. It was noted that the focus should be on the 30 countries where 9 out of 10 people who need ARV treatment do not have access to them, and key populations affected by HIV, such as men who have sex with men, sex workers and injecting drug users. This concentrated attention will help to push the global HIV epidemic into irreversible decline.
The framework sets out three fundamental pillars in reaching this treatment access goal; demand, invest and deliver. People living with HIV and populations heavily affected by it should drive the demand, while “civil society and the international community” should sustain it. For the second pillar- invest- the report calls for the mobilisation of sufficient resources to achieve effective and efficient scale-up in spending. Among the many suggestions on how to deliver on treatment scale-up was to empower communities to own their treatment programmes and promote community partnerships.
Compelling evidence has also shown treatment to be an important component in preventing HIV. A study in Kenya and Uganda involving 4,758 discordant couples (where one person is HIV-positive and the other is negative), found daily ARV treatment to reduce transmission by 73 percent and 62 percent. As the report encourages, it is therefore vital for enhanced public health programmes and services to ensure there are no unmet needs in HIV treatment.
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UK: new HIV risk among MSM injecting drug usersback to top
11th Jul 2013
The National AIDS Trust (NAT) has warned that changing patterns of injecting drug use among men who have sex with men (MSM) may increase HIV prevalence rates in the UK. Currently, the UK has one of the lowest rates of HIV among injecting drug users (IDUs) in Europe at 1.2 percent. This is largely due to the provision of opioid substitution therapy (OST), needle and syringe exchange programmes and other harm reduction approaches that have been proven to prevent HIV transmission.
The report shows there has been an increase in the use of newer drugs such as mephedrone, crystal meth and GHB/GBL, and also image and performance enhancing drugs among MSM. In a London treatment centre, it was reported that 85 percent of MSM are now using one or more of these newer drugs, compared to 3 percent in 2005. As this sub-group of users represent new trends, there is concern these IDUs are not being targeted by traditional harm reduction interventions, and may not fully understand risks involved, as shown by reports of frequent needle sharing and drug use in the context of risky sexual behaviours. This poses a significant threat to the current low prevalence rates of HIV and other blood-born diseases, such as Hepatitis among IDUs.
The Director of Policy at NAT, Yusus Azad, urged local authorities to do more to tackle the problem - “if newer communities are starting to inject drugs, there is an urgent task to ensure health promotion and harm reduction messages reach these groups”.
Despite these worrying patterns, the UK government made a decision to promote abstinence for IDUs, and aims to cut the number of people receiving OST. NAT, along with other advocates were “alarmed” by these comments, as maintaining people on OST is a vital element of harm reduction, and premature exit from treatment may be detrimental to the individual.
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Cash incentives reduce new HIV infections by 39% in Lesothoback to top
9th Jul 2013
Cash incentives have been shown to reduce new HIV infections by 39 percent among young women in Lesotho, according to a study presented at the 7th International AIDS Society (IAS) Conference in Kuala Lumpur last week. The study is one of only a few that measures the biological outcome of an HIV prevention intervention, as opposed to simply a change in knowledge.
Lesotho has one of the highest HIV prevalence rates in the world, and according to UNAIDS (2012), around 60 percent of all adults infected are women. Over two years, 3,426 young people aged 18 to 32, from 29 different villages, were enrolled in the study to assess the effectiveness of a lottery scheme to reduce risky behaviour and HIV incidence in this group. All participants were HIV negative at the beginning of the study, and were subsequently tested for HIV at 16, 20 and 24 months. Every four months, participants were tested for STIs and given counselling, and treatment if necessary. All those who tested negative for an STI in their village were enrolled in a lottery, and were up for the chance of winning a cash prize depending on the arm of the study they were enrolled in; either a high-value lottery ($100 prize), a low-value arm ($50 prize) and a control arm (no prize).
The intervention was found to be highly successful among young women, whilst there was no difference between the control group and the lottery arm among young men. The intervention was most effective for woman in the high-value lottery- 14.6 percent of young woman in the control group acquired HIV after two years, compared to 10.6 percent in the high-value lottery group. This study complements a growing body of research that shows the benefits of financial incentives as an HIV prevention strategy, and the authors recommend implementing and scaling-up this intervention in other settings.
