A Life of Dignitiy for All

Despite the many challenges that we face, I have always had strong confidence in what the people of this region can achieve by focusing together on our shared goal of ending these epidemics.
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This post is a speech given by Michel Kazatchkine on the opening day of the 4th Conference on HIV/AIDS in Eastern Europe and Central Asia.

As we open this conference, I would like to salute the physicians, scientists, healthcare and social workers, representatives of civil society and of the community who tirelessly work in the region to fight AIDS, TB and MDR-TB. A number of them are here today; others have decided not to come. Everywhere I travel in the region, I meet extraordinary, dedicated people working in hugely challenging contexts.

Despite the many challenges that we face, I have always had strong confidence in what the people of this region can achieve by focusing together on our shared goal of ending these epidemics.

Since I attended the first of these conferences in 2006, the numbers of new HIV infections, new AIDS cases and AIDS-related deaths have continued to increase in this region. Of the 130,000 new infections reported in the WHO European region in 2012, three-quarters occurred in countries in the East. While reported AIDS cases declined by 54 percent in Western Europe, the number of people newly diagnosed with AIDS increased by 113 percent in the East between 2006 and 2012. [According to UNAIDS and WHO, the numbers of estimated deaths were 91,000 in Eastern Europe and central Asia compared to 7,600 in Western and central Europe in 2012].

These figures are in sharp contrast with the decreasing numbers of new infections and AIDS-related deaths in other regions and globally. Coverage of antiretroviral treatment in this region also remains well below the global level of 60 percent.

The epidemic pattern is also evolving, with heterosexual infections now representing a significant proportion of newly diagnosed cases in addition to the "concentrated" epidemics, particularly among people who inject drugs and gay men that continue to expand, undefeated, and inadequately addressed.

Significant investments have been made in this region, but very little of it has been for effective prevention. The epidemic remains largely uncontrolled. This must be of major concern to all of us, and to anyone who cares about global public health. We need a common understanding of why this is the case and what our strategies should be, so that we can make more substantial progress.

I expect that this conference will focus clearly on this question. "Business as usual" is not enough, and we need a frank and solution-oriented debate on what needs to change. I am not talking about a polarizing or simplistic debate, such as whether treatment or prevention is the right approach. I mean a real debate about both the evidence, and its implications.

For example, there is strong evidence that antiretroviral treatment decreases transmissibility of HIV. But the implication is not that we should abandon prevention in general, and harm reduction efforts among vulnerable groups and people in vulnerable settings, such as prisons, in particular. I strongly believe that an open debate based on evidence will show that, of course, we must do both these things together.

The same is true for harm reduction. Harm reduction for people who use drugs is a set of interventions, including OST and NSP, that is recommended by WHO, UNAIDS and UNODC, and for which there is comprehensive and compelling evidence that, together with ART: it averts HIV infections, reduces HIV transmission, decreases mortality, reduces drug dependency, improves quality of life and reduces crime and public disorder.A health-based approach to drug policies starts with the implementation and scaling up of harm reduction. If there is any evidence to the contrary, let it be debated, in the spirit of scientific enquiry, and the conflicts resolved, so that we can finally move forward with one voice and a common strategy for action.

In this context, as a scientist, physician and in my role as UN Envoy, I must clearly say that the recent statements made on the lack of effectiveness of OST in Crimea and the decision by the Crimean authorities to discontinue these programs, are to me unjustified by the evidence, inconsistent with human rights standards, and a source of unnecessary suffering.

I want to take this opportunity to call on the Russian and regional medical and scientific community to engage in the open and evidence-based debate on preventing HIV/AIDS that for too long has not been a real confrontation between evidence and evidence, but an issue where science has taken a back seat to politics and ideology. This conference provides a critical venue for such debates, but more are likely to be needed, and the UN is ready to support the region in organizing them in the coming weeks or months.

We cannot avoid this debate any longer. Too many lives have been lost to HIV, TB and hepatitis in Eastern Europe and Central Asia. Too many people have become resigned to this region not making progress, because of ideological differences, and to the grim inevitability of even more disease and death. It is past time to change this paradigm. But whether we do so ultimately depends on us. It is within our power alone to make different choices than have been made in the past, and to shape a more hopeful future.In the words of the Secretary General: Let us "continue to listen to and involve the people... We must continue to build a future of justice and hope, and a life of dignity for all".

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