REPORT SECOND SIDA PROJECT ADVISORY COMMITTEE MEETING November 2008 Manila, Philippines. Convened by

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2 (WP)HSI/2008/DCC/05 English only RS/2008/GE/50(PHL) REPORT BUILDING COMPREHENSIVE HARM REDUCTION SERVICES FOR INJECTING DRUG USERS IN CAMBODIA, THE LAO PEOPLE S DEMOCRATIC REPUBLIC AND VIET NAM: TOWARDS UNIVERSAL ACCESS TO HIV/AIDS PREVENTION, TREATMENT AND CARE SECOND SIDA PROJECT ADVISORY COMMITTEE MEETING November 2008 Manila, Philippines Convened by World Health Organization Regional Office for the Western Pacific Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines

3 NOTE The views expressed in this report are those of the participants in the Second SIDA Project Advisory Committee Meeting and do not necessarily reflect the policies of the Organization. This report has been prepared by the World Health Organization Regional Office for the Western Pacific for governments of Member States in the Region and for those who participated in the Second SIDA Project Advisory Committee Meeting from 10 to 12 November 2008 in Manila, Philippines.

4 SUMMARY In some countries of the South-East Asia and Western Pacific Regions, HIV epidemics have been concentrated among people who inject drugs. The United Nations Office on Drugs and Crime (UNODC) estimates that more than 5.5 million people who inject drugs live in these two Regions. Although HIV/AIDS prevention, treatment and care services for this vulnerable group remain far from adequate, some significant policy developments and advances have been made recently. However, the need to strengthen the response and accelerate its development remains. In 2007, the WHO Regional Office for the Western Pacific, in collaboration with the Swedish International Development Agency (SIDA), developed a regional harm reduction project with emphasis on Cambodia, the Lao People s Democratic Republic and Viet Nam to better respond to epidemics related to people who inject drugs. The SIDA Project Advisory Committee, composed of United Nations agencies, country representatives and the affected community, held its first meeting a year ago in Cambodia. The Second SIDA Project Advisory Committee Meeting was held at the WHO Regional Office for the Western Pacific in Manila, Philippines from 10 to 12 November It was designed as a mid-term review of the SIDA project.

5 ABBREVIATIONS AIDS HAARP HIV HR3 PAC SIDA STI UNODC UNAIDS WHO Acquired immunodeficiency syndrome HIV/AIDS Asia Regional Programme Human immunodeficiency virus Harm Reduction, Human Rights, Human Resources Project Advisory Committee Swedish International Development Agency Sexually transmitted infection United Nations Office on Drugs and Crime Joint United Nations Programme on HIV/AIDS World Health Organization

6 CONTENTS Page 1. INTRODUCTION Objectives Participants Organization of the meeting Opening ceremony PROCEEDINGS Objectives and expected outcomes of the meeting Report of the Commission on AIDS in Asia and its implications for the national HIV responses for people who inject drugs Global and regional overview of harm reduction and existing tools United Nations Regional Task Force on Injecting Drug Use and HIV/AIDS for Asia and the Pacific: progress made in 2008 and how SIDA is contributing HIV/AIDS Asia Regional Programme: harmonization of donor support for HIV prevention, treatment and care for people who inject drugs Community organization: reinforcing the role of people who inject drugs in Asia and the Pacific in response to the HIV/AIDS epidemic Movies by Korsang and WHO Cambodia Country presentations Group work CONCLUSIONS... 6 ANNEXES: ANNEX 1 - LIST OF PARTICIPANTS ANNEX 2 - PROGRAMME OF ACTIVITIES ANNEX 3 - OPENING SPEECH OF THE WHO REGIONAL DIRECTOR FOR THE WESTERN PACIFIC ANNEX 4 - POWERPOINT PRESENTATIONS ANNEX 5 - PRESENTATIONS ON COMPREHENSIVE BRIEFINGS FROM CAMBODIA, LAO PDR AND VIET NAM ANNEX 6 - COUNTRY WORKPLANS ANNEX 7 - REGIONAL WORKPLAN Keywords: Harm reduction / Acquired immunodeficiency syndrome - prevention and control, transmission / HIV infections - prevention and control, transmission / Substance abuse, Intravenous - complications, prevention and control / Cambodia / Laos / Viet Nam

