Kaiser Daily Global Health Policy Report
In The News
- U.S. President Obama Urges Continuation Of Development Initiatives At White House Summit, Signs Global Food Security Act Of 2016
Associated Press: Obama: Development must remain top foreign policy plank
“President Barack Obama, taking stock Wednesday of his efforts to boost living standards in developing countries, said he made global development a ‘fundamental pillar’ of U.S. foreign policy because it’s a good investment, and he urged his successor to continue to prioritize the issue. Obama said funding development projects in spite of pressing needs in the U.S. is worthwhile because it helps with security at home…” (Superville, 7/20).
USA TODAY: Obama signs Global Food Security Act to end hunger
“A bipartisan bill promoting global food security, resilience, and nutrition could make hunger history, President Obama announced Wednesday during the White House Summit on Global Development. The Global Food Security Act of 2016, which the president signed Wednesday, determined it is in the U.S. national security interest to accelerate growth that reduces poverty, hunger, and malnutrition…” (Crescente, 7/20).
VOA News: Obama Presses for Development Initiatives to Continue Beyond Presidency
“… ‘I’m here to say that whoever the next president is, development has to remain a fundamental pillar of American foreign policy,’ [Obama] said Wednesday during the White House Summit on Global Development in Washington. … ‘We know there is a correlation between no education, no jobs, no hope, the violation of basic human dignity, and conflict and instability,’ he told the group, which included development leaders, private and public sector officials, members of civil society, religious groups, and entrepreneurs…” (Salinas, 7/20).
Washington Post: Obama will ensure his global development policy outlasts his presidency
“…Obama’s development initiative has been based in part by building on his predecessors’ work — by expanding George W. Bush’s PEPFAR program to combat the spread of AIDS in Africa — and by launching a new agriculture initiative as well as ones focused on electrification and strengthening the global health system. Although some development experts have identified areas where Obama could have pushed harder or devoted more attention and resources, most credited the president with working to expand and establish programs that could have an enduring impact…” (Eilperin, 7/20).
- UNAIDS/Kaiser Family Foundation Report Showing Drop In Donor Government Funding For AIDS Prompts Increased Calls For Action From Advocates, Others
The Economist: The 21st International AIDS Conference: Rallying the troops
“…A report published on July 15th by the Kaiser Family Foundation, an American charity, in conjunction with UNAIDS, showed that in 2015, for only the second time since 2002, international aid for AIDS was down … That made for a gloomy backdrop to the AIDS conference’s return to Durban. But it also gave urgency to two main themes — prevention and cure. … [D]espite the lack of money and the plateauing of infection rates, the progress that has been made since 2000 against something unknown to medical science 36 years ago is impressive. With the new tools now available, and with but a little more willpower, AIDS can surely be beaten” (7/23).
Eyewitness News: TAC slams global governments over HIV/AIDS funding cuts
“The Treatment Action Campaign (TAC) has accused governments across the globe of not doing enough to address HIV/AIDS. The group has made reference to recent data published by UNAIDS showing that donor governments have reduced funding for programs to combat the pandemic in low- and middle-income countries. The International AIDS Conference being held in Durban enters its third day…” (Rahlaga, 7/20).
Times of India: 13% decline in global HIV funds, NACO says all’s well.
“Global funding to fight HIV in lower- and middle-income nations declined for the first time in five years by a whopping 13 percent in 2015, according to a joint report by the United Nations Programme on HIV/AIDS (UNAIDS) and the Kaiser Family Foundation … The decrease in allotment from $8.6 billion in 2014 to $7.5 billion in 2016 by wealthy donor nations has alarmed anti-HIV crusaders, who caution that it will cripple research and rob millions of their access to treatment and prevention…” (Royl, 7/20).
- Elton John AIDS Foundation, PEPFAR Announce First Recipients Of LGBT Fund Grants To Address Stigma, Discrimination
Associated Press: Elton John: LGBT people must be part of AIDS fight
“British musician Elton John on Wednesday committed money for protecting LGBT people in Africa, saying that leaving them behind in the fight against AIDS will only increase the spread of the disease. The rock star spoke at a global AIDS conference in South Africa that has also attracted philanthropist Bill Gates, actress Charlize Theron, and Britain’s Prince Harry…” (7/20).
