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[Mauro Guarinieri]

EATG, IHRD, Thai Drug Users Network, e CEE-HRN hanno lanciato una Sign-On letter indirizzata al Dr. Lee, direttore generale dell'OMS, che sottolinea la necessit� di garantire l'accesso ai farmaci antiretrovirale per i consumatori di sostanze illegali.     La lettera chiede all'OMS di intraprendere alcune azioni che si ritiene possano contribuire a rimuovere gli ostacoli che limitano l'accesso ai trattamenti antiretrovirali per i consumatori di sostanze illegali: � di riconoscere che esistono tali ostacoli, ed assumere la rimozione di tali ostacoli come una delle priorit� dell'iniziativa "3 by 5"  ; � di assumere un ruolo di leadership raccomandando ai governi la rimozione di ogni legge repressiva contro i consumatori di sostanze illegali ; �  di includere il metadone nella lista dei farmaci ritenuti essenziali per la lotta all'HIV/AIDS  ; � di rendere ampiamente disponibili le informazioni relative alla interazioni tra farmaci antiretrovirali e sostanze illegali, e  � di intraprendere una serie di studi clinici per la valutazione delle potenziali interazioni tra i farmaci antiretrovirali e le pi� comuni sostanze illegali per uso ricreativo    Di seguito il testo della lettera (in inglese). L'iniziativa � stata lanciata dallo European AIDS Treatment Group (EATG http://www.eatg.org), IHRD, Thai Drug Users Network, CEE-HRN.   Tutte le organizzazioni (ed i singoli individui) che desiderano sostenere l'iniziativa sono inviatati ad inviare la loro adesione entro il primo febbraio 2004.  Vi preghiamo di inviare i dati relativi alla vostra organizzazione, il vostro nome, la vostra posizione all'interno dell'organizzazione che sottoscrive l'appello, l'indirizzo presso la quale ha sede l'organizzazione, e l'indirizzo di posta elettronica a [EMAIL PROTECTED].   Una nota di conferma confermer� l'inserimento della vostra organizzazione nella lista dei sostenitori, che sar� inviata all'Organizzazione Mondiale della Sanit�   Mauro Guarinieri EATG Chairperson   ###############   To: Director General Dr. LEE Jong-wook World Health Organization CH-1211 Geneva 27, Suisse , Dear Dr. LEE, We would like to commend you and the World Health Organization (WHO) for launching the historic �3by5� initiative. We strongly support your commitment to reach the target of 3 million people on antiretroviral treatment by 2005 and your efforts to secure equal and universal access to life-saving treatment for the millions of people living with HIV/AIDS. Your recent meeting with the Delegation of People Living with HIV/AIDS, held in Geneva on November 4, 2003, clearly signals your commitment to involve the primary beneficiaries of the �3by5� initiative. We strongly hope it represents a watershed in the way the WHO sees the role of activists in advising and supporting the WHO to make �3by5� a reality. As representatives of the international intravenous drug user (IDU) community and service-providers/advocates working with the populations vulnerable to HIV/AIDS, we advocate for full, equal and universal access to antiretroviral treatment to those who are often marginalized and discriminated in access to HIV treatment and prevention interventions. Our main goal is to ensure that the WHO statement, that �access to HIV treatment should not be artificially restricted due to political or social constrains [and that] there should be no categorical exclusion of injection drug users from any level of care� will be accomplished by all national authorities. This is why we propose the WHO takes into consideration the following points, and promotes them as crucial components of the �3by5� initiative: There is growing evidence that illicit drug users are at risk of poor access to antiretroviral therapy[1]. Since the full benefits of highly-active antiviral therapy (HAART) are not compromised when patients are successfully retained in treatment, regardless of their history of injection drug use, efforts to address social, cultural, and medical barriers should be taken as an urgent priority by the �3by5� initiative. Taking into consideration that repressive national drug policies are among the main obstacles for ensuring adequate access to treatment and prevention programs for IDUs, the WHO should take a leading role by strongly recommending that governments remove any repressive laws and policies against IDUs as a core part of the �3by5� initiative and make healthcare principles a priority over the law enforcement approaches in dealing with drug problem. These principles should be also highlighted in all international documents that cover international drug policy including the UN Convention on drugs. Methadone Maintenance Therapy (MMT) is one of the most effective tools for ensuring adherence and access to treatment for HIV-positive IDUs and is recommended as an integrated part of HIV care for this population. Despite this, methadone treatment is still unavailable and, further, is often illegal in many countries where the IDU population remains most vulnerable to HIV. We appeal to the WHO to consider the inclusion of methadone hydrochloride into the List of Essential Drugs as part of the AIDS kit that will be crucial for making antiretroviral therapy (ARV) treatment available for the majority of HIV-positive people in Asia and Central and Eastern European countries. While there is a great deal of information about prescribed drugs, there is little reliable evidence about possible interactions with illegal drugs. Even where such information does exist, there is disagreement over how it should be used. Despite the limitations in applying such data to clinical practice, we believe that the WHO should make information on potential interactions between ARV and street drugs available to �3by5� recipients. There is a crucial need to both undertake a number of clinical studies evaluating potential interactions between ARV and most common illegal drugs ( including so-called recreational drugs) and to secure informed and equal involvement of active drug-users into ongoing clinical trials of new anti-HIV agents. This is particularly important for regions such as Asia, Eastern Europe, and especially the Newly Independent States, where 90% of HIV + individuals are active drug users and yet less than 1% of them have access to antiretroviral treatment. We strongly believe that the WHO should take a leading role in promoting research in this area by releasing specific guidelines on how to design clinical trials in this field. Considering that national follow up of the 3by5 initiative is crucial for establishing adequate national standards of care, organizing cost-effective and rational procurement of the medicines, and ensuring transparent and equal process of patient selection, we would also like to ensure that national WHO representative offices facilitate partnerships with community organizations and promote equal involvement of people living with HIV/AIDS and representatives of the vulnerable groups including IDUs on the country level.