On 3 February 2022, Treatment Action Group (TAG), the International Network of People Who Use Drugs (INPUD), Harm Reduction International (HRI), and the World Hepatitis Alliance (WHA) co-hosted a PEPFAR Watch webinar ‘Promoting Interventions for Viral Hepatitis and Harm Reduction in PEPFAR COPs’. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is the largest source of funding for the HIV response globally. PEPFAR Watch brings together activists ahead of the Country Operational Plan (COP) planning process to develop priority recommendations and community demands for PEPFAR.
This particular PEPFAR Watch webinar focused on how to integrate harm reduction and viral hepatitis programming into COP guidance, to more effectively engage people who use drugs (PWUD). The program’s presenters emphasized why and how PEPFAR can integrate viral hepatitis and better serve affected drug user communities.
Here’s a brief rundown of what the speakers covered:
While PEPFAR-funded programs have implemented strategies for working with key populations at risk of and living with HIV, they’ve often overlooked people who use drugs. And yet, this is a highly vulnerable community central to PEPFAR’s mission: according to the presentation by Maria Goretti-Loglo of the International Drug Policy Consortium, an estimated 30 percent of people who use drugs in Africa are living with HIV, and drug use on the continent is projected to rise by 40 percent by 2030. While global health discussions have begun to shift from a ‘war on drugs’ framework to a harm reduction one, laws, culture and funding have been slower to change – and around the world, punitive environments surrounding drugs and a lack of social support for those who use them pose a serious problem for public health. A greater focus on harm reduction could bring marginalized people out of the shadows, and help connect them with health services. But as Colleen Daniels of HRI noted, harm reduction is seriously underfunded, with resources totaling only 5 percent of the global need – down from 13 percent in 2015. Only 0.05 percent of PEPFAR’s HIV programs go to address prevention among people who use and inject drugs.
Key Populations and Viral Hepatitis
Viral hepatitis is a significant burden within key populations benefiting from PEPFAR programs: as Danjuma Adda of WHA laid out that only 10 percent of people with HIV/HBV globally have been diagnosed, according to 2019 figures. With respect to HCV, there are 2.3 million people living with HIV/HCV globally, and over half of the estimated 15.6 million people who use and inject drugs test positive for HCV, explained Joelle Dountio O. of TAG. Yet, this is only a tiny fraction of diagnoses, let alone those who’ve been treated. Viral hepatitis is a ‘silent killer’ and a leading cause of death in the African region. When undiagnosed and untreated, viral hepatitis can lead to advanced HIV disease, liver disease, liver cancer, and liver failure. Simpler pathways and additional resources for testing and treatment would vastly improve the health and lives of some of the most vulnerable and overlooked people — people who use and inject drugs — in PEPFAR countries.
Advocacy and Integration
As several presenters stressed, harm reduction and viral hepatitis programming can and should be integrated into existing infrastructure for HIV, something advocates can push for in their COPs. One example of how to do this was offered by presenter Aditia Taslim of INPUD, who alongside other civil society organizations representing PWUD and men who have sex with men wrote a letter to Secretary of State Anthony Blinken demanding that their communities remain a key focus of PEPFAR funding. In another example, Olga Denisiuk, head of the Program Optimization and Research Team of the Alliance for Public Health, Ukraine shared with attendees how she worked with her colleagues to incorporate HCV testing in settings already providing HIV testing in Ukraine.
Other resources for activists who are involved in the COP process and to amplify funding priorities for harm reduction and prevention of HIV and viral hepatitis among people who use and inject drugs:
- Euroasian Harm Reduction Network documents HCV treatment access in the Eastern Europe and Central Asia (EECA) region: click here
- Euroasian Harm Reduction Network shares good practices and program implementation to address HCV elimination among people who inject drugs in the EECA region: click here
- INPUD has training materials and briefs related to HIV/HCV program implementation and care among people who use and inject drugs: click here
- INPUD’s submission to PEPFAR: Vision 2025: click here
Video recordings of the full webinar in English, Portuguese and French are below:
All speakers’ slides in English, Portuguese and French can be downloaded below: