Mr. Antonio Maria Costa
Under-Secretary General
Director-General, UNOV and Executive Director, UNODC
Vienna International Centre
Wagramer Strasse 5
A 1400 Vienna, Austria

March 1, 2005

Dear Mr. Costa: We are writing to seek your assurance that the U.N. Office on Drugs and Crime (UNODC) will remain faithful to its obligation to promote all effective measures to reduce HIV vulnerability among drug users. The enclosed letter, signed by 334 organizations and individuals in 56 countries, attests to the gravity of international concern surrounding an apparent shift in UNODC's commitment to syringe exchange and other measures to prevent HIV/AIDS. We would be grateful for the opportunity to meet with you to clarify UNODC's commitment to syringe exchange and other measures to reduce adverse health consequences associated with injecting drugs.

Over 13 million people worldwide inject drugs, the majority (nearly 80%) in developing and transitional countries. The sharing of syringes by injection drug users accounts for the majority of new HIV infections in numerous countries in Eastern Europe, Central and South Asia, and South America. If current trends continue, tens of thousands of injection drug users will die from HIV/AIDS because they are excluded from basic HIV prevention services and HIV care.

These are needless deaths. National and international public health agencies-including in the United States, the largest donor to UNODC- agree that for individuals who cannot or will not stop injecting drugs, using sterile syringes only once is a safe and effective approach to limit HIV transmission. Provision of opiate substitutes such as methadone and buprenorphine has similarly been shown to reduce HIV risk and social costs associated with drug use. As a co-sponsor of the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the current chair of the committee that coordinates the activities of that body, UNODC has a responsibility to promote the full range of HIV prevention services for injection drug users.

As you know, a 2001 memorandum from the United Nations System High Level Committee on Programmes stated clearly that syringe exchange and substitution treatment were acceptable in the context of a wider package of drug prevention interventions. Signatories to the Declaration of Commitment at the 2001 General Assembly Special Session on HIV/AIDS, including the United States, pledged to ensure "harm reduction efforts related to drug use," and "expanded access to essential commodities, including [.] sterile injecting equipment" by 2005.

We have welcomed the many positive steps that UNODC has taken in the area of HIV prevention. The formation of an HIV/AIDS unit within UNODC, your vocal support of changes to Russian drug legislation that reduced indiscriminate imprisonment of drug users, and your remarks at the 2004 International Conference on AIDS in favour of expanded HIV prevention efforts such as syringe exchange to reach drug users were all welcome expressions of leadership from UNODC in general and your office in particular.

The contrast between these comments and your recent promise in a November letter to US Assistant Secretary Robert Charles to "be even more vigilant" in scrutinizing references to harm reduction in UNODC websites and publications is striking. For the sake of thousands of lives and the future of the HIV/AIDS epidemic, we call on UNODC to affirm its commitment to the UN System High Level Committee position paper and the UNGASS Declaration of Commitment, and to actively support and promote needle exchange and other measures proven to prevent HIV transmission among those who inject drugs.

Yours sincerely

Prof Gerry Stimson
Executive Director, International Harm Reduction Association
18 Gloucester Road
Richmond, Surrey
TW9 3BU United Kingdom

On behalf of:

Jonathan Cohen, HIV/AIDS and Human Rights Program, Human Rights Watch

Joanne Csete, Canadian HIV/AIDS Legal Network

Kasia Malinowska-Sempruch, International Harm Reduction Development Program, Open Society Institute