Open letter to the Global Fund
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24.06.2011

Mr. Martin Dinham
Chair of the Board
The Global Fund to Fight
AIDS, Tuberculosis and Malaria

The Global Fund to Fight
AIDS, Tuberculosis and Malaria Board Members

We, the undersigned leaders and activists representing affected communities and non-governmental organisations working in the field of HIV/AIDS prevention, care and treatment around the world, address you with this letter in advance of the Global Fund’s 4th Partnership Forum which will take place on 28 - 30 June 2011 in Sao Paulo, Brazil. We ask you to consider at the Forum the development and introduction of a formal strategy and its implementation plan aimed to address the vulnerabilities and the needs of injection drug users.  During the meeting in Brazil, we will also urge participants at the Partnership Forum to identify the introduction of such a strategy to the Global Fund Board as one of its priority recommendations.
Of the estimated 15.9 million people who inject drugs globally, around 3 million are living with HIV. Injecting drug use with unsterile equipment accounts for at least 10 percent of global HIV infections and around 30 percent of HIV infections outside of sub-Saharan Africa. Drug injecting has been formally documented in 151 countries and 120 countries report HIV infections among people who inject. In some Eastern European and Central Asian countries, up to 37% of injecting drug users live with HIV.
The Global Fund plays a key role in HIV prevention, treatment, care and support for people who inject drugs in low and middle-income countries and has become a major source of international funding for these activities. Between 2004 and 2009, it invested around US$ 180 million in harm reduction interventions in 42 countries. Thanks to the Global Fund, 3 million people living with HIV around the world, including drug users, have gained access to antiretroviral drugs.
 Despite these significant advances people who inject drugs have consistently less equitable access to HIV prevention, treatment, care and support, even in countries where HIV programs supported by the Global Fund have been implemented. Access to these services is often limited by stigma, discrimination and the denial of human rights. As their behavior is criminalized in most countries, people who inject drugs often face incarceration (or, in some countries, extrajudicial detention) further limiting access to comprehensive HIV services.
In spite of all of these challenges in their proposals to the Global Fund many countries request significantly less resources than they require to adequately address the needs of people who inject drugs. Only 3% of Global Fund HIV portfolio funds were allocated for harm reduction activities within Rounds 7, 8 and 9 budgets. Harm Reduction International (formerly known as the International Harm Reduction Association) estimates that US$ 160 million was spent on harm reduction in 2007 in low- and middle-income countries – less than US$ 13 per person who injects drugs. Other harms related to drug use include hepatitis C (HCV) which is becoming the leading cause of death amongst people living with HIV in Western Europe, and overdose which is the leading cause of death for injecting drug users in the region of Eastern Europe and Central Asia.
Past initiatives and strategies introduced by the Global Fund have been effective in meeting the needs of other marginalized key affected populations including: women and young women; men who have sex with men; sex workers; transgender people; and pregnant women living with HIV. To address the needs and vulnerabilities of people who inject drugs, a formal strategy and implementation plan needs to be introduced as a matter of urgency. It should outline concrete actions that the Global Fund can take, as a major international funding entity addressing health challenges based on scientific evidence, human rights principles, and measurable outcomes, to encourage countries to address the vulnerabilities and the needs of people who inject drugs.
We wish to emphasise our continued commitment to promoting for equitable access to HIV prevention, treatment and care for people who use drugs.