Representatives of 19 international and regional harm reduction organizations meeting in Toronto this week have issued a declaration calling for immediate action to address the spread of HIV through injection drug use. Known as the Declaration of Unity, the statement demands that governments and international anti-drug organizations stop impeding the adoption of harm reduction measures proven to reduce the spread of disease, such as needle exchanges and safe injection sites.

The groups urged governments to:

• provide adequate coverage and low threshold access, including in correctional settings, to sterile injection equipment, condoms, methadone and buprenorphine as essential components of comprehensive HIV prevention and care;
• ensure that drug users and all marginalized populations have equitable access to quality HIV prevention, medical care, and highly active antiretroviral treatment, that concrete country-level and global targets be established, and that progress be monitored;
• provide meaningful involvement of drug users at all levels of planning and policy, and financial support for their organizations; and
• put an end to disenfranchisement and human rights violations of drug users including mass imprisonment, punitive and degrading drug treatment programs, and the widespread use of withdrawal as a form of coercion.

Noting that UNAIDS cannot effectively slow the spread of HIV when forces within the UN system are creating obstacles to effective harm reduction measures, the groups demanded that:

• the United Nations Office on Drugs and Crime, as the UN agency tasked with leadership on HIV prevention among drug users, ensure that effective community protection against HIV is not ignored in the name of drug control and law enforcement;
• the International Narcotics Control Board, as the body charged with responsibility for monitoring implementation of the drug treaties, publicly and unambiguously endorse and promote harm reduction as an approach consistent with those treaties and monitor global delivery of substitution treatment and HIV prevention measures for drug users;
• the international community and all major UN bodies involved in drugs and HIV approach drug use as a health and social matter which also requires some law enforcement interventions rather than being primarily a matter of criminal justice.

The harm reductionists from around the globe were in Toronto for the International AIDS 2006 conference. "HIV is being spread increasingly -- in some parts of the world, chiefly-through the sharing of injecting equipment, said Dr. Diane Riley, who signed the declaration on behalf of the Canadian Foundation for Drug Policy and the Youth Network for Harm Reduction International. "Considerable evidence exists that harm reduction strategies such as needle exchange programs can effectively, safely and cheaply reduce the spread of HIV; yet very few such programs are in place. Governments are in effect spreading infection through their own drug control and enforcement policies which encourage use of non-sterile equipment, and marginalization and incarceration of users," Riley added in a press release announcing the declaration.

"The United States, the world's most important donor of international aid, restricts implementation of harm reduction strategies," Riley charged. "Political and social commitment, including commitment of the necessary resources, and an end to the US administration's embargo on harm reduction are needed now," Riley said. "If we fail to do this, further catastrophe is inevitable and the global economy will simply not be able to cope with the resultant burden."