Programme Slowing the HIV and HCV epidemics among people who inject drugs Monday 26 Wednesday 28 February 2018 WP1578

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1 Programme Slowing the HIV and HCV epidemics among people who inject drugs Monday 26 Wednesday 28 February 2018 WP1578 Context People who inject drugs (PWID) are at much higher risk of HIV, hepatitis C (HCV) and HIV/HCV co-infection than the general population. Of the estimated 15.6 million PWID globally, approximately one in six (17.8%) are living with HIV and more than half (52.3%) are living with HCV. The vast majority of PWID living with HIV are co-infected with HCV (82.4%). Globally, PWID represent 23% of new HCV infections and 31% of HCV-related deaths. Regionally, Eastern Europe and Latin America are estimated to have the highest prevalence of HIV and HCV among PWID. Though significant progress has been made to curb these epidemics, PWID remain particularly susceptible to new infections, co-infections, chronic diseases and mortality. In 2011, the United Nations set a target to cut new HIV infections among PWID in half by However, new HIV infections in PWID increased by 33% between 2011 and In 2015, the internationally agreed Sustainable Development Goals included a new call to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol (SDG3). The demographics of PWID vary by geography, age and gender, which further complicate public health and drug policy. The largest populations of PWID are in East and Southeast Asia, Eastern Europe and North America. Additionally, PWID in high-income countries tend to be older and include a higher proportion of women than those in low-income countries. Many countries around the world are also experiencing rising overdoses and drug-related deaths as opioid addiction and injection drug use continue to increase. PWID continue to face significant social and structural barriers to healthcare that are rooted in stigma, discrimination and criminalisation. According to UNAIDS, over half of PWID will be incarcerated at some point in their lives. While in prison, PWID are further exposed to HIV and HCV through continued, unsafe drug use. PWID are also more likely to engage in sex work and are at higher risk of homelessness or unstable housing. In association with: /RH/LE

2 Available tools Many proven tools and strategies already exist to improve the health and lives of PWID. The United Nations Office on Drugs and Crime (UNODC), World Health Organization (WHO) and UNAIDS support expansion of evidence-based, harm reduction interventions, and recommend integrating them with other health and social services to reduce vulnerability to infectious diseases. Proven harm reduction measures include: syringe exchange programmes, opioid substitution therapy, voluntary HIV/AIDS and HCV testing and treatment, overdose prevention and voluntary treatment for drug dependence. Service integration is recommended by UNODC, WHO and UNAIDS and mounting evidence shows that comprehensive harm reduction programmes can reduce new HIV and HCV infections, improve adherence to antiretroviral therapy and HCV treatment. Historically, support for these programmes has been tied to HIV funding; however, increased momentum around global HCV goals could expand support for integrated PWID treatment and care. Barriers to access Notwithstanding efforts to address HIV and HCV, stakeholders remain concerned that global goals have not generated the support and funding needed to serve PWID. Proven interventions have not been brought to scale and life-saving medicines are still difficult to access due to prohibitive laws and policies. The latest data show that, out of 179 countries where injection drug use has been reported, only half provide some level of needle and syringe programmes (52%) or opioid substitution therapy (45%). Less than one per cent of PWID live in countries with high coverage of both needle and syringe programmes and opioid substitution therapy. There is also growing concern over reduced funding from global donors for harm reduction programmes, particularly in middle-income countries where many PWID live. New commitments and policies that address these access challenges through a human rights lens will be key to reaching PWID effectively and slowing the HIV and HCV epidemics. Whilst funding for HIV/HCV co-infection has been made available through traditional HIV funders (Global Fund, UNITAID, United States Agency for International Development (USAID), United States Centers for Disease Control and Prevention (CDC)) funding for HCV treatment and care remains a significant challenge. Addressing the challenges: aim and objectives This Wilton Park meeting will convene high-level stakeholders including policymakers, researchers, clinicians, advocates, implementers and industry representatives, to discuss how to reach PWID with HIV and HCV prevention, treatment and care measures. Specifically, discussion will aim to: Identify effective strategies to overcome barriers to providing PWID with health care, including reaching incarcerated PWID populations. Share lessons from countries that have successfully carried out effective PWID programmes.

3 Look for synergies to expand integrated service delivery models for PWID. Recognise and strengthen the role of community networks of PWID in the response. Determine how to better coordinate across sectors to improve data collection, surveillance and research. Build the case for international donors to invest in evidence-based solutions. Explore how global frameworks such as the UNAIDS Fast-Track Strategy to End the AIDS Epidemic by 2030, WHO Global Health Sector Strategies for HIV/AIDS and Viral Hepatitis, 2016 United Nations General Assembly Special Session (UNGASS) on the World Drug Problem Outcome Document and Sustainable Development Goals commitments to leave no one behind can be leveraged for greater political and financial support for PWID programmes and policies. Create a roadmap of opportunities, milestones and actions in the lead-up to the 2018 International AIDS Conference in Amsterdam, and the 2019 UNGASS on the World Drug Problem that will take place in March 2019 in New York. In partnership with the Global Health Group at the University of California, San Francisco and Gilead Sciences, Inc. Monday 26 February Participants arrive and buffet lunch available Welcome and introduction Robin Hart Barriers and opportunities for progress What are the major global and regional issues political, legal and social that PWID face trying to access care? What is the latest public health research on the state of HIV and HCV access and how can this shape policy? How do affected communities view the barriers and opportunities? Chair: Robin Hart Michel Kazatchkine Special Advisor to the Joint United Nations Programme on HIV/AIDS (UNAIDS) for Eastern Europe and Central Asia; Member, Global Commission on Drug Policy, Geneva Julie Bruneau Professor, Department of Family Medicine and Emergency Medicine, CRCHUM, University of Montréal Judy Chang Director, International Network of People Who Use Drugs (INPUD), London Photograph followed by tea/coffee

