Vietnam to offer heroin addicts methadone

By, Radio Australia, April 29, 2008

Vietnam has opened clinics offering drug users the substitute drug methadone, to help wean heroin addicts off injected drugs and reduce the spread of HIV/AIDS.

Two clinics have opened in the northern port city of Haiphong, which has a large number of heroin addicts and high HIV infection levels.

It's expected to treat 700 drug users with the heroin substitute methadone from now until December.

More clinics will open next month in Ho Chi Minh City, which has the highest HIV infection rate in the country.

The United Nations AIDS agency UNAIDS has welcomed the program, saying methadone programs can reduce illegal drug use, crime and mortality, as well as reducing the spread of HIV and hepatitis.

Observers say around 300,000 people in Vietnam are believed to be living with HIV, the majority of whom are drug users, sex workers and homosexual men.

Source: http://www.radioaustralia.net.au/news/stories/200804/s2229749.htm?tab=asia

Thailand's Anti-Drug Efforts Hindering Fight Against HIV/AIDS, Advocates Say

By, Kaiser Network, April 23, 2008

Thailand's efforts to fight drug use are hindering HIV/AIDS control programs in the country, some HIV/AIDS and human rights advocates said recently, Thailand's Nation reports. According to a statement released by the groups on Tuesday, former Prime Minister Thaksin Shinawatra in 2003 implemented a policy aimed at eradicating drug use that included extrajudicial executions, forced drug rehabilitation, and "blacklisting" of suspected drug users and dealers. "The 2003 war on drugs is notorious for the crimes against humanity perpetuated by Thai authorities," Karyn Kaplan, director of policy and development at the Thai AIDS Treatment Action Group, said. She added that the groups are "horrified that Thailand would relaunch such a disastrous government policy."

The 2003 policy also hindered drug users' access to HIV/AIDS services -- such as treatment, prevention and counseling -- by driving users further into hiding, according to the statement. Kriengkrai Aiemprasert -- an outreach worker at the Ban Mit Sampan Harm Reduction Center in Bangkok, Thailand -- said that the war on drugs will have "disastrous consequences for the fight against AIDS in Thailand, and it will not work as a response to drug use in Thai society." Kriengkrai added that Thailand's prime minister should "end the war on drugs and promote a response to drug use based on evidence and human rights."

According to the statement, a large percentage of drug users in Thailand are HIV-positive. In addition, the statement said that although HIV rates are declining overall in Thailand, rates are not decreasing among vulnerable groups such as drug users or men who have sex with men. TTAG Director Paisan Suwannawong said that instead of an effective response to drug use, the Thai government has "pledged to crack down on drugs" and has told advocates to "expect more murders."

The groups plan to organize demonstrations outside upcoming UNAIDS meetings in Chiang Mai, Thailand, and New York City to call on Thailand to reconsider its war on drugs (Nation, 4/22).

Source: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=51692

Iran's addicts fall victim to geography

By, Anna Fifield (Tehran), Financial Times Deutschland, February 28, 2008

Iran shares a long border with Afghanistan, which produces 90 per cent of the world's opium, and as much as half of that is smuggled through Iran. The country's proximity to the world's biggest opium producer has led an estimated 5m into narcotics.

Three years ago things could hardly have been worse for Ali-Reza Fatehi. His family had disowned him, he had lost his profitable business selling socks in the Tehran bazaar and his television set was his only friend.

When he was not watching television he was rifling through rubbish bins to collect plastic that he could sell on to recycling companies.

"It was a very degrading job and completely out of character for me," says Mr Fatehi, looking down at his stained shaking hands through dark-ringed eyes. "But at the time I was doing crack and heroin and I wasn't myself."

Explosion in opium production since US-led invasion

Officially there are 1m drug addicts in Iran but international health workers estimate that the figure is much closer to 5m, in a country of 70m people. While much is known about the problem in neighbouring Afghanistan, and particularly about the explosion in opium production since the US-led invasion seven years ago, Iran's significant drug challenge is below the radar.

But Iran shares a long border with Afghanistan, which produces 90 per cent of the world's opium, and as much as half of that is smuggled through Iran, partly for export and partly for consumption by people such as Mr Fatehi.

Iran's addicts spend $3bn - the equivalent of 15 per cent of Iran's annual oil income - on drugs each year and their problem has led to a multitude of social ills, including an increase in HIV infections. There are about 70,000 HIV/Aids sufferers in Iran, about 60 per cent of whom were infected by sharing needles.