7 1 1. INTRODUCTION The Second SIDA Project Advisory Committee Meeting of the Harm Reduction, Human Rights, Human Resources (HR3) Project was held at the WHO Regional Office for the Western Pacific in Manila, Philippines from 10 to 12 November The meeting was organized as a mid-term review of the project. It was intended to provide a forum for the Committee to learn of progress made in the targeted countries and to decide on the next steps towards the end of the project. HIV epidemics in the South-East Asia and Western Pacific Regions have been characterized by concentrated epidemics among vulnerable populations at high risk, notably people who inject drugs, sex workers and men who have sex with men. It is estimated that more than 5.5 million people inject drugs in the two Regions. The United Nations Office on Drugs and Crime reports that drug use continues to increase. This specific sector of the population is extremely hidden due to strong criminalization of their behaviour. In addition, injecting drugs users who are affected or infected by HIV are doubly discriminated and, therefore, more difficult to be reached by health services. Although the challenges are complex, significant policy developments and advances have been made in Asia in recent years. Evidence-based strategies are being structured in many countries to address epidemics related to people who inject drugs. These strategies are based on the best approach developed in the last 27 years, namely, harm reduction. China, Malaysia and Viet Nam are developing comprehensive needle-and-syringe programmes, setting up methadone maintenance clinics for opioid dependents and increasing care, support and treatment of AIDS for people who inject drugs. In 2007, the WHO Regional Office for the Western Pacific, in collaboration with the Swedish International Development Agency (SIDA), developed a regional project with emphasis in Cambodia, the Lao People s Democratic Republic and Viet Nam to better respond to the epidemics related to people who inject drug. The project is being incorporated into the National Strategic Plans of those three countries and is filling the gaps of their responses. The project also supports the development of the United Nations Regional Task Force on Harm Reduction (coordinated from Bangkok) and community development, particularly communities of affected people, or people who inject drugs. To oversee the quality of the work carried out by the HR3 Project, a Project Advisory Committee was set up. The Committee is composed of country representatives, the United Nations Regional Task Force, some United Nations agencies (particularly United Nations Office on Drugs and Crime [UNODC] and Joint United Nations Programme on HIV/AIDS [UNAIDS] and people who inject drugs. The Project Advisory Committee had its first meeting a year ago in Cambodia. 1.1 Objectives (1) To share lessons learnt from countries on the implementation of harm reduction projects. (2) To review and finalize the annual report and the mid-term review of the HR3 Project.

8 2 (3) To identify the next steps to accelerate and scale up the response to HIV epidemics related to people who inject drugs in the Western Pacific Region. 1.2 Participants The meeting was attended by nine experts in the field of harm reduction among injecting drug users; representatives from HIV/AIDS Asia Regional Program (HAARP), UNAIDS Regional Support Team for Asia and the Pacific and United Nations Regional Task Force on Injecting Drug Use and HIV/AIDS for Asia and the Pacific; and WHO regional and country office staff. The participant list is attached as Annex Organization of the meeting The meeting was held at the WHO Regional Office for the Western Pacific in Manila, the Philippines from 10 to 12 November Methods used in the meeting were country presentations, plenary sessions and small group discussions. The meeting s programme of activities is attached as Annex Opening ceremony Dr Richard Nesbit, Director of Project Management, WHO Regional Office for the Western Pacific, presided over the opening ceremony. Dr Nesbit presented the opening speech, on behalf of Dr Shigeru Om, WHO Regional Director for the Western Pacific. Dr Omi s speech is attached as Annex 3. The meeting was officially opened after the welcome remarks. All attendees were invited to introduce themselves. 2. PROCEEDINGS After the introduction of all participants, Dr Fabio Mesquita, Technical Officer in Harm Reduction, WHO Regional Office for the Western Pacific, presented the proposed outputs of the project and the objectives of the meeting. The proposed outputs of the HR3 Project are: (1) regional and in-country communication and collaboration mechanisms are supported and advanced; (2) best harm reduction practices are disseminated and regional exchange of programme management experience; (3) community-based organizations for the delivery of harm reduction services are advocated for and supported; and (4) regional and country-specific technical assistance are provided. The meeting aimed to assist participants to: (1) understand the environment with its many stakeholders; (2) learn from country experiences; (3) progress in implementing harm reduction