The Guardian: Elton John pledges millions to support LGBT people in Africa
“Elton John has pledged to spend his AIDS foundation’s money on supporting lesbian, gay, bisexual, and transgender people in Africa who are stigmatized and penalized in their own countries. The singer has joined PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief, in a $10m LGBT fund that will issue grants and provide expertise to help those living under homophobic regimes…” (Boseley, 7/20).
PEPFAR/Elton John AIDS Foundation: Elton John AIDS Foundation and PEPFAR Announce Inaugural LGBT Fund Recipients
“The Elton John AIDS Foundation (EJAF) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) are … announcing the first two recipients of the LGBT Fund. The inaugural recipients are the International HIV/AIDS Alliance (The Alliance) and the Global Forum on MSM & HIV (MSMGF). These partners will administer small grants and provide key technical expertise addressing stigma and discrimination through innovative and community-led approaches in sub-Saharan Africa and the Caribbean…” (7/20).
- In AIDS 2016 Speech, Charlize Theron Encourages More Conversation About Roles Of Sexism, Racism, Homophobia In HIV Spread; Foundation Offers South African Children Safe Place, Education
CNN: Charlize Theron: HIV spread through sexism, racism, homophobia
“Oscar-winning actress Charlize Theron was born and raised in South Africa, where she grew up around HIV and experienced people dying from AIDS. Now 40, she blames society — not the infection — for why the virus still persists. … In an interview with CNN, Theron discussed her experiences with HIV/AIDS and why she cares so much about ending the AIDS epidemic, particularly among teenagers, through her projects and promoting #GenEndIt, part of the U.N. strategy to ‘be the generation that end AIDS’…” (Senthilingam, 7/20).
The Guardian: Racism an underlying cause of HIV epidemic, says Charlize Theron
“Racism is one of the underlying causes of the HIV epidemic and one of the reasons why it has not yet been brought to an end, according to actor and AIDS campaigner Charlize Theron, who says that people are afraid to talk about it. Theron, one of the speakers at the official opening of the International AIDS Conference in Durban on Monday night, is South African by birth and started a foundation in 2007 to help prevent adolescents and young people becoming infected with HIV in ever greater numbers. In an interview with the Guardian, she said increased funding was very important in the effort to end AIDS. ‘But at the same time I also think that there are very fundamental issues like stigma, and there’s a racial part of it too that I think we haven’t really talked about or people are too scared to talk about’…” (Boseley, 7/19).
The Guardian: Under the shadow of ‘dirty’ HIV, South African children offered a refuge
“…WhizzKids, funded by the Charlize Theron Africa Outreach Project, gives young people a safe place to come, away from stigma and the judgmental gaze of parents and other relatives. … WhizzKids helps these children and others who do not have HIV but are at risk because there is no family conversation about safe sex, and adolescents are afraid to go to family planning clinics…” (Boseley, 7/19).
- New Strategy To End Pediatric AIDS Launched At AIDS 2016; Researchers Report Successes In Preventing Mother-To-Child HIV Transmission
aidsmap: New strategy aims to end AIDS in children by 2020
“A new strategy to end pediatric AIDS launched at the 21st International AIDS Conference (AIDS 2016) in Durban, South Africa on Tuesday calls for antiretroviral treatment services to reach 1.6 million children and 1.2 million adolescents by 2018. The Super-Fast Track strategy is intended to close the gap between adult and pediatric treatment access, says UNAIDS, and will pull together the actions of numerous agencies…” (Alcorn, 7/19).
International Business Times: Maternal antiretroviral therapy may eliminate HIV transmission from mother to infant via breast milk
“A study has revealed that HIV-infected mothers who have a strong immune system can benefit from a three-drug antiretroviral regimen during the breastfeeding period. Researchers found evidence that this therapy may eliminate HIV transmission to infants via breast milk. The findings showed that daily infant nevirapine and three-drug antiretroviral therapy were effective and safe at preventing HIV transmission from mother to child during breastfeeding…” (Roy, 7/20).
