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Open Letter to US Secretary of State

Re: State Department guidance for HIV prevention among injection drug users


June 28, 2010

Secretary Hillary Clinton

United States Department of State

2201 C Street NW

Washington, DC 20520

Dear Secretary Clinton,

We are concerned that the State Department has yet to release updated guidance for HIV prevention among injection drug users. Last December, the Office of the Global AIDS Coordinator (OGAC) released a new Five-Year Strategy for the President's Emergency Plan for AIDS Relief (PEPFAR) that underscored the importance of establishing prevention priorities necessary to combat the epidemic. Around the same time, Congress voted to allow federal funding for syringe exchange programs (SEPs) in the US, underscoring the importance of evidence-based prevention programming. Despite clear statements from the Administration in support of syringe exchange as part of a comprehensive program, without Administration guidance domestic and international programs are still prohibited from using federal funds for one of the most effective HIV prevention tools.

Outside sub-Saharan Africa one third of new HIV infections are due to injection drug use.  In countries such as Russia, Ukraine, Georgia, Vietnam and China, more than half of infections are due to injection drug use. By implementing syringe exchange, some countries, like Britain, Australia and France avoided large scale epidemics among people who inject drugs. A review of data from 81 cities across Europe, Asia, and North America with and without SEPs found that, on average, HIV infection increased by 5.9 percent per year in the 52 cities without SEPs and decreased by 5.8 percent per year in the 29 cities with SEPs. This represents an 11 percent net difference in seroprevalence when comparing cities with and without SEPs.  Programs could, right now, prevent thousands of new HIV infections at very little cost.

The upcoming International AIDS Conference in Vienna will have a special focus on Eastern Europe and the former Soviet Union where injection drug use is the cause of one of the world's fastest growing HIV epidemics. As the single largest donor for HIV/AIDS programs around the world, the United States will be in the spotlight. We urge you to release guidance that embraces syringe exchange in advance of that event.


ACT UP Philadelphia, Philadelphia, PA

After Hours Project, Inc., Brooklyn, NY

Agua Buena Human Rights Association, San Jose, Cost Rica

AIDS Action Baltimore, Baltimore, MD

AIDS Action Council, Washington, DC

AIDS Alliance for Faith and Health, Atlanta, GA

AIDS Care Ocean State, Providence, RI

AIDS Community Research Consortium, Redwood City, CA

AIDS Education Global Information System (, San Juan Capistrano, CA

AIDS Foundation of Chicago, Chicago, IL.

AIDS Foundation Houston Inc, Houston, TX

AIDS Policy Project, Philadelphia, PA 

AIDS Project Greater Danbury, Danbury, CT

AIDS Project Hartford, Inc., Hartford, CT

AIDS Services for the Monadnock Region; The Cleve Jones Wellness House, Gilsum, NH

AIDS Taskforce of Greater Cleveland, Cleveland, OH

AIDS Task Force, Inc., Fort Wayne, IN

AIDS Treatment Activists Coalition, New York, NY

AIDSfreeAFRICA, Ossining, NY

Alaskan AIDS Assistance Association, Anchorage, AK

American Civil Liberties Union, New York, NY and Washington, DC

American Medical Student Association, Reston, VA

American Public Health Association, Washington, DC

amfAR, The Foundation for AIDS Research, New York, NY

Aniz, Inc, Atlanta, GA

Association of Nurses in AIDS Care, Akron, OH

AVAC: Global Advocacy for HIV Prevention, New York, N.Y.