Source:AIDSMAP
Greater African investment in the HIV responseback to top
5th Jul 2013
The newly elected Kenyan government has this week committed to strengthening the national response to HIV and AIDS, health and development. This includes increasing the availability of domestic funding, such as innovative public-private investment initiatives, and decreasing dependency on finance from external sources to ensure sustainability. The Deputy President also outlined Kenya’s commitment to further exploring local production of antiretrovirals (ARVs) to bring down the price of treatment.
Last week the Republic of Congo and the Republic of Senegal became the first African countries to make financial contributions to the multilateral body, UNAIDS, which plays a critical role in the global response to HIV and AIDS. This is a significant development, which demonstrates both the importance of African leadership, and the continent’s commitment to taking forward the African Union Roadmap on Share Responsibility and Global Solidarity. The roadmap, which was agreed by member states at the 2012 Summit of the African Union, calls on both African governments and international stakeholders to fill the funding gap in the AIDS, TB and malaria responses in Africa.
Ahead of the 2012 International AIDS Conference, UNAIDS released a supplement to the Together we will end AIDS report, entitled Meeting the investment challenge, outlining the progress to date in funding the global HIV and AIDS response. The supplement revealed that in the last five years domestic public spending in sub-Saharan Africa (excluding South Africa) increased by 97 percent, while in South Africa domestic investment increased four-fold in that period – now more than 80 percent of spending in the country comes from domestic sources.
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Patents are keeping new HIV drugs unaffordable warns MSFback to top
3rd Jul 2013
Increased competition from generic drug manufacturers is the main factor driving down the prices of first- and second-line antiretrovirals (ARV). However, newer ARV prices remain “astronomically high”, according to a recently published report by Médecins Sans Frontières (MSF). MSF recognised ‘patent oppositions’ - such as the Indian court case against pharmaceutical firm Novatis in April of this year - as a key factor in falling prices.
The high prices of some ARVs can be attributed to their patent protection. A patent is a temporary license granted by a government to an inventor, giving them sole rights to their product. For pharmaceutical companies, patent protection gives the opportunity to exclusively utilise the profitability of a drug for a specific period of time, which can be up to 20 years. During this time, other companies are prohibited from reproducing the drug. Where a drug patent is lifted, however, generic drug companies are able to reproduce the drug and generally sell them at much lower prices. Steep prices can keep life-saving drugs out of reach for many people, especially in low-resource settings. To tackle this problem, MSF calls for issuing of compulsory licences that legally allow generic production of patented drugs, when drugs are priced out of reach.
The report titled Untangling the web of ARV price reduction, shows there has been a 75 percent drop in second-line treatments since 2006, but comments “today’s lowest second-line price is still more than double the cost of first-line treatment”. Countries that do not have access to the lowest possible prices of “salvage regimens” – drugs that are a last resort when first- and second-line drugs fail – because of patent laws in their country, are paying thousands of dollars. Paraguay for example, pays US$7,782 for etravirine, while Armenia pays US$13,213 for raltegravir, and these are only some of the drugs needed for a full regimen.
With estimation of up to 55 million people expected to need ARVs by 2030, addressing the challenges of achieving universal access is integral. Securing low prices for drugs should be a top priority going forward, along with ensuring other barriers such as lack of trained staff, infrastructure and resources to safeguard reliable supplies of ARV drugs.
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New WHO guidelines recommend earlier treatment back to top
1st Jul 2013
During the International AIDS Society meeting in Kuala Lumpur, Malaysia, The World Health Organisation (WHO) released its new guidelines for HIV treatment and care. Recommendations include providing antiretroviral treatment (ART) to people living with HIV earlier than previously recommended, and initiation of treatment for certain populations regardless of their CD4 count, such as; people living with both HIV and tuberculosis or HIV and hepatitis B, serodiscordant couples (when one person is HIV positive and the other HIV negative), pregnant or breastfeeding women, and children under five. These new guidelines aim to expand the eligibility for treatment to 26 million people globally, which is an additional 9.2 million from the previous WHO guidelines that were released in 2010.
The 2010 WHO guidelines suggested initiation of treatment when CD4 counts fell to 350 cells/mm3, while the new guideline recommends starting treatment when the CD4 count is below 500 cells/mm3. CD4s are white blood cells that fight infection and help indicate the strength of a person’s immune system and HIV progression - higher CD4 counts per millimetre cubed (cells/mm3) signify a stronger immune system.
The guidelines were formulated following the release of numerous reports showing that earlier initiation of ART can reduce the risk of transmission, and help people living with HIV have healthier and longer lives. One study found heterosexual serodiscordant couples starting treatment at CD4 counts between 250-500 cells/mm3 cut the transmission risk by up to 96 percent.