U.N. News Centre: New drive for pediatric HIV treatment launched at global AIDS conference
“…The new global push comes at a time when children, aged 0 to 14 years, accounting for five percent of people living with HIV in 2015, represent 10 percent of all AIDS-related deaths. Half of all children who acquire HIV perinatally die by their second birthday unless they receive antiretroviral therapy, with peak mortality occurring at six to eight weeks of life. Discussions at the conference also underlined the need to increase the political commitment for pediatric HIV treatment, scaling-up of point-of-care diagnostic tools for children, intensifying testing efforts for older children, strengthening of service delivery and patient monitoring for mothers and their infants, and expanding the array of child-appropriate antiretroviral medicines…” (7/20).
VOA News: World Sees Hope in Ending Mother-to-Child HIV Transmissions
“…Governments, scientists, and U.S. health agencies are working hard to end mother-to-child transmission of HIV/AIDS around the world. ‘Mother-to-child transmission is one of the greatest success stories in HIV research, but there are still 150,000 children in low- and middle-income countries who become infected with HIV every year,’ said Rachel Sturke, a senior scientist at Fogarty International, a division of the National Institutes of Health…” (Pearson, 7/20).
- 'Test And Treat' Goal Achievable, According To African Study Results Presented At AIDS 2016
Thomson Reuters Foundation: African study exceeds U.N. ‘test and treat’ goal for ending HIV pandemic
“A U.N. goal to get seven out of 10 HIV positive people to take a test, start medication, and suppress the deadly virus in their blood is achievable, a study in East Africa showed on Wednesday, raising hopes of ending the AIDS pandemic. Almost 80,000 adults in Uganda and Kenya took part in the study, which used community campaigns, free testing, and tests at home to encourage people to know their HIV status and get treatment. After the intervention, 81 percent of people with HIV had an undetectable viral load, because they tested, initiated medication, and adhered to it successfully, up from 45 percent two years earlier… (Migiro, 7/20).
- China Investigating Leak Of HIV Patients' Personal Information; WHO Calls Infraction Violation Of 'Fundamental Right' To Privacy
Agence France-Presse: China HIV leak violates patients’ rights: WHO
“A leak of HIV carriers’ identities in China was a violation of their ‘fundamental right,’ the World Health Organization said, after reports that hundreds of infected people were approached by telephone swindlers. A total of 313 HIV-positive people have been contacted by callers claiming to be government officials offering financial allowances in exchange for their banking information, the Southern Weekly newspaper reported Monday, citing campaign group Baihualin…” (7/19).
New York Times: China Investigating Data Leak and Swindling of HIV Patients
“…[Bai Hua, the director of a support network based in Beijing for people with HIV/AIDS,] said that despite years of work by nongovernmental organizations and civic groups and legal changes prohibiting discrimination, social prejudice persisted. ‘If you look at the comments on Weibo, you’d be surprised to see how many people say “They deserve it” or “Information on HIV carriers should be published,”‘ he said. ‘It reminds me that there’s still a long way to go in China to achieve equal rights for HIV carriers’…” (Kan, 7/21).
- U.S. Sens. McConnell, Reid Blame Each Others' Political Parties For Zika Funding Stalemate
Roll Call: Standoff Over Zika Spending Arrives at Convention
“The blame game over stalled Zika funding made its way to the Republican National Convention on Tuesday night, as Senate Majority Leader Mitch McConnell faulted ‘Clinton Democrats’ for blocking action. … Senate Minority Leader Harry Reid of Nevada responded Tuesday by blaming Republicans for not passing a funding package that would send extra money to fight Zika…” (Mejdrich, 7/20).
- WHO Encourages International Community To Step Up Efforts To Treat, Prevent Viral Hepatitis
U.N. News Centre: ‘World has ignored hepatitis at its peril,’ warns U.N. health agency ahead of World Day
“With some 400 million people around the world infected with hepatitis B or C, the United Nations health agency [Wednesday] encouraged countries to boost testing and access to services and medicines for people in need. ‘The world has ignored hepatitis at its peril,’ said Dr. Margaret Chan, director general of the U.N. World Health Organization (WHO). ‘It is time to mobilize a global response to hepatitis on the scale similar to that generated to fight other communicable diseases like HIV/AIDS and tuberculosis.’ The number of people with hepatitis B or C is more than 10 times the number of people infected with HIV, according to U.N. figures…” (7/20).
VOA News: Global Strategy Aims to Reduce Infections, Deaths From Viral Hepatitis
“…The head of the WHO’s global hepatitis program, Stefan Wiktor, says good tools are available to prevent and treat the needless deaths. … Governments at this year’s World Health Assembly adopted the first-ever Global Health Strategy to reduce new viral hepatitis infections by 90 percent and the number of deaths by 65 percent by 2030. Wiktor says seven million deaths could be prevented by 2030” (Schlein, 7/20).
