ID: 1026

Type of submission: Oral

Conference track: Policy

Topics: Harm Reduction Services and Service Provision

Presenting author: Susie McLean

Presenting author biography:

Susie McLean is an HIV and harm reduction programming specialist, experienced in implementing programmes in many countries. Susie has been part of the community based response to HIV for 30 years, and has published widely. She chairs the Strategic Advisory Group to the UN on HIV and Drug Use.

Testing the system: New analysis needed to "end AIDS” among people who inject drugs

Susie McLean, Daniel Wolfe

Issue: UNAIDS and its co-sponsors, Member States and civil society have endorsed a set of global targets for ending AIDS by 2030. The most prominent of these is the 90-90-90 targets - 90% of all people living with HIV will know their status, 90% of all people living with HIV will be on treatment, and 90% of these will have viral suppression, by 2020. These sit alongside an ambitious HIV prevention target to reduce new HIV infections, and Sustainable Development Goals. What do these targets mean for people who inject drugs, their partners and families? Are we making progress? In the ‘critical five year window’ that UNAIDS refer to, are the HIV testing and treatment needs of people who inject drugs being prioritised?

Setting: Global and national HIV test-and-treat policies and practices will be examined, with a focus on low- and middle-income countries.

Key arguments: This paper will examine a range of structural barriers that keep drug users away from services, and the new analysis needed to increase HIV treatment access for drug users. Barriers include incarceration and detention, discrimination, patterns of drug (rather than HIV) testing, and an absence of services that use a harm reduction approach. How do we reach greater numbers of people who use drugs? Are our models of service relevant and likely to be effective? What new analysis is needed to make HIV test-and- treat programmes serve people who inject drugs, and what lessons can be taken from other efforts to reach marginalised people?

Policy recommendations will be proposed, along with a new analytic framework for evaluating the “treatment cascade.” Priority concerns include greater attention to decriminalization and de-incarceration, improved focus by HIV advocates on testing-without-treatment models, critical assessment of treatment-as-prevention in practice, and a policy threshold to enable rights protecting scale up of services.