9 3 interventions in the Greater Mekong Subregion and HR3 contribution; and (4) plan for 2009 and beyond. Mr Kah Sin Cho, Representative of UNAIDS, then gave a presentation on the recently launched Report of the Commission on AIDS in Asia. The report, which was recently launched by the United Nations Secretary-General, Ban Ki-moon, highlights the most-at-risk populations in the HIV/AIDS epidemic, including a clear emphasis on the role of people who inject drugs. With the majority of epidemics in the Region commenced by the injection of drugs, the report shows that people who use drugs can easily jumpstart an HIV epidemic through their relationships with sexual partners. The presentation outlined a few well-known, low-cost interventions that can easily avert epidemics. Examples of simply, cost-effective interventions are: (1) needle and syringe programmes; (2) drug treatment, particularly substitution therapy; and (3) the provision of care, support and treatment for people who inject drugs. If the epidemic among people who inject drugs is halted early on, the whole epidemic could be halted very efficiently Global and regional perspectives Dr Fabio Mesquita gave a panoramic overview of the HIV/AIDS epidemic and the response to it among people who inject drugs, both globally and regionally. During his slide presentation, Dr Mesquita highlighted that people who inject drugs are directly involved in 10% of the global reported AIDS cases and that this region is particularly affected. Despite the difficulties in establishing a proper response to the problem, the Region has been successful in developing a comprehensive harm reduction strategy that is properly addressing the problem Perspective from the International Network of People Who Use Drugs Mr Ananda Pun, Regional Director, International Network of People Who use Drugs, focussed his presentation on his organization s mission statement: "Nothing About Us, Without Us", meaning that people who use drugs are seeking to participate in the solutions needed to address the HIV/AIDS epidemics among and from them. Reporting the Nepalese experience, Mr Pun brought to the meeting the voice of the community most affected in the Region for the HIV/AIDS epidemic and other health and social consequences of the misuse of drugs. 2.4 United Nations Regional Task Force on Injecting Drug Use and HIV/AIDS for Asia and the Pacific: progress made in 2008 and how SIDA is contributing Dr Anne Bergenstrom, Coordinator, United Nations Regional Task Force on Injecting Drug Use and HIV/AIDS for Asia and the Pacific, UNODC, presented the Report of the Regional Task Force, emphasizing the role of SIDA. Dr Bergenstrom presented the advocacy work carried out in the Region and presented two of the most important developments in 2008: (1) the organization of a Asian Good Practice Session during the International Conference on Harm Reduction 2008 in Barcelona; and (2) a study to determine the costs of response in order to prepare for a donors meeting on harm reduction planed for early 2009.

10 4 2.5 HIV/AIDS Asia Regional Programme: harmonization of donor support for HIV prevention, treatment and care for people who inject drugs Dr Virginia Macdonald, Programme Officer of the AusAID-funded HIV/AIDS Asia Regional Programme (HAARP) based in Bangkok, presented a summary of the objectives of the HAARP programme and its relative flexibility and described its implementation so far. Dr Macdonald gave very useful information on the concept of donor harmonization and reiterated that countries should be listed when donors define their agenda and intentions. HAARP and SIDA projects are functioning with a very similar strategy give project ownership to the countries and follow their National Strategic Plans to confront the epidemic together. The HAARP delegate expressed their wish to maintain close collaboration with SIDA-funded activities in each country and regionally. 2.6 Community organization: reinforcing the role of people who inject drugs in Asia and the Pacific in response to the HIV/AIDS epidemic Dr Anne Bergenstrom from UNODC proposed holding a meeting for people who use drugs in the Region in conjunction with the International Conference on Harm Reduction 2009 in Bangkok in April. The meeting, using SIDA funds, would be a joint activity of the WHO Regional Office and UNODC. The proposed meeting would be a consultation on HIV/AIDS prevention and care for people who use drugs. The objectives of the meeting would be: (1) to share experiences and needs for HIV/AIDS prevention, treatment and care, including drug-dependence treatment; (2) to consider UNODC and WHO initiatives and support for expanding HIV and drug-dependence treatment and how these may be addressed through community development initiatives; and (3) to make recommendations on how to address HIV prevention, treatment and care with drug users, including community development initiatives, and how to achieve equitable access to services. 2.7 Movies by Korsang and WHO Cambodia At the end of the first day, participants watched four movies produced by the WHO Representative Office in Cambodia and Korsang, a local nongovernmental organization. The movies, which were supported with SIDA funds, were on: (1) injecting drug use; (2) tama (methamphetamine) and ice (crystal methamphetamine); (3) inhalant and solvent use; and (4) safer sex. The first movie was awarded during the International Conference on Harm Reduction 2008 in Barcelona. The intense discussion continued during a reception hosted by WHO at the Regional Office.

