Heidi Hautalan puhe hiv/aids-kokouksessa Moskovassa 10.10.2011
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MERGING EFFORTS AND RESOURCES FOR MAXIMIZING REGIONAL PROGRESS ON MDG-6
– Experience in Europe
First of all, let me thank you for the opportunity to speak here today. It is extremely encouraging that after the UN High Level meeting on AIDS in June we are already gathered here to discuss concrete ways of making our common vision of zero new HIV infections, zero discrimination, and zero AIDS-related deaths a reality.
Since this forum is also about development cooperation and because “charity starts at home”, I will share with you an experience in Europe, namely a good practice from my own country, Finland. I will then go on to discuss how development policy and cooperation can be used to achieve MDG 6.
The low threshold health service centers for people who inject drugs has been selected as an example of good practice because the service has played a successful role in Finland in reducing the HIV epidemic among one of the key populations at higher risk of HIV infection, people who inject drugs. HIV-infections among people who inject drugs were very rare in Finland before 1998, when a local epidemic started, concentrating mainly around Helsinki metropolitan area.
Development of the service centres began already in 1996, but because of strong opposition, the first health counseling centre for people who inject drugs was not opened until 1997, just before the peak of the HIV epidemic among them. In addition to being criticized in the media, the opening of these centres faced opposition from social welfare services, the police and even health care services. The attitudes became more positive when the various actors began to work together and became familiar with the goals and practices of these centres: comprehensive harm reduction with an emphasis on health counseling, information and health promotion – not only needle and syringe exchange. Expansion of the service started in earnest in 1998 when a sudden increase in HIV infections among people who inject drugs was discovered.
Since the opening of the first health service centre, the network has increased to some 30 centers in 23 towns, including some mobile units. The network of Low Threshold Health Service Centers for people who inject drugs is working well and has gained the trust of the users. The services are free-of-charge, confidential, anonymous and available without an appointment. The services provided vary between the centers, including personal health counseling and giving information on how to prevent infectious diseases, basic health care services, counseling and referrals to detoxification services, vaccinations, condom distribution, and HIV testing; the cornerstone in all centres being exchange of injecting equipment. One centre in Helsinki also houses a specific service centre for HIV-positive people who inject drugs, and provides ARV treatment, methadone maintenance, short term accommodation and other social services. The idea is to offer all necessary services under one roof.
One of the important factors in expanding the services is the 2004 Act on Communicable Diseases which obligates municipalities to provide health counseling for people who use drugs in their area, including exchange of injecting equipment. The basic idea of health counseling is preventive work i.e. it aims to prevent diseases and deterioration of health among people who use drugs through comprehensive harm reduction and by facilitating access to other necessary services.
It is evident that health counseling for people who inject drugs has been successful in reducing the risk of HIV-infection, and – on the basis of a rough financial estimate – also a very cost-effective health intervention. The very ambitious targets set – suppressing the epidemic among people who inject drugs and limiting new HIV infections to less than 30 annually – have actually been met. Transmission remains very low; about 5 % of HIV cases in Finland are reported to be associated with injecting drugs. Whereas in Russia most of the cases are due to injecting drugs.
The paradigm change in approach to harm reduction has been a remarkable success factor. In the past ten years Finland has moved from a situation where harm reduction was barely tolerated, to taking an evidence-informed and pragmatic approach to simultaneous reduction of harm and working towards reducing drug use and availability of drugs. Multisectoral collaboration between actors – at central, regional and local government level as well as with non-governmental organisations – and inclusion of people who use the services are keys to this success.
An Interdisciplinary Evaluation of the Effectiveness of Health Promotion Services for Infectious Disease Prevention and Control among Injecting Drug Users was conducted in 2008. The evaluation report is available on the Internet in English and in Russian.
The evaluation shows that the model used in Finland forms a working social innovation, by successfully combining low threshold health services and health promotion for harm reduction. We hope that those countries in the Eastern European and Central Asia region where harm reduction is already in use, find this experience encouraging enough to continue on their chosen path of maximizing progress to achieve MDG 6.
I will now go on to discuss how development policy and cooperation can be used to tackle HIV and to achieve MDG 6.
Experience shows that, although HIV and AIDS are complex and sensitive development issues, it is possible to prevent the epidemic. All the countries that have had successful responses have something in common: a responsible political leadership that translates its commitments into action and an active civil society. Both of these are also important components of human rights based approach to development.
With better understanding of the nature and causes of the epidemic, international efforts in the field of HIV and AIDS are increasingly characterized by the demand for strengthened respect for human rights and efforts for gender equality. UNAIDS has in its new global strategy for 2011-15 identified key human rights concerns namely 1) Punitive laws and practices around HIV transmission, sex work, drug use or homosexuality that block effective HIV responses, 2) HIV-related restrictions on entry, stay and residence, 3) HIV-specific needs of women and girls and 4) Gender-based violence.
We still believe that greater focus and effort on comprehensive combination prevention of HIV is our best hope, and that effective strategies must be built on knowledge of the epidemic – including what drives it – and its likely progression.
Even when the services to reach out to key populations are implemented in collaboration between government and civil society, they require and benefit from targeted investments in a health system that includes services for HIV and other infectious diseases, such as TB and hepatitis. By linking HIV prevention efforts with initiatives for sexual and reproductive health and rights, a vastly increased number of opportunities will be provided for tackling the epidemic. Protection of women and girls against sexual violence must be at the centre of our attention.
HIV can affect anyone, but certain groups are more affected, including women, young people, children, sex workers and their clients, men who have sex with men (MSM), people who inject drugs, prisoners and migrants. These groups are often most neglected in the AIDS response. I would like to emphasize the need for a comprehensive legislation against all form of discrimination and the need for humanization of prison conditions. We consider it essential that in all our development efforts the civil society has a key role to play.
Stigma and discrimination towards people living with and affected by HIV – based on fears and false beliefs – present yet another major barriers to achieving MDG 6. Acts of discrimination deny people’s rights to freedom of movement, information and services; stigma and discrimination discourage people from getting tested, disclosing their status and accessing treatment and care. We can challenge these barriers by empowering key populations at higher risk of HIV and vulnerable groups to act on their own behalf and in their own interests as regards achieving MDG 6.
In the Finnish Development Policy HIV and AIDS is an important objective that has to be integrated into our development policy and cooperation. For example in our Wider Europe Initiative HIV/Aids is a crosscutting theme in Central Asia. In our response we emphasize prevention, comprehensive sexuality education, health system strengthening, human rights and gender equality, particularly sexual and reproductive health and rights and rights of key populations at higher risk of and groups vulnerable to HIV.
Financially, our support is mainly channeled through multilateral organisations such as UNAIDS, UNFPA, UNICEF, WHO and the Global Fund and through non-governmental organisations.
Although donor support and involvement of emerging donors is to be encouraged, sustainability of HIV response can only be guaranteed through partnership that include national ownership, domestic resource mobilisation and investments for stronger national health systems that provide quality services for all.
With the Busan Forum on Aid Effectiveness coming up, I want to emphasize its importance as a milestone in promoting aid effectiveness, and Paris Declaration as a central framework in international development discourse. Donors need to know that their money is being used effectively, and results on the ground need to be maximized.
Coordination and harmonisation are important elements of aid effectiveness. We highly value the initiative taken by the organizers of this Forum also in this respect.