AXIOS Eastern Orthodox LGBT Christian AIDS Ministry, New York, NY

Brandywine Counseling, Inc., Wilmington, Delaware

Brown University AIDS Program, Providence, RI

California Communities United Institute, Citrus Heights, CA

Caring Ambassadors Program, Oregon City, OR

Center for Health and Gender Equity (CHANGE), Washington, DC

Center for Health Justice, Los Angeles, CA

Center for Women Policy Studies, Washington, DC

Centre for Health Policy and Innovation, Johannesburg, South Africa

Chattanooga CARES, Chattanooga, TN

Chicago Recovery Alliance, Chicago, IL

Children With AIDS Project of America, Tempe, AZ

Circles of Fire Productions, Brooklyn, NY

CitiWide Harm Reduction, Bronx, NY

Common Ground - the Westside HIV Community Center, Santa Monica, CA

Community Access National Network (CANN), Washington, DC

Community Health Action of Staten Island, Staten Island, New York

Community Health Awareness Group, Detroit, MI

Community HIV/AIDS Mobilization Project (CHAMP), Providence, RI

Community Information Center, Inc., Portland, OR

DC Community AIDS Network (DC CAN), Washington, DC

Delaware HIV Consortium, Wilmington, DE

Delhi Network of Positive People (DNP+), Delhi, India

Dignity/USA National AIDS Project, Boston, MA  

Divine Openarms, Port Harcourt, Nigeria

Downtown Manhattan HCV Support Group, New York, NY

Drug Policy Alliance, New York, NY

Eastern Maine AIDS Network, Bangor, ME

Education for Healthy Choices, Sacramento, CA

EL HAYET des personnes vivant avec le VIH, Paye, Algerie

Elton John AIDS Foundation, New York, NY

Family and Medical Counseling Service, Inc. (FMCS), Washington, DC

Family Services Network of New York, Brooklyn, NY

Fenway Health, Boston, MA

Foundation for Integrative AIDS Research (FIAR), Brooklyn, NY

Frannie Peabody Center, Portland, ME

Gay Men's Health Crisis, New York, NY

Global AIDS Alliance, Washington, DC

Global Coalition of Women against AIDS, Kampala, Uganda

Global Health Strategies, York, NY

Global Justice Ministry, Metropolitan Community Churches, Metropolitan Community Church of New York, NY

Grand Rapids Red Project, Grand Rapids, MI

Greater Love Tabernacle-HIV/AIDS Services, Dorchester, MA

Harm Reduction Action Center, Denver, CO

Harm Reduction Coalition, New York, NY

Harm Reduction Institute, Indianapolis, Indiana

Health GAP (Global Access Project), New York, NY

HealthReach Harm Reduction, Augusta, ME

Hep C Connection, Denver CO

Hepatitis Education Project, Seattle, Washington

HIV/AIDS Law Project, Phoenix, AZ

HIV/AIDS Resource Center, Ypsilanti, MI

HIV Education and Prevention Project of Alameda County, Oakland, CA

HIV Medicine Association, Arlington, VA

HIVictorious, Inc., Madison, WI

Housing Works, New York, NY and Washington, DC

Human Rights Watch, New York, NY

IDSA/HIVMA Center for Global Health Policy, Arlington, VA

Indiana Minority Health Coalition; Brothers Uplifting Brothers, Inc., Merrillville, IN

International Community of Women Living with HIV and AIDS-North American Region, Washington, DC

International AIDS Empowerment, El Paso, TX

International HIV/AIDS Alliance, Washington, DC

International Women's Health Coalition, New York, NY

Interpharm International Limited, Kenya

Intersect Worldwide, New York, NY

Laramie Reproductive Health, Laramie, WY

Liberty Research Group, Rochester, NY

Life Foundation, Honolulu, HI

LifeLinc of Maryland, Baltimore, MD

Lilitan Research and Consultancy, Accra, Ghana

Lower East Side Harm Reduction Center, New York, NY

MCCNY Charities, New York, NY

Mendocino County AIDS/Viral Hepatitis Network, Ukiah, CA

Mennonite Central Committee U.S. Washington Office, Washington, DC

Metropolitan Community Church Key West, Key West, FL

Michigan Positive Action Coalition, Detroit, MI

Minnesota AIDS Project, Minneapolis, MN

Minority Health Coalition of Marion County, Indianapolis, IN

MOCHA Center, Inc., Buffalo, NY & Rochester, NY

National AIDS Fund, Washington, DC

National Alliance of State and Territorial AIDS Directors, Washington, DC

National Association of Social Workers - USA, Washington, DC

National Forum of People Living HIV/AIDS Networks in Uganda (NAFOPHANU), Kampala  Uganda