11 Learning from country experiences: Indonesia, Malaysia and China On the second day, presentations were given by representatives from Indonesia (Ms Ingrid Irawati Atmosukarto from the National AIDS Commission), Malaysia (Dr Rushidi Ramly from the Mental Health Program of the Ministry of Health of Malaysia) and China (Dr Wu Zunyou, from the National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention). These three countries have made excellent progress in response to the HIV/AIDS epidemic related to people who inject drugs in Asia and generously shared their national experience with countries from the Greater Mekong Subregion. Indonesia s presentation focused on public health, the role of people who inject drugs in responding to the HIV/AIDS epidemic, and the contribution of the general community. Malaysia highlighted the comprehensive approach that they are using to address their epidemic. China highlighted the methadone maintenance treatment as the axis of their response and the role of public health services. The presenters were frank about limitations, advances and steps that still need to be taken, but the discussion was very reach and intense. Participants from the Greater Mekong Subregion were able to see what they still have to do to properly face the epidemic. The above-mentioned presentations are attached as Annex Progress in implementing harm reduction interventions in the Greater Mekong Subregion and HR3 contribution: Cambodia, Lao People s Democratic Republic and Viet Nam Comprehensive briefings were given by Cambodia, the Lao People s Democratic Republic and Viet Nam as to the current status of their harm reduction programmes and the specific contribution of the HR3 Project (Annex 5). The ensuing question-and-answer session resulted in a flow of information and lessons learnt about the relative strengths and weaknesses of the development of HR3 in each of the three countries. The participants were divided into country-specific groups to discuss their respective harm reduction programme needs in the near future and to identify specific activities for which they required SIDA funding through WHO in Following the country-specific discussions, each country presented their draft workplans for 2009 (Annex 6) and indicated what support is needed from SIDA. It was agreed that each country would finalize their SIDA workplans upon return to their respective country. The regional workplan is attached as Annex 7. The meeting was evaluated by participants who generally agreed that this meeting was one of the best in the field of harm reduction in the Region in recent years, due to the impressive sharing of experiences. The meeting was closed with the acknowledgements of all the participants.

12 6 3. CONCLUSIONS (1) The meeting was very productive and helped participants to think about steps to take in the near future. After a clear review of the environment and the players, it was easier to understand the role of the SIDA project. (2) Presentations by China, Indonesia and Malaysia, which highlighted good practices within the Region, helped to enlighten the response to the HIV/AIDS epidemics in the Greater Mekong Subregion. (3) Presentations on Cambodia, the Lao People s Democratic Republic, Viet Nam and the regional response contributed to the positive evaluation of the first year of the HR3 Project. Because of its very good performance and strong influence, the project is being viewed as innovative, comprehensive and crucial. (4) The SIDA HR3 Project is essential for the further development of the response to the HIV/AIDS epidemic among and from people who inject drugs. The innovative project does not stand alone; it is integrated into the National Strategic Plans of priority countries to better address the epidemic. Comprehensively, the project is working to promote universal access to prevention, care, support and treatment for all in need. (5) The participants expressed optimism regarding the second year of the project and looked forward to a possibly broader second phase.

13 ANNEX 1 LIST OF PARTICIPANTS TEMPORARY ADVISERS (1) Ms Ingrid Irawati Atmosukarto, Research Coordinator/Regional Coordinator for Eastern Indonesia, National AIDS Commission, Kpan Menara Eksekutif, Jl. Mh Thamrin Kav. 9, 9 th Floor Jakarta 12030, Indonesia. Tel: ext 132. Fax: Mobile: ingrid.irawati@gmail.com; irawati@aidsindonesia.or.id (2) Mr Saykham Douangmany, Deputy Director of Drug Control Unit, Department of Curative Medicine, Ministry of Health, Vientiane Capital, The Lao People's Democratic Republic. Tel: Fax: (3) Dr Chanthone Khamsibounheuang, Deputy Director, Center for HIV/AIDS and STI, Km3, Thaduea Road, Vientiane Capital, Lao People's Democratic Republic. Tel: Fax: chanthon@laotel.com (4) Mr Neak Yuthea, Director, Department of Legislation Education, Secretariat-General of the National Authority for Combating Drugs, Ministry of Interior, Norodom Boulevard, Phnom Penh, Cambodia. Tel: neak_yuthea@yahoo.com (5) Dr Nguyen Thi Minh Tam, Vice Head, Harm Reduction Department, Viet Nam Administration of HIV/AIDS Control, Ministry of Health, 135/3 Nui Truc Street, Ba Dinh District, Ha Noi, Viet Nam. Tel: Fax: minhtam71@yahoo.com (6) Mr Ananda Pun, Executive Director, Recovering Nepal, International Network of People Who Use Drugs, Sachal Marg, Sanepa 13, Lalitpur Disctrict, Kathmandu, Nepal Tel: Mobile: ananpun@gmail.com (7) Dr Rushidi Ramly, Senior Principal Assistant Director, Head of Substance Abuse Unit, Non-communicable Disease Section, Disease Control Division, Ministry of Health Malaysia, Level 6, Block E10, Complex E, Putrajaya, Malaysia. Tel: ; Fax: rusdi@dph.gov.my; suaibahjaafar@yahoo.com (8) Mr Thong Sokunthea, Deputy Director, Drug Prevention Department, Secretariat-General of the National Authority for Combating Drugs, Ministry of Interior, Phnom Penh, Cambodia. Tel: , kunthears@yahoo.com (9) Dr Wu Zunyou, Director, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xuanwu District, Beijing , China. Tel: Fax: wuzy@263.net