But just as Iran is a victim of its geography, Mr Fatehi, 37, was in some ways a victim of his success.

"I dropped out of school and started selling socks and stockings," he says at the Persepolis centre, a non-governmental treatment centre in southern Tehran where he goes every day for methadone, an opiate-replacement therapy.

"I was making very good money so I hired someone to run the business for me. I had a lot of free time to go to my friends' houses and have fun, but one of them introduced me to opium."

He progressed to heroin, crack cocaine and crystal meth and was an addict for more than a decade, until he finally sought help three years ago.

"Physically I'm clean now but mentally I'm not. I can't imagine not having any substances in my life," he says. "But this medicine has helped me a lot."

The Persepolis centre is one of a handful of pioneering institutions that treats drug users. It focuses on harm reduction - giving fresh syringes and condoms to addicts - and provides methadone to about 250 people a day, a fifth of whom are women.

Spread of HIV and AIDS

"Many addicts catch other diseases such as HIV or hepatitis so we teach them how to inject cleanly and to uphold healthy practices," says Gaila Darvishany, one of the centre's managers. Volunteer workers dole out plastic cups of methadone and change the dressings on the wounds of crack users who have accidentally burnt themselves.

Iran is a natural bridge between Afghanistan and Europe - ideal for smugglingThe government is trying to stem the flow of drugs into the country, a struggle that has led to the killing of more than 4,000 police officers in the course of drug control operations since the 1979 Islamic revolution.

Iran has built what Roberto Arbitrio, the head of the United Nations office on drugs and crime in Tehran, calls an "Iranian Great Wall" of ditches and fences along the border with Afghanistan and Pakistan.

Heroin trafficking on a huge scale

"Iran is a natural bridge between Afghanistan and the 'Balkan route' to Europe. Plus, to the north there is the Caspian Sea and the Russian market, and to the south is the Gulf, increasingly a route for hashish," Mr Arbitrio says.

"But this is not a situation where you've got a guy coming across the border with a suitcase containing 1kg of heroin," Mr Arbitrio says. Traffickers in 4WDs carry Kalashnikov machine guns and rocket-propelled grenade launchers, travelling "like an army" and using guerrilla warfare, he says.

After waging waging his own struggle, Mr Fatehi - who has now found himself a cleaner line of work, selling cigarettes from a sack on the pavement - has modest ambitions for the future.

"My life has already got a lot better," he says. "But now I'd like to get married and have kids. I'd like my mother to come and visit me more. I'd like for my dad to accept me. I'd like to be myself again."

Source: http://www.ftd.de/karriere_management/business_english/:Business%20English%20Iran/322896.html

The success and limits of harm reduction

By, Lawrence D., Gay City News, February 14, 2008

Research presentations by AIDS epidemiologists and medical doctors offer ample understanding of the impact of harm reduction in preventing or slowing the spread of HIV. When it comes to preventing the virus' transmission, the two biggest harm reduction innovations have been needle exchange and safer sex approaches conceptualized and implemented in the US in the mid-to late 1980s.

I work in addiction medicine, specifically methadone maintenance, which fosters needle exchanges and offers opiate-injecting addicts a means of obtaining opiate medication without the use of needles. It has emerged as one of the most effective harm reduction tools.

Two decades later, how do needle exchange and safer sex campaigns compare in terms of results? Harm reduction successes have been stunning in the case of needle use and addiction. HIV rates among needle-using addicts in New York -still the epicenter of AIDS among injection drug users - are down by as much as 80 percent. So much for former New York City Mayor Ed Koch's observation that needle exchanges were an idea whose time had not come and would never come for our city.

Much of this success would have been impossible but for the work of early activists in ACT UP, passionate fighters who bucked the system with a mission of life-saving, the results of which they can be justly proud and likely are beyond their most outsized hopes. Their pioneering advocacy on needle exchange sits alongside ACT UP'S work in spearheading the push for anti-retroviral treatments, which have transformed HIV disease from a certain death sentence to a chronic condition very often compatible with longevity and high quality of life.

Encouraging the use of these treatments led to another clear success of harm reduction - the prevention of HIV transmission from mother to fetus. The success rates in New York now approach 100 percent.

What about the impact of safer sex harm reduction efforts on the rate of sexual transmission of HIV? Have they achieved comparable success?