- On African Union Summit Sidelines, Leaders Endorse Roadmap For Malaria Elimination By 2030
CNBC Africa: Africa could be malaria-free by 2030
“Africa is missing out on an opportunity to earn billions by not investing more in the eradication of malaria, this is what Joy Phumaphi, executive secretary at the African Leaders Malaria Alliance had to say on the back of the 27th Summit of the African Union in Kigali. The Catalytic Framework to end AIDS, TB and Eliminate Malaria in Africa by 2030 was endorsed by African leaders during the summit, outlining methods to eliminate malaria incidence and mortality across the continent…” (7/20).
New Times: African leaders commit to eliminate malaria by 2030
“…The roadmap, dubbed Catalytic Framework to end AIDS, TB and Eliminate Malaria in Africa by 2030, was adopted during a meeting held on the sidelines of the African Union summit that [took place] in Kigali. The meeting was organized by the African Union Commission and chaired by President Idriss Déby, chair of the A.U., the African Leaders Malaria Alliance (ALMA), and AIDS Watch Africa…” (7/18).
Xinhua News: Africa adopts roadmap for malaria elimination by 2030
“…The leaders endorsed the new framework which outlines a pathway to eliminate malaria incidence and mortality, and prevent its transmission and re-establishment in all countries by 2030. In a gradual process, the framework also outlines milestones and targets, with the aim to reduce malaria incidence and mortality rates by at least 40 percent by 2020, and 75 percent by 2025…” (7/19).
- El Niño-Induced Drought Leading To Increases In Child Marriage, Labor In Southern Africa, Report Says
Reuters: El Niño driving child marriage and labor across Southern Africa — agencies
“Tens of thousands of children across Southern Africa are being pushed out of school and into early marriage or child labor because of drought and hunger caused by the El Niño weather pattern, charities said on Wednesday. … Increased numbers of children are trading sex and doing domestic work to survive across nine countries, a report by World Vision, the United Nations Children’s Fund (UNICEF), and Plan International said…” (Migiro, 7/20).
- DRC Launches Yellow Fever Vaccination Campaign In Capital, Nearby Province
Reuters: Democratic Republic of Congo launches yellow fever vaccination drive
“Democratic Republic of Congo launched a campaign on Wednesday to vaccinate about a million people against yellow fever over the next 10 days in the capital Kinshasa and a nearby province. A wider campaign to vaccinate more than 10 million people in the city and along the border with Angola will have to wait at least two more weeks, however, due to shortages of vaccine and syringes…” (Ross, 7/20).
- UNICEF Ramps Up Operations In South Sudan To Prevent Widespread Cholera Outbreak
Reuters: Hunger, looting, and now suspected cholera hit South Sudan
“Dozens of people have fallen ill with suspected cholera in South Sudan’s capital of Juba, while a U.N. food warehouse was looted and destroyed, incurring $20 million of damage, the United Nations said on Tuesday…” (Miles, 7/19).
U.N. News Centre: U.N. agency steps up operations in South Sudan to thwart possible cholera outbreak
“Dozens of people in South Sudan may have cholera, the United Nations children’s agency [Wednesday] announced, saying it is working with partners to step up its operations to avoid a possible cholera outbreak in the country…” (7/20).
VOA News: Cholera Outbreak Suspected in Beleaguered South Sudan
“…UNICEF said the main hospital in Juba, admitted 69 new cases Wednesday, bringing the total number of people being treated in the capital to 112. Nationwide, there were 141 suspected cholera cases, with six reported deaths. This was down from an earlier report of 11 deaths…” (7/20).
- WFP Launches Food Aid Relief Program To Reach 6.5M People In Malawi
Deutsche Welle: Severe drought elevates food crisis in Malawi to ‘highest level’
“The United Nations World Food Programme (WFP) has launched a relief program to feed families affected by the severe drought in Malawi. Over 18 million people are said to be in need of food aid in Southern Africa. DW spoke to the executive director of the World Food Programme, Ertharin Cousin, while she was in Malawi…” (Padatha, 7/20).
