the aids walk approaches - 
the ways you can support ending the pandemic abound!
that's the focus of this blog update:


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collective documentary Stigma: HIV/AIDS and Youth in NYC!


check out www.endaidsnow.org (we endorsed the campaign today)


donate to me for the aidswalk (go to www.aidswalk.net/newyork and search team 9124 - LPOV


get your org to endorse this letter by emailing tobias@harmreduction.org

May 10, 2005

Ambassador Randall Tobias
Office of the United States Global AIDS Coordinator
US State Department
2201 C Street NW
Washington DC 20522

Dear Ambassador Tobias:

As the US increases its commitment to global HIV prevention efforts, we
write to express our concern about recent reports that US officials have
questioned the efficacy of needle exchange programs and sought to block
support for needle exchange in United Nations resolutions and policy
documents.  As you know, the sharing of syringes by injection drug users is
a major driver of the AIDS epidemic both in the United States and
internationally.  As researchers, practitioners and representatives of
affected populations, we affirm the important role that needle exchange and
other sterile syringe programs play in helping to avert the spread of

Outside of Africa, an estimated one-third of new HIV infections are
attributed to injection drug use.  In some countries, the proportion is
even higher.  In Russia, as many as 1.2 million people are living with HIV,
with 75 percent of new infections stemming from injection drug
use.  Injection drug use accounts for the majority of HIV/AIDS cases in
Ukraine, all of the Baltic States, the Central Asian Republics, Indonesia,
Nepal, Iran, and Pakistan.  In China, Vietnam and Malaysia, the majority of
those living with HIV are injection drug users. Often, the vast majority of
those infected are under thirty.  Injection driven HIV epidemics
consistently spread faster than sexually transmitted epidemics such as
those found in sub-Saharan Africa.

In the United States, according to the Centers for Disease Control and
Prevention, 23 percent of new AIDS cases reported in 2003 were attributed
to injection drug use and/or sex with an injection drug user.  This
percentage is higher for women and African American men.  Of all cases
diagnosed through 2003, 53 percent of cases among women and 43 percent
among African American men were attributed to injection drug use or sex
with an injection drug user.

As the US Public Health Service has noted, for injection drug users who
cannot or will not stop using drugs, using sterile syringes remains the
safest and most effective method of HIV prevention.  Medically appropriate
treatment remains out of reach to the vast majority of drug users who need
it: in the United States, one of the world’s richest countries, over 80
percent of those needing treatment for drug abuse as of 2000, did not have
access to it.  At the same time, extensive evaluation and research has
shown that sterile syringe programs can dramatically decrease the spread of
HIV without increasing drug use.  These programs can additionally provide a
bridge to drug treatment services by offering clients with information and
referrals to treatment providers.  No fewer than seven federally-funded
reviews and reports conducted by public health officials, researchers and
US government agencies have concluded that syringe exchange programs are
effective, safe and cost effective.

The efficacy of syringe exchange has recently been affirmed by the US
government’s top scientists.  In an October 7, 2004 letter to Congress,
Director of the National Institutes of Health Dr. Elias Zerhouni stated,
“Research shows that SEPs [syringe exchange programs], when implemented as
part of a comprehensive HIV/AIDS prevention strategy, can be an effective
public health approach to reduce the spread of HIV and other blood borne
pathogens in the community.” In an August 4, 2004 letter, Director of the
National Institute on Drug Abuse Dr. Nora Volkow stated, “The majority of
studies have shown that NEPs/SEPs [needle exchange programs/syringe
exchange programs] are strongly associated with reductions in the spread of
HIV when used as a component of comprehensive approach to HIV prevention…
In addition to decreasing HIV infected needles in circulation through the
physical exchange of syringes, most NEPs/SEPs are part of a comprehensive
HIV prevention effort that may include education on risk reduction, and
referral to drug addiction treatment, job or other social services, and
these interventions may be responsible for a significant part of the
overall effectiveness of NEPs/SEPs. NEPs/SEPs also provide an opportunity
to reach out to populations that are often difficult to engage in treatment.”

In 2004, this consensus was reinforced by the World Health Organization
(WHO), which stated that the available data “present a compelling case that
needle and syringe programs substantially and cost effectively reduce the
spread of HIV among injection drug users and do so without evidence of
exacerbating injecting drug use at either the individual or societal
level.”  The WHO accordingly recommended that “authorities responsible for
areas threatened by or experiencing an epidemic of HIV infection among IDUs
(injection drug users) should adopt measures urgently to increase the
availability and utilization of sterile injecting equipment and expand
implementation to scale as soon as possible.”

As the single largest funder of global HIV/AIDS programs in the world, the
US carries enormous influence in shaping global approaches to the
epidemic.  Even beyond its role as a donor, many look to the United States
for guidance in the design and implementation of their programs.  The fact
that the United States remains the only country in the world to impose an
explicit ban on federal funding of needle exchange already sets a poor
example to other nations battling severe injection-driven HIV/AIDS
epidemics.  It is more critical than ever that US agencies communicate
accurate information about needle exchange, faithfully represent the public
health consensus supporting these programs, and refrain from standing in
the way of countries, and organizations within its own borders, that wish
to pursue this proven, effective method of prevention.  With so many at
risk for HIV, we need all the tools we have.


amfAR, The Foundation for AIDS Research, New York, NY
GMHC, New York, NY
Harm Reduction Coalition, New York, NY
Housing Works, New York, NY
Human Rights Watch, New York, NY
North American Syringe Exchange Network, Tacoma, WA
League of Pissed Off Voters, New York, NY
Open Society Institute, New York, NY