4 Working towards global policy coherence What are the ambitions of global policy? Where are the tensions? How are countries and programmes responding to this? What are the prospects for future global policy development? What are the international milestones and how can these be best used to achieve greater global coherence? How to find common ground? To what extent is policy coherence, or lack of, impacting at the country level? Chair: Anton Ofield-Kerr Director, Equal International Consulting Ltd, Horsham and Robin Hart Ann Fordham Executive Director, International Drug Policy Consortium, London José Queiroz Executive Director, Piaget Agency for Development, Porto 1900 Reception followed by dinner with speaker HIV, morality, politics and the law Michael Kirby Former Justice, High Court of Australia, Sydney introduced by: Tuesday 27 February Breakfast Curbing the HIV and HCV epidemics: what progress? What progress is being made in curbing HIV and hepatitis C generally, including through medical interventions? What progress has been made towards achieving the UNAIDS HIV Fast Track Goals, and in particular, ensuring that no one is left behind? How is the WHO s new global strategy on viral hepatitis working at country level? How are national hepatitis strategies developing and are they including strategies to reach PWID? Chair: Gregg Alton Executive Vice President, Corporate and Medical Affairs, Gilead Sciences, Inc., Foster City Margaret Hellard Co-Chair, World Health Organization (WHO) Strategic and Technical Advisory Committee on HIV and Viral Hepatitis; Deputy Director (Programs), Burnet Institute, Melbourne Grigory Kaminskiy Head, Infectious Disease Department, National Medical Research Centre of Phthysiopulmonology and Infectious Diseases, Ministry of Public Health, Moscow John Kimani (by video link) Coordinator, Kenyan Network of People Who Use Drugs (KENPuD), Nairobi Jonathan Mermin Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta

5 Tea/coffee Curbing the HIV and HCV epidemics for PWID: what practical solutions and evidence-based models are working? What are the practical solutions for working across the law enforcement and public health sectors to reach PWID and curb the HIV and HCV epidemics? Chair: Robin Hart Carlos Magis-Rodriguez Director, Integral Care, National Programme on AIDS for Mexico, (Censida), Mexico City Tetiana Deshko Director, International Programmes, Alliance for Public Health, Kiev Nalinikanta Rajkumar President, Community Network for Empowerment (CoNE), Manipur Tengiz Tsertsvadze Director General, Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi Lunch Explore the garden (optional) How can shifts in policy drive access to prevention, treatment and care for PWID? Tea/coffee What are the local challenges that constrain PWID-focused programming? What changes might encourage shifts in local and regional policy to provide PWID with access to prevention, treatment and care? How can national budgets meet local PWID needs? What roles exist for international donors in both funding and policy? Chair: Anne Aslett Executive Director, Elton John AIDS Foundation, London Manpreet Chhatwal Project Director, Punjab State AIDS Control Society, Chandigarh Shaun Shelly Project, Policy, Advocacy and Human Rights Manager, TB/HIV Care Association, Cape Town Slowing the HIV and HCV epidemics for PWID: finding solutions: breakout discussions Introduction in plenary followed by discussion in four or five smaller groups to discuss how to bring about real change for PWID s access to prevention and treatment. Chair: Daniel Wolfe Director, International Harm Reduction Development, Public Health Program, Open Society Foundations (OSF), New York Possible themes for breakout groups: Translating science into effective policy and action: How? How can perceptions and care of PWID follow the scientific research and clinical guidelines? Why are PWID treated differently despite medical guidance? How can the science be better used to shape policy and programmes?

6 What role for community networks in the PWID response? How can the lived experience of PWID, their families and communities help shift national policy? How can community networks maximise their impact? What support do they need? Other potential themes for breakout groups: How can integrated service delivery be expanded? What is needed to improve data collection and surveillance for PWID? How can prisoners who inject drugs be reached while incarcerated and after release? How can programmes and policies be adapted for PWID who are women, sex workers and men who have sex with men? What is needed to reach adolescents and youth who inject drugs? How can funding for PWID health be increased and maintained? Slowing the HIV and HCV epidemics for PWID: finding solutions: feedback Chair: Daniel Wolfe Director, International Harm Reduction Development, Public Health Program, Open Society Foundations (OSF), New York A rapporteur from each group will summarise key points from their breakout discussion, followed by round-table discussion Reception followed by dinner hosted by: Sharmila Nebhrajani Chief Executive, Wilton Park Wednesday 28 February Breakfast and checkout Reflections Addressing policy pressure points for change Tea/coffee Chair: Monique Middelhoff Senior HIV and Health Adviser, Ministry of Foreign Affairs, The Hague Round-table discussion, with potential to break into smaller group discussion Evaluation survey Completion of online survey which will include participants outlining their actions Conclusions and next steps Round-table discussion of recommendations and next steps, including personal commitments. Chair: Michael Kirby Former Justice, High Court of Australia, Sydney

7 1300 Lunch Final remarks: 1400 Participants depart