U.N. News Centre: U.N. agency starts food aid to 6.5 million people affected by severe drought in Malawi
“… ‘I’ve talked with women in rural areas who told me they have enough food for just a few more weeks, after which they will have nothing,’ said Ertharin Cousin, executive director of the U.N. World Food Programme (WFP), who [Wednesday] concluded a three-day visit to the country. In a telephone briefing yesterday with reporters, Ms. Cousin said severe flooding and prolonged dry spells last year have devastated this year’s harvest…” (7/20).
Editorials and Opinions
- White House Summit Offers Opportunity To Renew Commitment To Global Development
The Guardian: The gender agenda: what has Obama done for women and girls?
Sarah Degnan Kambou, president of the International Center for Research on Women
“…The global development summit on Wednesday provides a moment to take stock of success and continue our commitments to navigating the global forces that are transforming our world. The first of these is climate change. … The second force is urbanization … And finally, conflict and migration. … Over his two terms, [President] Obama has taken important steps to integrate gender in his development agenda, and that’s a real accomplishment. There has been an increased understanding that if we are to eradicate poverty, women and girls must be at the center of our efforts. The summit provides an opportunity to reflect upon the enduring global challenges that lie ahead and how to best prepare for them. The next administration must build on these reforms to ensure an even stronger, more evidence-based and comprehensive approach to ensuring women and girls are full partners in finding solutions to global challenges” (7/20).
Huffington Post: Renewing Our Commitment To Global Development
Susan Rice, U.S. national security adviser
“…[The White House Summit on Global Development] is a chance to institutionalize the tremendous progress we have made together and to catalyze momentum across several key areas. First, we’ll continue encouraging broad-based and inclusive economic growth. … Second, building on the lessons of programs like our Feed the Future initiative, we will continue to transform food security and nutrition. … Third, we’ll do more to advance global health. … Finally, we’re investing in the young people who are the future of their countries and our world. … There will be no shortage of challenges for the next administration to face. But there are few greater opportunities to address those challenges, enhance the United States’ own security, and lift the lives of billions, than by advancing inclusive global development. Together, we must recommit ourselves to the vital task of expanding dignity and opportunity across the globe” (7/20).
- Congress's Response To Zika 'Unsympathetic,' 'Shameful'
Baltimore Sun: Capitol Hill’s shameful indifference to Zika
“…Only one group seems remarkably unconcerned about Zika and the threat it poses to public health: the men and women of the United States Congress who left Washington last week for a seven-week recess without approving a dime more in spending to combat Zika. … [T]he timing could scarcely have been worse. It means some local communities won’t have the money to spray for mosquitoes, and development of a vaccine will be delayed as researchers at the National Institutes of Health have already been forced to halt testing. … There may be more fearsome diseases on the planet — the majority of adults recover from a Zika infection without permanent disability — but rarely has a public health threat of this magnitude evoked such a unsympathetic response from Congress. Shame on all of them for not staying on the Senate floor until their work was done” (7/20).
- Finding Cure, Control Strategies For HIV Possible With Continued Research
The Conversation: A cure for HIV: what science knows, and what it doesn’t
Sharon Lewin, consultant physician at Alfred Hospital’s Department of Infectious Diseases and director of the Peter Doherty Institute for Infection and Immunity; and Thomas Aagaard Rasmussen, clinical research fellow at the Peter Doherty Institute
“…A successful strategy [for curing or controlling HIV infection] is likely to need two components: reducing the amount of virus that persists on antiretroviral treatment and improving long-term immune surveillance to target any residual virus. Far more work must be done on an HIV cure in low-income settings to better understand the effects of different HIV strains, the effects of co-infection, and the impact of host genetics. Lessons from other fields, particularly oncology, transplantation, and fundamental immunology are all relevant to inform the next advances needed in cure research. Finally, we have to ensure that any intervention leading to a cure is cost effective and widely available. … Finding a cure for HIV remains a major scientific challenge, but many believe it to be within the realm of possibility and it will hopefully play an important role in seeing an end to HIV” (7/20).
