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The Guardian (UK), June 28, 2005
Sarah Boseley, Guardian Health Editor
The US is pressing the UN to block the use of needle exchange programmes in countries where drug use is driving the spread of Aids, arguing that the schemes encourage users to continue their habit.
But critics, including Britain, believe that the fight against Aids in eastern Europe, central Asia and other parts of the world could be jeopardised if the US manages to water down the UN's policy.
The board of UNAids, the UN agency which coordinates the fight against the pandemic, is formulating a global prevention strategy in Geneva.
But the board may be forced for the first time to a vote on the issue.
Britain opposed the US position yesterday, when Gareth Thomas, the international development minister, told the meeting in his opening statement that the UK wants to see "efforts to intensify harm reduction strategies, including needle and syringe exchange programmes".
He said: "We support effective harm reduction programmes, especially needle and syringe exchange and methadone substitution therapy because they have been proven to reduce HIV infection among infecting drug users and their sexual partners in many countries."
The UK, he said, had "a different approach" from the US.
The row is critical, because needle sharing by injecting drug users is the main cause of the soaring figures for HIV/Aids infection in many countries, and provides a gateway for the spread of infection into the heterosexual community through the partners of drug users.
Drug injecting is responsible for 80% of the cases in eastern Europe and central Asia, and is also driving the epidemic in a wide range of countries in the Middle East, north Africa, south and south-east Asia and Latin America. HIV prevalence within certain populations of drug injectors exceeds 80%.
Europe accepts evidence from studies which have shown needle exchanges to curb the spread of infection, but the US, which will not fund such studies domestically, does not.
The issue has already become fraught. At a meeting in Vienna earlier this year the UN agency responsible for the policing of narcotics, the United Nations office on drugs and crime, was forced to accept the US line and oppose needle exchanges.
USAid, the American development agency, is not permitted to fund or be involved with programmes that include needle exchange. Democrats are lobbying against the government's position.