National Hepatitis C Advocacy Council, Brooklyn, NY

National Viral Hepatitis Roundtable, Decatur, GA

National Youth Advocacy Coalition (NYAC), Washington, DC

Needle Exchange Program of Asheville (NEPA), Asheville, NC

Network of Zambian People Living with HIV/AIDS, Lusaka, Zambia

New Destiny Recovery Ministry, Inc, Baltimore, MD

New York Harm Reduction Educators, Inc., Bronx, NY & New York, NY

North American Old Catholic Church, Washington, DC

North Carolina Harm Reduction Coalition, Winston Salem and Chapel Hill, NC

North Shore Health Project, Gloucester, MA

NYC AIDS Housing Network (NYCAHN), Brooklyn, NY

NYU Medical Center Hepatitis C Support Group, New York, NY

O'Connor Hospital HCV & HBV Support Group, Delhi, NY

Open Society Institute, Washington, DC

Philadelphia Global AIDS Watchdogs (GAWD), Philadelphia, PA

Phoenix Center, Springfield IL

Physicians for Human Rights, Cambridge, MA & Washington, DC

Population Council, New York, NY

Positive Health Project, Inc., New York, NY

Positive Outreach Foundation, Ota, Ogun State, Nigeria

Positive Voice, Athens, Greece

Praxis Housing Initiatives Inc., New York, NY

PreventionWorks, Washington, DC

Project Inform, San Francisco, CA

PSI (Population Services International), Washington, DC

Public Health - Seattle & King County, Seattle, WA

Safe Nepal, Kathmandu, Nepal

SafeGames Project, New York, NY

Salud Latina/Latino Health, Chicago, IL

San Francisco AIDS Foundation, San Francisco, CA

Sexuality Information and Education Council of the U.S. (SIECUS), New York, NY and Washington, DC

Sisters and Brothers Helping Each Other, Kankakee, IL

SLO Bangers Syringe Exchange, San Luis Obispo, CA

Sonoma County Commission on AIDS, Santa Rosa, CA

Sonoma County Hepatitis AIDS Reduction Program (SHARP)/syringe exchange, Santa Rosa (and surrounding areas), CA

Spokane AIDS Network, Spokane, WA

St. Ann's Corner of Harm Reduction, Bronx, NY

Status C Unknown, Medford, NY

Support on AIDS and Life through Telephone Helpline (SALT) Uganda, Kampala

Tapestry Health, Florence, MA

The AIDS Institute, Washington, DC & Tampa, FL

The Brown Global Health Initiative, Providence, RI

The Center for Prisoner Health and Human Rights, Providence RI

The Foundation for Research on Sexually Transmitted Diseases, Inc (FROST'D), New York, NY

The Global Forum on MSM & HIV (MSMGF), Oakland, CA

The Miriam Immunology Center, Providence, RI

The Space at Tompkins, New York, NY

The Women's Center, Bronx, NY

Timi Hami Ani Hamro Nepal, Kathmandu, Nepal

Total Health Awareness Team, Rockford, IL

Transexuales y Transgeneros en Marcha (TTM), San Juan, PR

Treatment Action Group, New York, NY

Treatment Education Network, Denver CO

Triangle Health Collective, Durham, NC

Tri-County Health Coalition of Southern Indiana Inc., New Albany, IN

Trust for America's Health, Washington, DC

2 God B The Glory, Inc Women Supportive Housing Program, Baltimore, MD

25 Messengers, Indonesia

Uganda Integrated Community Based Projects, Kampala, Uganda

UHAP -- Upstate New York Hepatitis Awareness Project, Delancey, New York

Universal Fellowship of Metropolitan Community Churches, Abilene, TX

Urban Coalition for HIV/AIDS Prevention Services (UCHAPS), Washington, DC

Voices Of Community Advocates & Leaders (VOCAL), Brooklyn, NY

Vortex Consulting, LLC, Wenonah, NJ

Washington Heights CORNER Project, New York, NY

Wateree Aids Task Force in Sumter, SC

West County Health Centers, Inc., Guerneville, CA

Women in Motion, Inc., Indianapolis, IN

Youth Empowerment & Human Development Initiative (YEHDI), Kano, Nigeria


Senator John Kerry, Chair, Foreign Relations Committee

Senator Richard Lugar, Ranking Member, Foreign Relations Committee

Senator Inouye, Chair, Appropriations Committee

Senator Leahy, Chair, State, Foreign Operations Appropriations Subcommittee

Senator Gregg, Ranking Member, State, Foreign Operations Appropriations Subcommittee

Senator Tom Harkin, Chair, Labor, Health and Human Services Appropriations Subcommittee

Senator Richard Durbin, Majority Whip

Representative Nancy Pelosi, Speaker of the House

Representative Howard Berman, Chair, Foreign Affairs Committee

Representative Ileana Ros-Lehtinen, Ranking Member, Foreign Affairs Committee

Representative Waxman, Chair, Energy and Commerce Committee

Representative David Obey, Chair, Appropriations Committee

Representative Nita Lowey, Chair, State, Foreign Operations Appropriations Subcommittee

Representative Kay Granger, Ranking Member, State, Foreign Operations Appropriations Subcommittee

Representative José Serrano, Chair Financial Services Appropriations Subcommittee

Representative Donald Payne, Chair, Foreign Affairs Africa and Global Health

Representative Michael Castle

Representative Elijah Cummings

Representative Jesse Jackson, Jr.

Representative Barbara Lee

Representative Lucille Roybal-Allard

Ambassador Eric Goosby, Global AIDS Coordinator

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