Civil society groups across Eastern Europe and Central Asia are consolidating resources and presenting a unified front to national governments to call for a greater domestic investment in harm reduction as part of the HIV response.
As the resources available from the Global Fund for regional programs are limited due to the implementation of the new funding model (NFM), there is a very real risk to the sustainability of existing harm reduction activities across the region -- most of which were in large part supported by Global Fund grants.
At a series of regional events hosted by the European Harm Reduction Network (EHRN) in Georgia and Latvia, civil society stakeholders were exhorted to plan strategically and develop an evidence base for the value of harm reduction programming in order to advocate with national governments.
Advocacy by communities in favor of policy change is the only way harm reduction will make it on to the agenda, and into the budget, of regional governments, said Anna Dovbakh, deputy director of technical support and information for EHRN -- itself a recipient of a Global Fund regional grant. In response to declining support from the Fund, the network itself is transitioning away from direct service provision into a more strategic role, helping at the country-level to develop advocacy and policy campaigns to promote harm reduction as a pillar of the public health response to HIV.
Stakeholders from countries participating in the EHRN meetings were encouraged to share best practices and demonstrate how the case can be made for governments to support harm reduction, which has been politically sensitive due to the nature of responding to the needs of people who inject drugs. But because this vulnerable population is the driver of the majority of HIV infections in the region, doing nothing poses an even greater health risk, noted Dovbakh.
Much of the discussion was conducted within the context of the three-year regional initiative underwritten by the Global Fund called Harm Reduction Works: Fund It!
Launched in May 2014 in Belarus, Georgia, Kazakhstan, Moldova, Tajikistan and Ukraine, the program seeks to mobilize community support as a political tool to encourage legislative and budgetary support for harm reduction.
An assessment tool for community-level stakeholders to measure program quality and accessibility was presented at the Georgia meeting, to allow individual countries to prioritize the right kinds of activities and interventions based on the needs of their populations. Developing this evidence base will go a long way towards building an investment case for harm reduction, according to EHRN.
There are some good examples of state-supported harm reduction in the region; Ukraine, for example, is seen as a regional leader in integrating opioid substitution therapies, needle exchange and methadone programs into its national response to HIV. Other best practices were shared during a session co-sponsored by the International Alliance - Ukraine that included representatives from Armenia, Azerbaijan and Russia.
Although the majority of Global Fund-eligible countries in EECA saw their envelopes diminish in the March 2014 announcement of country allocations under the NFM, the region remains eligible for regional programmatic support. EHRN together with the East Europe and Central Asia Union of People Living With HIV (ECUO) were invited to submit a proposal for a 7 million-dollar project to strengthen the advocacy potential of communities to ensure the sustainability of harm reduction and HIV programming.
Regional dialogue has begun and a three-day workshop took place October 19-21 to begin to develop the concept note, due in January 2015. Lively discussions about what areas to emphasize, how to achieve maximum efficiency and how to ensure collaboration and coordination ensued, according to Gennady Roshchupkin, a participant and the co-founder of the Eurasian Coalition on Male Health.
"We met against the backdrop of a bleak picture due to a funding crisis, but gradually realized that there are opportunities available -- we just have to move quickly," he told Aidspan. "Some of our priorities are bringing drug prices down, changing the policy environment and implementing the [new WHO recommendations on ARV use]. In order to accomplish this, we have to work hard on coming up with a cooperative strategy [involving all of the participating countries]. So that is where our emphasis needs to be, now."