"The fastest growing epidemics in the world are being driven by injection-drug use, and provision of sterile injection equipment is among the most important, proven strategies to contain them," said Kasia Malinowska-Sempruch of the Open Society Institute, another of the letter's signatories. "It is reprehensible that the U.S. would try to compel the U.N. to keep silent about one of the best studied and most effective HIV prevention measures."

Injection-drug use accounts for the majority of HIV cases in China, Iran, Afghanistan, Nepal, the Baltic states, and all of Central Asia, as well as much of Southeast Asia and South America. In Russia, where there are now more cases of HIV than in North America, as many as 80% of
infections are attributed to injection drug use.

Syringe exchange has been endorsed as an effective means of HIV-prevention by leading scientific, public health, and medical associations in the United States, including the American Medical Association, the American Public Health Association, and the National Academy of Sciences. The World Health Organization has also endorsed syringe exchange. Opponents of syringe exchange are among the same U.S. lawmakers who oppose sexually explicit HIV-prevention messages in favor of unproven "abstinence only" approaches.

"Whether it's sex or drugs, the U.S. is exporting an abstinence-only agenda to countries hard hit by HIV/AIDS," said Joanne Csete, executive director of the Canadian HIV/AIDS Legal Network. "If governments do not stand up to this bullying, millions will pay the price."

Human Rights Watch is an independent nongovernmental organization that monitors human rights developments in more than 60 countries worldwide. Human Rights Watch has issued numerous reports on human rights abuses against injection drug users that increase their risk of HIV/AIDS.

The Open Society Institute aims to shape public policy to promote democratic governance, human rights and economic, legal and social reform. On a local level, OSI implements a range of initiatives to support the rule of law, education, public health, and independent media. At the same time, OSI works to build alliances across borders and continents on issues such as combating corruption and rights abuses.

The Canadian HIV/AIDS Legal Network was founded in 1992 to promote the human rights of people living with and vulnerable to HIV/AIDS, in Canada and internationally, through research, legal and policy analysis, education, advocacy, and community mobilization. The Network is Canada's leading advocacy organization for legal, ethical, and human rights issues raised by HIV/AIDS.

Open Letter to the delegates of the Forty-eighth session of the Commission on Narcotic Drugs (CND)

The following letter was endorsed by 334 organizations and individuals in 56 countries.

March 1, 2005

In a year when the United Nations Office on Drugs and Crime (UNODC) is chair of the governing body of the UN's Joint Programme on HIV/AIDS (UNAIDS), we write to express concern about U.S. efforts to force a UNODC retreat from support of syringe exchange and other measures proven to contain the spread of HIV among drug users. Injection drug use accounts for the majority of HIV infections in dozens of countries in Asia and the former Soviet Union, including Russia, China, all of Central Asia, and much of Southeast Asia. In most countries outside Africa, the largest number of new infections now occurs among injection drug users. As UNODC director Antonio Maria Costa noted at the July 2004 International AIDS Conference, effective responses to injection driven AIDS epidemics require expanded HIV prevention, including syringe exchange, rather than policies that accelerate HIV infections through widespread and indiscriminate imprisonment.

Unfortunately, recent events suggest that UNODC-under pressure from the United States-is being asked to withdraw support from proven HIV prevention strategies at precisely the moment when increased commitment to measures such as syringe exchange and opiate substitution treatment is needed. It is particularly alarming that the silencing of UNODC is occurring in a year when the agency is chair of UNAIDS' Committee of Co-sponsoring Organizations and in a year when HIV prevention is a focus of thematic debate at the 48th meeting of the CND. Among the events that have particularly heightened our concern are:

Mr. Costa, who last year expressed support for positive changes in the Russian criminal code, expansion of syringe exchange in countries facing injection driven epidemics and other measures to reduce drug-related harm, has apparently been rebuked by the U.S. State Department. Following a meeting with Robert Charles, U.S. Assistant Secretary for International Narcotics and Law Enforcement Affairs, Mr. Costa pledged to review all UNODC electronic and printed documents for references to "harm reduction" and to be "even more vigilant in the future."

In Southeast Asia, UNODC has suspended a program that sought reduce drug users' vulnerability to HIV prevention through approaches that emphasized public health and drug users' human rights, rather than punishment.

Even syringe exchange, affirmed as an effective and essential part of HIV prevention by UNAIDS, WHO, and UN member nations, has become politically unpalatable. A November e-mail from a senior UNODC staff member asked junior staff to "to ensure that references to harm reduction and needle/syringe exchange are avoided in UNODC documents, publications and statements."

We recognize that UNODC is dependent on contributions from donor nations, and that the U.S. is the single largest donor to UN drug control. At the same time, the lives of hundreds of thousands depend on sound, scientific approaches to HIV prevention. Numerous studies, including U.S. government studies, have found that strategies such as syringe exchange and methadone maintenance demonstrably diminish HIV transmission and other health risks. The fact that U.S. delegates declare the evidence in support of syringe exchange "unconvincing," as they did in last year's CND session, should not be allowed to determine the course of the UN drug control and HIV prevention efforts, which are inextricably and essentially linked. Nor should UNODC-a co-sponsor of UNAIDS, and an agency with an essential role to play in the course of the HIV epidemic-be asked to refrain from public statements about needle exchange simply because they do not fall within the realm of what the U.S. deems acceptable.

Strategies that attempt solely to achieve abstinence from drug use do not constitute an acceptable alternative to programs, such as syringe exchange, that help active drug users protect themselves from HIV/AIDS. Experience has shown that "zero tolerance" drug control efforts can have the effect of driving injection drug users underground and away from drug treatment and other health services. This is particularly true where, as in many countries, counter-narcotics efforts lead to false arrest, beatings and extortion by police, prolonged detention without trial, forced drug treatment, disproportionate incarceration in cruel conditions and, in some cases, extrajudicial execution. Programs such as syringe exchange and opiate substitution, by contrast, both prevent HIV infection and can provide a bridge to other health services. Restricting these programs is a blatant infringement of drug users' human right to health.

As you gather this year to debate HIV/AIDS prevention and drug abuse, we respectfully urge you to support syringe exchange, opiate substitution treatment and other harm reduction approaches demonstrated to reduce HIV risk; to affirm the human rights of drug users to health and health services; and to reject efforts to overrule science and tie the hands of those working on the front lines. No less than the future of the HIV epidemic is at stake.

###