There is no doubt that safer sex practices have prevented and continue to prevent countless cases of HIV transmission, but the results of this harm reduction approach offer a more complex, variable, and ultimately disappointing picture.

Not only are the declines in new HIV cases these days a lot less dramatic among the sexually active, they are nonexistent or worse in some populations. We are seeing increasing rates of infection, sometimes dramatic, and often accompanied by escalations of other STDs, now including MRSA, the multi-drug-resistance strain of staph. And that phenomenon has been seen in diverse settings - among inner-city men who have sex with men; in the 13-19 year-old demographic, especially black and Latino; in those who use crystal meth; and among middle-aged and older gay men.

It seems clear that safer sex approaches, not to mention abstinence, however intermittently successful, do not currently achieve anywhere near the success of needle exchange in reducing the transmission of HIV. I strongly agree with Gay City News' s condemnation of panic-mongering in the media - articulated in Duncan Osborne's critique of the recent New York Times story on the spread of MRSA in gay men.

But we must recognize that until we find a way to achieve the same sort of success in our harm reduction efforts on safer sex that we've seen through needle exchange, the gay community will have to navigate the tempests of prejudice stirred up every time there is an outbreak or upsurge of infection among us. Coming up with such an approach should earn the innovator the Nobel Prize, a recognition already overdue to ACT UP for its collective achievements.

In the meanwhile, we have no choice but to continue the painstaking work of harm reduction through safer sex, neighborhood by neighborhood, demographic slice by demographic slice, region by region, individual by individual, and, with the migration of sexual hook-up opportunities to the Internet, communications technology by communications technology.

But we need to do this work more innovatively, diligently, consistently, and intensively than we currently are. Perhaps then we will flatten the spikes of outbreaks and lower the rates of new cases to an extent that will be comparable to the successes currently attributable to needle exchange.

Should we close the bathhouses and shut down sex parties? That would make no more sense than expecting to reach needle-using addicts by shutting down shooting galleries and preventing access to clean works. If needle exchanges are the model to emulate, we must find new ways to make safer sex more accessible and appealing, by utilizing rather than eliminating or even policing the venues where sex takes place.

In the 1980s, we thought of safer sex initiatives as a stopgap in advance of a preventive vaccine we felt certain would be forthcoming. Dr. David Sencer, the city's health commissioner, for one - and I agreed with him - did not believe, on the basis of STD history and experience, that sexual behavior would prove particularly amenable to change, at least in the long term. Safer sex options and regulations might be effective in some contexts, but we felt that even where most successful there would be periodic breakdowns.

What we could not foresee at that time was just how elusive an HIV vaccine - and, for that matter, a vaccine for hepatitis C, a virus even more transmissible via contaminated blood - would prove to be. With a vaccine still nowhere in sight, we have no choice but to redouble our efforts at safer sex and harm reduction, undaunted by periodic setbacks, such as those to which we can no longer turn a blind eye.

In the spring of 1981, Dr. Lawrence D. Mass, writing in the New York Native, became the first to report on the emergence of what came to be known as AIDS. He is a co-founder of Gay Men's Health Crisis and the author/editor of "We Must Love One Another Or Die: The Life and Legacies of Larry Kramer."

Source: http://www.gaycitynews.com/site/news.cfm?newsid=19297131&BRD=2729&PAG=461&dept_id=568864&rfi=6

Harm-reduction advocates outraged at UN call to shut Insite

By, Christina Montgomery, The Province, March 08, 2008

Supporters of Canada's harm-reduction approach to drug addiction are livid that a United Nations monitoring body wants Ottawa to slam the door shut on Vancouver's safe-injection site -- and put an end to distribution of "safe" crack kits to addicts.

In an annual report by the International Narcotics Control Board released this week, the UN board said distribution of the kits in some areas of Canada contravened part of the UN's Convention against Illicit Traffic in Narcotic Drugs.

The board said the drug programs violate international drug-control treaties to which Canada is a party.

The disposable crack-pipe mouth pieces -- usually rubber-tipped glass tubes -- are given to addicts to avoid the spread of blood-borne diseases, including HIV and hepatitis, when addicts share pipes.

Vancouver's Downtown Eastside safe-injection site, known as Insite, allows addicts to inject their own heroin and cocaine under the supervision of a nurse, who provides them with clean needles.

Medical journals report that Insite, the only facility of its kind in North America, has reduced overdoses and blood-borne infections.