MSF and UNAIDS are some of the organisations that have applauded the move as a way to further improve treatment coverage from the record 9.7 million people living with HIV receiving treatment in 2012. The WHO has suggested that implementation of the guidelines will result in 3 million fewer AIDS-related deaths and prevent 3.5 million new infections by 2025.
UNAIDS has stated that the additional costs incurred by an increased number of people on treatment as a result of the guidelines could be covered by the projected 2015 global budget of $22-24 billion for HIV treatment and care. They have estimated that the savings in costs could be met through a reduction in the cost of treatment and medical supplies, devising simpler treatment delivery systems and improving the overall efficiency of the AIDS response. However, there are some concerns from advocacy groups and key players in the HIV and AIDS field about the need for greater investment in health systems to facilitate the process, as well as increased political and financial commitments from governments and international stakeholders to ensure that progress in treatment coverage is even across the world.
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HIV infections among children halved in seven African countriesback to top
26th Jun 2013
The UN has reported that seven sub-Saharan African countries have at least halved the number of new HIV infections in children since 2009. The report entitled, Global Plan towards elimination of new HIV infections among children by 2015 and keeping their mothers alive, reveals how Ghana has seen the largest decline at 76 percent, closely followed by South Africa at 63 percent. Tanzania and Zimbabwe are also making substantial progress, showing that headway is being made in reaching the goal of a 90 percent reduction in the number of newly infected children by 2015, outlined in the Global Plan. The Plan was launched in 2011 at the UN General Assembly High-Level Meeting on AIDS, with another central target to reduce the number of AIDS-related maternal deaths. Much of the progress made can be linked to the increased number of pregnant women on antiretroviral treatment, which drastically reduces transmission of HIV from mother to child. Coverage in some countries has been reported to exceed 75 percent.
Overall, 130,000 fewer newly infected children were reported across 21 countries in sub-Saharan Africa. However the improvement has not been universal – “progress has stalled in some countries with high numbers of new HIV infections. We need to find out why and remove the bottlenecks,” commented Michel Sidibé, the Executive Director of UNAIDS, who spearheaded the plan. New infections in children have increased in Angola and in Nigeria, which has the largest number of children acquiring HIV with nearly 60,000 in 2012, there has been no change in the rates of newly infected children since 2009. The report warns that without urgent and decisive action from the international community, the target may not be reached in Nigeria by the deadline. Moreover, for the children that do become infected, only 3 in 10 from priority countries are getting the HIV treatment they need.
Michel Sidibé remained positive about the findings of the report - “The progress in the majority of countries is a strong signal that with focused efforts, every child can be born free from HIV”. This is strongly supported by the announcement earlier this month by the US Secretary of State, John Kerry that the millionth baby has been born HIV-free in sub-Saharan Africa.
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US Supreme Court strikes down ‘anti-prostitution pledge’back to top
24th Jun 2013
The United States (US) Supreme Court has struck down the section of The Leadership Act that prohibited US government funding to organisations that do not explicitly oppose sex work. The decision to end the 10 year ban that is sometimes referred to as the ‘anti-prostitution pledge’, means organisations working in HIV no longer have to sign oaths denouncing sex work to receive funding. The ban was lifted on the grounds it violated the US constitution's first amendment of free speech, which “prohibits the government from telling people what they must say”.
This policy has long been seen as an overreach by the US government that puts their ideological views above evidence, and undermines organisations ability to take a non-judgemental approach to their work. Research has also indicated demonising sex workers, and other groups vulnerable to HIV to hinder prevention efforts as it creates barriers. As such, many organisations have had to forgo funding by the USA, such as Brazil who declined US$40 million in 2005.
The engagement of sex workers has also been shown to be a crucial element in the global HIV response, yet in the 2012 AIDS conference in Washington, US, sex workers were barred from participating because of the travel and visa restrictions by US authorities on sex workers. Consequently, many health organisations have welcomed the supreme court decision - “We are very happy that the Court has spoken out in defence of our ability to engage with sex workers so we can better put in place programmes that protect them and their clients from HIV”, a representative from the sexual health charity, Pathfinder international, commented.
The President’s Emergency Plan for AIDS Relief (PEPFAR) is one of the world’s most influential and the largest single government funding initiative for HIV and AIDS, with US$45.7 billion being made available for HIV programming since 2003. The lifting of this ban therefore has the potential to “greatly contribute to expand and improve the global AIDS response even further”.