- Opinion Pieces Discuss Approaches To Achieving SDGs
The Guardian: We must focus on the U.N. goals that are the best value for money
Bjørn Lomborg, president of the Copenhagen Consensus Center; Finn Kydland, professor of economics at the University of California Santa Barbara; and Nancy Stokey, professor of economics at the University of Chicago
“…[B]eing smart about spending — focusing first on the [Sustainable Development Goal] targets where we can achieve the most — would effectively be the same as doubling or quadrupling the aid budget. In tough times, when donor budgets are under threat, we should ensure that every cent achieves the most possible. That means focusing first on the areas where we can achieve the most. One development target that should be prioritized over others is the eradication of tuberculosis (TB). … Preventing childhood malnutrition is another excellent target. … There are excellent targets involving the environment as well. … Better nutrition and better schools will help alleviate poverty, but there is another target that promises to be even more effective: lowering barriers to international trade. … These are the policies that should be prioritized by policymakers, among the Sustainable Development Goals. Focusing on them first would vastly increase the benefits from development to people around the world, as well as generations to come” (7/20).
Huffington Post: The Sustainable Development Goals Are Coming To Life
Magdy Martínez-Solimán, U.N. assistant secretary general, UNDP assistant administrator, and director of Bureau for Policy and Programme Support; Omar Abdi, U.N. assistant secretary general and deputy executive director at UNICEF; and Amir Abdulla, U.N. assistant secretary general and deputy executive director at the World Food Programme
“…Achieving the [Sustainable Development Goals (SDGs)] will require very bold new approaches. Five elements are key: National ownership on and leadership of the SDGs is vital … Countries will need to follow a whole-of-government approach … Building broad coalitions around the goals will be crucial to achieving them … All available financial resources must be drawn on for the new agenda … Every country has relevant experiences to share and new things to learn … The U.N. will strengthen its support for Member States in implementing the SDGs. Our commitment is to work together in enabling the exchange of experiences and mutual learning, which are essential for turning the ambitions of the 2030 Agenda into reality on the ground, where sustainable development happens” (7/20).
From the Global Health Policy Community
- 'Science Speaks' Continues Coverage Of AIDS 2016 Conference
Center for Global Health Policy’s “Science Speaks”: AIDS 2016: Elton John, PEPFAR announce first recipients of joint fund supporting sexual minority access to HIV services
Antigone Barton, senior editor and writer at “Science Speaks,” reports on an announcement by the Elton John AIDS Foundation and PEPFAR that the International AIDS Alliance and the Global Forum on MSM & HIV will receive the first grants under the $10 million LGBT Fund to “open and ensure access to HIV services for men who have sex with men and other sexual minorities in sub-Saharan Africa and the Caribbean” (7/21).
Center for Global Health Policy’s “Science Speaks”: AIDS 2016: Reducing stigma against gender and sexual minorities, a one-day training makes a difference
Ashley Gibbs, senior associate for health, and David Mbote, technical policy adviser, both at Palladium and both serving on Health Policy Plus (HP+), discuss the HP+ project, a USAID- and PEPFAR-funded initiative that works “toward mainstreaming expertise on gender and sexual diversity in the global HIV response,” and its predecessor, Health Policy Project (HPP), in which public health professionals participated in training to “better understand and address the needs of gender and sexual minorities in the context of HIV programming around the globe” (7/21).
Center for Global Health Policy’s “Science Speaks”: AIDS 2016: Trial shows higher dose rifampicin could reduce deaths among TB/HIV patients who are severely immunosuppressed
Christine Lubinski, executive director of the Center for Global Health Policy, reports on a discussion at AIDS 2016 on trial results that explored whether changes in TB treatment could improve the odds of survival for patients. The results “demonstrated that increasing patients’ rifampicin dosage along with the other TB medications and providing antiretroviral therapy within eight weeks of starting TB treatment reduced the risk of early death among co-infected patients” (7/21).
- AIDS 2016 Should Put Rights Of Drug Users On Conference Agenda
Open Society Foundations: How an AIDS Conference Sidelined an At-Risk Population
Shaun Shelly, advocacy and psychosocial coordinator at the TB/HIV Care Association, says there is a lack of visibility and support for drug users at the International AIDS Conference, writing, “Advocates for the health and human rights of people who use drugs have come to rely on HIV funding to do their work. … [S]ince drug users are only visible through the lens of HIV prevention, it is very concerning that the world’s biggest gathering of HIV scientists, policymakers, health professionals, and activists has kept drug users, and even the narrowest definition of harm reduction, out of the main proceedings…” (7/19).