But five years into operation, the site's fate is uncertain. It operates under an exemption from Canada's Controlled Drugs and Substances Act, which runs out in June.

The Conservative government has not said whether it will extend the exemption.

But the UN report incensed supporters of Insite.

Sen. Larry Campbell, a former mayor of Vancouver and a former coroner, called the narcotics board "stooges for a failed U.S. war on drugs" and told reporters he would personally block Insite's doorway if officials tried to close it down.

Vancouver Mayor Sam Sullivan also dismissed the board's report by insisting it simply didn't understand Insite's success.

"The way we've approached drug addiction worldwide has been a failure," Sullivan told reporters. "We need new approaches. We need to be open to innovations."

Thomas Kerr, a research scientist at the B.C. Centre for Excellence in HIV-AIDS, voiced concern that Ottawa would seize on the report as an excuse to close Insite.

Richard Pearshouse, speaking for the Canadian HIV/AIDS Legal Network, told reporters the report was "driven more by ideology and a war-on-drugs ideology than the research and the scientific evidence that supports these as a public-health intervention."

cmontgomery@png.canwest.com

Source: http://www.canada.com/theprovince/news/story.html?id=e9cd841a-a468-4634-b9e1-685ce330b864&k=25195

Female IDUs in Asia call for greater access to services

By,Baralee, HDN Key Correspondent, February, 2008

When the problems associated with injecting drug use in Asia are discussed, stigma and discrimination are often listed among users’ main concerns. For female injecting drug users (IDUs), these problems are often exacerbated.

Onuma, a female IDU from Thailand said, “If you were injecting drugs, you would face discrimination. If you were a female IDU, you would be treated worse than men and if you were a female IDU living with HIV you would be at the bottom of the scale—completely worthless.”

Many Asian countries are adopting harm reduction approaches to the fight against HIV and AIDS and drop-in centres and programs for IDUs are available in some areas. Unfortunately, few of these services cater to the needs of women.

Ekta, a founding member of Recovering Nepal who works with the National Association for AIDS Network in Nepal, said that female IDUs in the country remained largely hidden.

“We have some abstinence-based rehabilitation centres, a methadone program, and syringe exchange services, but women are not informed and therefore do not access those services,” Ekta said.

Women should be told what services are available and how they can be adapted to meet their needs. Women in Asia play an important role in the home and they face the burden of high domestic expectations.

Poverty, illiteracy and a lack of educational opportunities have held many women back, limiting their understanding of their own rights and forcing them to remain heavily reliant on their partners.

“In Nepal, we don’t have legal security, we don’t get citizenship until our father or maybe husband get us citizenship. Women are the key and principal caregivers. They always have children or husbands to take care of,” Ekta said.

“Taking responsibility for the family is more important for women and girls and such responsibilities?are blocking them from getting services. They are concerned with their children and often in our country, many don’t have husbands.”

Many of the services available to IDUs are male-oriented if not completely male dominated. Onuma said few women were treated with respect at her local drop-in centre.

“Male clients at the drop-in centre do not treat female IDUs with respect and some of female clients refused to come to drop-in centre because the male clients were rude to them,” Onuma said.

In areas where separate facilities are not available for men and women, cases of sexual harassment and abuse have been reported. This needs to be addressed and mechanisms should to be developed to educate women’s partners about their needs and to ensure they have support.

Ekta said that many programs for women focused solely on getting them to stop taking drugs and to find work. But when women struggle to quit and relapse, they often face higher levels of stigma and discrimination.

“Personally, my biggest problem is relapse. I have relapsed so many times . . . the rehabilitation people didn’t want to admit me. They said ‘what is the use of enrolling Ekta because she will relapse after three months . . .”

“I am struggling for my life . . . Please accept us as drug users. We cannot stop using drugs all at once.”

Source: http://www.healthdev.net/site/post.php?s=1346

The Goa Declaration

By, Bobby Ramakant, Health and Development networks KC, January, 2008

Besides being the world’s largest producer of opiates and other drugs such as Amphetamine type substances (ATS), the Asian and the pacific region is home to the largest number of drug users. �Although evidence-based, cost-effective approaches are endorsed and promoted by various agencies people who use drugs in the region continue to be oppressed by discriminatory government policies and non-evidence based ‘solutions’ to drug use, such as imprisonment and compulsory detoxification and rehabilitation. