Civil society says to United Nations: Eastern Europe and Central Asia message to the HIV Declaration
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11.04.2011

Member states must prioritize evidence-informed and comprehensive interventions targeting populations at higher risk of HIV infection i.e. people who inject drugs, men who have sex with men (MSM), sex workers, women and girls, migrants, prisoners and others. Human rights, dignity and fundamental freedoms should be at the basis of all responses to HIV/AIDS, reproductive and sexual health, and drug use.
Ten percent of all HIV infections are the result of unsafe injection. People who inject drugs account for 30% of HIV infections outside of sub-Saharan Africa, and up to 80% of infections in Eastern Europe and Central Asia. The interrelated nature of  drug use and HIV epidemics requires that drug use should be first and foremost treated as a health issue in laws, policies and practices. The vulnerability of women and girls, especially due to strong links between drug use, sexual relations with drug using partners and sex work, results in the greater feminization of the HIV epidemic and requires gender sensitive responses that would be appropriate for women and men.
The epidemic among gay men and other MSM continues to be hidden in most countries but could be 19 times higher than in the rest of the population and needs to be openly recognized and adequately addressed. People living with HIV (PLHIV) and other key populations have directly experienced the factors that make individuals and communities vulnerable to HIV infection. Their involvement in programs and policymaking will  improve the relevance, acceptability and effectiveness of the responses.
While we celebrate the great success of introducing and scaling up treatment and care for PLWHIV, we are concerned with the low rates of access to antiretroviral therapy in some regions as well as low responses to co-infections with tuberculosis and hepatitis C.
United Nations’ agencies should support the efforts of civil society to make the voices of vulnerable communities, particularly people who use drugs, heard and help ensure universal access to HIV prevention, treatment, care and support.
1. HIV funding should be urgently reframed as a vital investment in national economies, lives and wellbeing of future generations. Member states in cooperation with international community should develop national and regional HIV investment plans to ensure long-term economic gains and to achieve optimal health outcomes at individual, community and society levels. Such plans should become the basis for sustainability of the HIV response irrespective of the current economic environment.
2. Barriers created by laws and policies that interfere with health service delivery and increase vulnerability of the key populations should be removed immediately and legal services should be expanded. The time has come to align drug control and public health priorities. In particular, the Drug Conventions should be revisited and amended to reflect modern health science and respect for human rights and with the explicit objective of facilitating, not obstructing, universal access to health care. National policies should be revised to eliminate gender inequality, as well as marginalization and criminalization of sex work, homosexual relations, HIV travel restrictions and unintended HIV transmission.
3. Adequate coverage of the vulnerable populations with comprehensive interventions should be achieved. Political compromises limiting access to lifesaving medicines and leading to violations of the RIGHT TO LIFE should be immediately removed. Member states should immediately remove all barriers limiting access and coverage of people who use drugs with the comprehensive package of prevention, care and treatment interventions recommended by WHO, UNODC and UNAIDS (2009) including HIV, tuberculosis, hepatitis, and drug dependency. Opioid substitution therapy should be provided in all settings in which people are likely to benefit, including harm reduction programs, hospitals, detention centers and prisons. In addition to the basic comprehensive package, all countries with HIV epidemics among people who inject drugs should establish and expand overdose prevention interventions, including education on overdose prevention and management and distribution of naloxone – a safe, highly effective opioid overdose antidote – to people who inject drugs. There are many reasons to urgently take up overdose programs, including that overdose is a major cause of death among people who use drugs who are living with or at risk of HIV infection, nonfatal overdose may exacerbate HIV disease, and overdose prevention programs may link new clients to HIV prevention, care and treatment programs. Bearing in mind that HIV prevalence in men who have sex with men is higher in most countries Member states should guarantee universal access to comprehensive prevention, treatment and support services for gay men, and other MSM to ensure minimum 60% coverage of services in this particular community by 2014. Member states should prioritize, guarantee and fund access to antiretroviral medicines, tuberculosis and hepatitis C treatments for all in need. Effective tools to reach this goal should include price reduction, generic medicines production, efficient and transparent medicine supply systems. Effective tools to reach this goal should include price reduction, generic medicines production quality control, efficient and transparent drug supply systems, patent pools, use of intellectual property flexibilities.
Members state should commit to increasing the number of people on equitable, affordable, acceptable and quality ART and act immediately by taking real actions and funding appropriate scale up of access to ART.
With a growing number of people receiving lifesaving ART and reported ART medicines stock outs worldwide, member states in cooperation with civil society and with the international community support should evaluate and adjust medicine procurement system in order to avoid bottlenecks and stockouts by the end of 2012.
4. Meaningful and direct involvement of civil society, particularly key populations, in HIV-related decision making and implementation of relevant interventions should be ensured. Member states and the international community must ensure and support meaningful involvement of PLHIV, people who use drugs, men who have sex with men, sex workers, women and girls, migrants and prisoners in HIV response, including facilitating their participation in national and international decision-making processes and program implementation evaluation and monitoring. This will improve quality of interventions and contribute to their successful implementation and uptake. Infected and affected communities should take active positions in protecting the rights and interests of their constituents.