14 OBSERVERS/REPRESENTATIVES (1) HIV/AIDS Asia Regional Program. Dr Virginia Macdonald, Technical Advisor, Regional Technical Coordination Unit, HIV/AIDS Asia Regional Program, Chamnan Phenjati Building, 2nd Floor 65/32 Rama 9 Road, Huay Kwang, Bangkok 10310, Thailand. Mobile: Fax: +66 (2) virginia.macdonald@haarp-online.org (2) UNAIDS Regional Support Team for Asia and Pacific. Mr Kah Sin Cho, Regional Programme Advisor, UNAIDS Regional Support Team for Asia and Pacific, 9 th Floor, A Block, United Nations Building, Rajdamnern Nok Avenue, Pranakorn, Bangkok 10200, Thailand. Tel: Fax: choks@unaids.org (3) United Nations Regional Task Force on Injecting Drug Use and HIV/AIDS for Asia and the Pacific. Dr Anne Bergenstrom, Coordinator, United Nations Regional Task Force on Injecting Drug Use and HIV/AIDS for Asia and the Pacific, UNODC, United Nations Bldg., 3rd Floor, Rajdamnern Nok Avenue, Bangkok 10200, Thailand. Tel: +662 (288) Fax: +662 (288) anne.bergenstrom@unodc.org SECRETARIAT WHO/WPRO (1) Dr Massimo N Ghidinelli, Regional Adviser in HIV/AIDS and STI, World Health Organization, Western Pacific Regional Office, United Nations Avenue, 1000 Manila, Philippines. Tel: Fax: ghidinellim@wpro.who.int (2) Dr Fabio Mesquita, Technical Officer in Harm Reduction, World Health Organization, Western Pacific Regional Office, United Nations Avenue, 1000 Manila, Philippines. Tel: Fax: mesquitaf@wpro.who.int (3) Dr Nguyen Thi Thanh Thuy, Medical Officer/Epidemiologist, HIV/AIDS and STI, World Health Organization, Western Pacific Regional Office, United Nations Avenue, 1000 Manila, Philippines. Tel: Fax: thuyn@wpro.who.int (4) Ms Gaik Gui Ong, Technical Officer, HIV/AIDS and STI, World Health Organization, Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines. Tel: Fax: ongg@wpro.who.int WR/Philippines (1) Dr Madeline Salva, Programme Officer, HIV, AIDS & STI, World Health Organization, National Tuberculosis Centre Building, Second Floor, Bldg. 9, Department of Health, San Lazaro Hospital Compound, Sta Cruz, Manila, Philippines. Tel: / Fax: salvam@wpro.who.int

15 WR/Viet Nam (1) Dr Masami Fujita, Senior Adviser, HIV/AIDS, World Health Organization, 63 Tran Hung Dao Street, Hoan Kiem District, Ha Noi, Viet Nam. Tel: to 36. Fax: (2) Dr David Jacka, Medical Officer (HIV and IDU), World Health Organization, 63 Tran Hung Dao Street, Hoan Kiem District, Ha Noi, Viet Nam. Tel: to 36. Fax:

16 ANNEX 2 PROGRAMME OF ACTIVITIES Activity/Agenda item/subject of presentation Presenter Day 1 Monday, 10 November 08:00-08:30 Registration 08:30-09:00 Opening remarks WHO/WPRO Dr Shigeru Omi 09:00-09:15 Introduction to the meeting Introduction of participants Dr Fabio Mesquita Objectives and expected outcomes of the meeting 09:15-09:45 The Report of the Commission on AIDS in Asia Mr Kah Sin Cho and its implications for the national HIV responses for people who inject drugs (PWID) 09:45-10:15 Coffee/Tea Break 10:15-12:15 Global and regional overview of harm reduction and existing tools Global and Regional Perspective Dr Fabio Mesquita Perspective from the International Network Mr Ananda Pun of People Who Use Drugs: "Nothing about us without us" 12:15-14:00 Lunch Break 14:00-16:00 United Nations Regional Task Force on Injecting Drug Dr A Bergenstrom Use and HIV/AIDS for Asia and the Pacific Progress made in 2008 and how Sida is contributing The HIV/AIDS Asia Regional Program (HAARP) AusAID Harm Reduction Project: Harmonization of donor support for HIV prevention, treatment and care for people who inject drugs Community Organization: Reinforcing the role of people who inject drugs in Asia and the Pacific in response to HIV/AIDS epidemic, UNODC/WHO/Sida initiative for the International Harm Reduction Conference in 2009, Bangkok, Thailand Dr Virginia Macdonald Dr A Bergenstrom 16:00-16:30 Coffee/Tea Break