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Tanzania: police abuse is impeding HIV progress back to top
19th Jun 2013
Efforts in the fight against HIV are being stifled by the widespread discrimination of groups vulnerable to HIV, according to a report by Human Rights Watch. The report details examples of how in Tanzania, sex workers, men who have sex with men (MSM) and injecting drug users (IDUs), are subjected to arbitrary arrests, refusal from police to accept crimes committed against them, denial of health services, violations of confidentiality, assault, torture and rape.
These actions by law enforcement and health workers are contributing to the marginalisation of these groups, and deterring them from seeking out HIV prevention and treatment services. The Tanzanian Ministry of Health and Social Welfare, recognise partnering with these groups is essential in stopping the spread of HIV, and the semi-autonomous Zanzibar territory of Tanzania, recommends national advocacy campaigns “to promote tolerance towards key population” and needle exchange programmes for IDUs. However, laws that criminalise consensual sex between men, with a penalty of 30 years to life in prison, and the actions by state agents undercut these expressed commitments to mitigate the spread of HIV.
It was also documented that certain practice, although not intended to discriminate, create barriers to health access. For example, a sex worker was refused STI treatment, as she was unable to fulfil the requirement of bringing in her sexual partner for testing. In another case, a sex worker who has been raped was denied treatment from a public hospital because “they said I should go to the police, but I couldn’t because I was a sex worker”.
HIV prevalence rate in the general population is 5.8 percent. In Dar es Salaamm, the commercial capital, a survey found 34 percent of IDUs, 31.1 percent of sex workers, and 12.4 percent of MSM to be HIV-positive. The report consequently calls for the Tanzanian government to act on its commitments, decriminalise all consensual sex between adults, and change policies that are inconsistent with public health and protecting the human rights of these groups.
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PrEP found to cut risk of HIV by 50% in IDUsback to top
17th Jun 2013
A clinical trial in Bangkok, Thailand, showed daily intake of antiretroviral (ARV) drug, tenofovir, cut HIV infections rates by 50 percent among injecting drug users (IDUs), indicating the use of ARVs as a promising approach to HIV prevention. This strategy is known as pre-exposure prophylaxis (PrEP), a relatively new method that has shown to reduce the risk of becoming infected with HIV in combination with other prevention methods.
The trial conducted by the Thailand Ministry of Public Health, in partnership with the U.S. Centers for Disease Control and Prevention (CDC), took place over a four year period. It included over 2000 IDUs who were randomly assigned a daily oral dose of tenoforvir or a placebo. Seven to eight per 1000 of the placebo group became infected with HIV, while only three to four per 1000 of the tenoforvir-taking group became infected. The participants were also offered to attend clinics on a monthly basis for HIV tests, risk-reduction counselling, and monitoring for any adverse effects to tenofovir, which were reported to be “tolerable”. This drug belongs to the class of ARVs that work by blocking crucial enzymes for the process of HIV replication, which stops the virus from spreading through the body.
The positive findings support previous studies on the efficacy of using treatment as prevention, however, there are potential concerns that need to be further looked into regarding adherence and doing more to reach the most marginalised IDU communities, as the trial only included those already attending drug treatment clinics.
With an estimated prevalence rate of 30-40 percent among IDUs in Thailand and a growing number of HIV-positive IDUs globally, especially in the Central Asian and Eastern European region, the Executive Director of UNAIDS, Michel Sidibé, welcomed these results – “The results of this study are important, and if used effectively in HIV programming could have a significant impact in protecting people who inject drugs from becoming infected with HIV.” UNAIDS also emphasised using a single intervention in isolation may not be enough to stop the spread of HIV, and therefore “advocates strongly for combination prevention” in curbing the epidemic.
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UN releases report on progress towards 2011 Political Declarationback to top
14th Jun 2013
At this week's meeting of the United Nations General Assembly in New York, Ban Ki-moon has stated that "we are paving the way to achieve an AIDS-free generation." His remarks were made with the release of a report that details the progress made towards achieving the goals set out by the 2011 Political Declaration on HIV and AIDS. Adopted in 2011 by the General Assembly, the Political Declaration brought leaders from around the work together to reinstate their commitment to fighting the AIDS epidemic, and “set out a new framework of shared responsibility and global solidarity.”
The report gives an update on the progress made in achieving an AIDS-free
generation, key actions that need to be made to continue and accelerate the
advancement of targets. It also urges for sustained commitment towards
achieving targets, such as, reducing sexual transmission of HIV by 50 percent. Much progress has
been made in reaching this goal, but many more changes must be made to
reach the 2015 deadline. For example, there is still a large disparity
between the supply and demand of condoms, with 10 billion condoms needed each year and
only 3.4 billion male condoms and 43.3 million female condoms procured and
distributed in low- and middle- income countries in 2011. Moreover, efforts
to increase male circumcision, an HIV
prevention method that has shown to reduce infection by up to 60
percent, has been slow. It was reported that by the end of 2011 only 5
percent of target males had been circumcised.
Ban Ki-moon states that Millennium Development Goal 6 to halt and reverse
the spread of HIV
has already been reached in more than 56 countries, and that new infection
rates have declined by a fifth. However, there are still many countries
struggling to realise this ideal. The problem, he noted, “cannot be
solved with more money. We all have to step up with courage and integrity
to protect vulnerable members of our human family”.
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Resolution passed to promote rights of groups affected by HIVback to top
12th Jun 2013
The Organisation of American States (OAS)- a coalition of 35 independent states from Latin America, North America and the Caribbean- have passed a resolution to promote and protect the human rights of people living, or affected by HIV in the region. The bold pledge aims to tackle obstacles faced by people living with HIV, and groups vulnerable to HIV. Entrenched stigmatisation and discrimination from community and religious leaders, and state officials were noted barriers in the draft resolution, as were the inadequacies in the access to health services, medical insurance and rights in the work place.
By approving the resolutions, during the 43rd General Assembly, delegates from the Americas are recognising there are still challenges that need to be addressed in the regions HIV response, despite the significant strides made in recent years. New infection rates in Latin America are approximately 10,000 down in 2011 from 2001, and treatment coverage is high resulting in a 10% decline in AIDS-related deaths between 2005 and 2011. While infection rates in the Caribbean are higher than any region outside of sub-Saharan Africa, it has seen a sharp drop in new infection, by 42% since 2001.
The draft resolution discusses the importance of executing mass campaigns to inform people, for improved prevention and treatment. But the most striking part of the draft resolution is the acknowledgement that that groups affected by HIV should play a more prominent role in the regions response to the epidemic. To intensify regional efforts the resolution urged member states to enforce legislations that protect human rights of people living with, or vulnerable to HIV, such as men who have sex with men, transgender people, sex workers, injecting drug users and indigenous populations.
The passing of the resolution is an important step forward. It shows the realisation that fundamental freedoms of people affected or living with HIV is an essential element in more effectively tackling the spread of HIV and giving more people access to treatment, support and care.
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Calls to decriminalise drugs at harm reduction conferenceback to top
10th Jun 2013
The International Harm Reduction Conference is taking place this week in Vilnius, Lithuania, with an emphasis on the social and ethical aspects of harm reduction philosophy. The conference has already seen high profile individuals such as British business magnate Richard Branson, musician Elton John, and Former Polish president, Aleksander Kwasniewski, calling for drug decriminalisation. Many believe punitive laws against drug users hinder the fight against HIV, as fear of arrest and stigma drive people away from HIV treatment and prevention services.
The four-day conference brings together key organisations, advocates, programmers, service users, and a host of others working in the field to discuss policy and developments relating to harm reduction. Harm reduction refers to programmes and pubic health policies that seek to reduce the negative consequences associated with drug consumption. These strategies range from needle exchange programmes and opiate substitution treatment, to peer-based education on the risks of HIV transmission for injecting drug users (IDUs). With some countries experiencing increasing HIV rates among IDUs, the conference is calling for “urgent” financial and political support to mitigate the spread of HIV within this group.
The conference has a special focus on Eastern Europe and Central Asia, home to a quarter of the world’s population who inject drugs, with up to one million IDUs living with HIV. Yet key countries in the region, notably Russia, have resisted implementing harm reduction programmes, despite evidence of their effectiveness. The Russian government is staunchly opposed to opiate substitution therapy, and they do not fund needle exchange programmes, meaning HIV prevention services are worryingly out of reach for the most at-risk group in the country. Over the course of the next few days, conference delegates will be discussing key issues affecting a harm reduction response in this region, including diminishing government funding, human right violations, and repressive laws and policies; follow what's going on via Twitter using #IHRC2013.
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