17 Activity/Agenda item/subject of presentation Presenter 16:30-17:00 Movies by KORSANG and WHO Cambodia 18:00 Welcome Reception Day 2 Tuesday, 11 November 08:30-10:30 Learning from country experiences Indonesia Ms Ingrid Atmosukarto Malaysia Dr Rushidi Ramly 10:30-11:00 Coffee/Tea Break 11:00-12:00 Learning from country experiences China Dr Wu Zunyou 12:00-14:00 Lunch Break 14:00-14:30 Progress report of the implementation of the first year Dr Fabio Mesquita and follow-up on the first Project Advisory Committee Meeting 14:30-16:00 Progress in implementing harm reduction interventions Country Representatives in the Greater Mekong Subregion and HR3 contribution Cambodia Lao People's Democratic Republic Viet Nam 16:00-16:30 Coffee/Tea Break 16:30-17:00 Introduction to preparation for group work on Day 3 Day 3 Wednesday, 12 November 08:30-10:30 Group work: Strategic planning for 2009 and beyond 10:30-11:00 Coffee/Tea Break 11:00-12:00 Reporting Rapporteur 12:00-13:00 Summary of conclusions and recommendations Dr David Jacka 13:00 Closing remarks

18 ANNEX 3 OPENING SPEECH OF DR SHIGERU OMI WHO REGIONAL DIRECTOR FOR THE WESTERN PACIFIC, AT THE SECOND SIDA PROJECT ADVISORY COMMITTEE MEETING Manila, Philippines, November 2008 REPRESENTATIVES OF THE UNAIDS REGIONAL SUPPORT TEAM FOR ASIA AND THE PACIFIC, THE UNITED NATIONS REGIONAL TASK FORCE ON INJECTING DRUG USE AND HIV/AIDS FOR ASIA AND THE PACIFIC, THE HIV/AIDS ASIA REGIONAL PROGRAMME, COLLEAGUES, EXPERTS FROM MEMBER STATES, LADIES AND GENTLEMEN. I would like to welcome you to Manila for the Second Swedish International Development Agency Project Advisory Committee Meeting of the regional project called "Building comprehensive harm reduction services for injecting drug users in Cambodia, the Lao People's Democratic Republic, and Viet Nam: Towards universal access to HIV/AIDS prevention, treatment and care". This meeting aims to review and finalize the annual report and the mid-term assessment of the Harm Reduction, Human Rights and Human Resources Project, known to many of you as HR3. The Western Pacific Region faces an important epidemic of HIV/AIDS related to people who inject drugs. According to the Reference Group to the United Nations on HIV and injecting drug use, there are more than 15 million people who inject drugs worldwide and around 5.5 million are in the Western Pacific Region. The use of injectable drugs can cause a series of social and health consequences and we have been working very hard to reduce the harm caused by them. WHO is one of the leading United Nations agencies promoting harm reduction. Since the establishment of the Global Programme on AIDS, WHO has been working towards an effective response to the HIV epidemic among people who inject drugs. WHO s work is organized into a number of components: establishing evidence base strategy; advocacy; development of normative standards, tools and guidelines; providing technical support to countries; ensuring access to essential medicines, diagnostics and commodities; and mobilizing resources. Harm reduction was a marginal strategy, normally conducted by small nongovernmental organizations which encountered all sorts of difficulties. WHO, together with the United Nations Office on Drugs and Crime, the Joint United Nations Programme on HIV/AIDS and other United Nations agencies, as well as bilateral partners, such as the Swedish International Development Agency, the Australian Agency for International Development, and the United Kingdom Department for International Development, among others, helped to include harm reduction as the core strategy to confront HIV/AIDS among people who inject drugs. The Swedish International Development Agency, or Sida, has been particularly helpful with the HR3 Project. Following the first Project Advisory Committee meeting a year ago in Phnom Penh, Cambodia, the evaluation of the project in its first year is the main objective of this week's meeting. We are happy to welcome today people involved in the response to HIV/AIDS of the three main countries involved in this project: Cambodia, the Lao People's Democratic Republic and Viet Nam. We also are pleased to welcome our main partners in

19 this effort such as UNODC, UNAIDS, the United Nations Regional Task Force members, and members of the community, very well represented by the International Network of People Who Use Drugs. I would like to make special mention of the Governments of China, Indonesia and Malaysia, who generously are sharing their successful experiences with us. Also, it is important to highlight the presence of AusAID and its Regional Harm Reduction Project which is interacting with us in many of the countries in the Region. HR3 is not a classic parallel project, but it was developed in coordination with the national strategic plans of Cambodia, the Lao People's Democratic Republic and Viet Nam. It is intended to complete, fill the gaps and complement the stakeholder's actions to face the epidemics in each country. It also was meant to promote harm reduction as an evidencebased strategy to confront the HIV/AIDS epidemic among people who inject drugs, encompassing the strategy in regular governmental and civil society activities. As a project coordinated by the WHO Regional Office for the Western Pacific, it was directed at enhancing the health sector response to the problem, but with a clear vision of the involvement of law enforcement and other sectors to make the needed changes in the environment and therefore facilitate the response to the threat of HIV/AIDS. I am certain you will have fruitful discussions and will reach decisions to help enhance the quality of this project for its second year and therefore the response to the HIV/AIDS epidemic in the Region. Thank you and enjoy your stay in Manila.

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78 ANNEX 6 Combined Work Plan for 2009 Technical Officer: HIV/AIDS, Drug Dependence & Harm Reduction WR Cambodia No ACTIVITY DESCRIPTION Engaging Police Force in AIDS Response in Asia & the Pacific: Regional Forum followed by High Level Meeting, Bangkok (Output 1) 9 th International Congress on AIDS in Asia & the Pacific, Bali, Indonesia: "Empowering People, Strengthening Networks" (Output 1) Monitor & evaluate the National Strategic Plan for Drug related HIV & AIDS, (Output 1) 4 Support DHA Working Group meetings (Output 1) MoH and Law Enforcement review of MMT Programme in Yunnan Province, China (Output 2) Implementation of VCCT, OI & ART demonstration sites for DU/IDU (Output 2) 19 th International Harm Reduction Conference, Bangkok (Output 2) Training to outreach teams to treat overdose and furnish teams with Naloxone (Output 2) Develop & implement operational modalities for VCCT, OI & ART access for DU/IDU in, and released from, drug treatment & rehabilitation centres (Output 2) Bridging funding gap for Korsang harm reduction medical clinic (Output 3) Continued of harm reduction capacity building of 5 Govt. & NGO partners in 5 provinces by Friends International (Output 3) Conduct donor meetings to report on progress made in the implementation of the National Strategic Plan for DU/IDU & HIV/AIDS & advocate for funds to address gaps (Output 3) Salary of WHO Technical Officer: HIV/AIDS, Drug Dependence & Harm Reduction & Duty Travel (Output 4) Consultant support to write a sub-grant for HIV prevention, treatment & care for DU/IDU for Round 10 of the Global Fund to Fight HIV/AIDS, TB & Malaria (Output 4) - TOTAL TIMEFRA ME FUNDING COST (USD) Feb. 3-6 Sida HR3 $5,000 Aug 9-13 Sida HR3 $10,000 Jan 1-Dec 31 Jan 1-Dec 31 Sida HR3 $1,000 Sida HR3 $4,000 Jan Sida HR3 $5,000 Jan 1-Dec 31 Sida HR3 $50,000 Apr Sida HR3 $10,000 Jan 1-Dec 31 Jan 1-Dec 31 Jan 1 Mar 31 Apr 1-Dec 31 Jan 1-Dec 31 Jan 1-Dec 31 Sida HR3 $5,000 Sida HR3 $10,000 Sida HR3 $8,000 Sida HR3 $42,750 Sida HR3 $1,000 Sida HR3 $179,400 Apr Jul Sida HR3 $15,000 Jan 1-Dec 31 Sida HR3 $346,150 Sida HR3 Building Comprehensive Harm Reduction Services for Injecting Drug Users in the Lao People s Democratic Republic, Cambodia and Viet Nam: Towards Universal Access to HIV/AIDS Prevention, Treatment & Care, Swedish International Development Agency (Sida), Harm Reduction, Human Resources & Human Rights (HR3).

79 Draft workplan and budget 2009 WR Laos V1 15/12/09 Sida Project on Harm Reduction 1. Attend conference What Activity Timeline Budget (USD) 10,000 Harm Reduction Conference in BKK 5 persons from LCDC, MOH and CHAS would attend the harm reduction (HR) conference in BKK April Study-tour What Activity Timeline Budget (USD) Study-tour to Malaysia HR Transborders activities 5 persons from LCDC, MOH and CHAS August 2009 Facilitate trans-borders HR dialogue, starting with China , Policy/Guidelines/advocacy What Activity Timeline Total budget (USD) Training of keypeople on guidelines for close-settings Finalizing the Drug dependency treatment policy Training Consensus and approval 2009 In parallel to HR policy development (possible integration) 56,000 Finalizing the National Drug Policy Translation and printing of documents As needed 1

80 4. Rapid Assessment and Response/ Surveillance, in addition of 2008 budget What Activity Timeline Total budget (USD) Injecting (behavioral) survey in selected locations and size estimation (rapid assessment and response) Integration of drug use and HIV prevalence in HIV surveillance - review of existing data - urban rural mix of locations - TA - Stakeholder meetings and consultations Design of response activities - Data collection (RDS?) - Implementation of response activities - Review of existing IEC material and further development - Data Analysis - Consensus meetings - Dissemination (translation, printing) , WHO Programme Officer What Activity Timeline Total budget (USD) Support the HR work with the task-force Running costs of the secretariat As soon as possible 28,000 2

81 Draft Project Work Plan of Viet Nam, 2009 Outputs and activities Output 1: Regional and in country communication and collaborative mechanism supported and enhanced 1.1. Strengthening of national harm reduction working group involving concerned ministries, projects and partners 1.2. Capacity building of MOPS, MOLISA and closed settings in harm reduction including basic care 1.4. Organize multi-sectoral delegation (MOH-MOPS-MOLISA) to international field workshop Output 2: Best harm reduction practices disseminated and regional exchange of programme management experience 2.1. Review of national harm reduction implementation and effectiveness for the development of new national HIV strategy including documentation of good practices from different project sites (in collaboration with DFID-WB, and Pepfar) National Workshop on harm reduction implementation 2.3. Strengthening of capacity of VAAC and other relevant bodies to monitor and support harm reduction interventions at local level and to improve quality 2.4 To support piloting of an electronic monitoring system of harm reduction interventions. Output 3: Community based organizations for the delivery of harm reduction services are advocated for and supported 3.1. Documentation, sharing, and promotion of peer support groups of IDU and SW 3.2. Continue development and implementation of comprehensive model including NSP, MMT, care and treatment, linkage between TE center and community based services involving MARPs and PLHIV in Hai Duong province. Amount 75,000 15,000 40,000 20,000 95,000 40,000 10,000 30,000 15,000 60,000 20,000 40,000 Output 4: Regional and county-specific technical assistance provided 70, National project officer 30, Duty travel 10, Short term consultant 30,000 Total 300,000

82 ANNEX 7 Draft regional workplan and budget, 2009 Sida Project on Harm Reduction 1. United Nations Regional Task Force on Injecting Drug Use and HIV/AIDS for Asia and the Pacific. What Activity Timeline Budget (USD) Current expenses: meetings, documents, consultancies Semester Meeting of the Regional Task Force; Consultancy for estimation of the cost of scaling up HR interventions in the region; Tentatively March and September 1 st trimester of , Other activities of the Task Force During Community Consultation Back to Back with the Harm Reduction Conference What Activity Timeline Total budget (USD) Mobilize the regional community of people who use drugs for a meeting in Bangkok Meeting in Bangkok will join people who use drugs from different countries of the region to discuss further collaboration of PWUD in the response of the HIV/AIDS epidemic in the region. April ,

83 3. Support Countries from the region to build their capacity participating in relevant Regional and International meetings. What Activity Timeline Total budget (USD) International Harm Reduction Conference, 2009, Bangkok, Thailand International Congress on AIDS in Asia and the Pacific (ICAAP), 2009 in Bali, Indonesia - Involve country participants from the Ministry of Health and from NGOs in the Conference, as participants - Involve country participants from the Ministry of Health and from NGOs in the Conference, as participants > April , > August , Publish a case study of Good Practices from Viet Nam What Activity Timeline Total budget (USD) Publication of a "case study" of the Harm Reduction Response in Viet Nam in the series "Good Practices" Compile information, getter it and publish. 1 st semester of , Collaborate with the Organization of a Workshop in Methamphetamines Drug Treatment What Activity Timeline Total budget (USD) Together with UNODC Bangkok and WHO SEARO, organize a workshop in Evidence Base Drug Treatment for Methamphetamines. Prepares and develop a workshop in Lao PDR with specialists, Member Sates and civil society on evidence based treatment for methamphetamine March ,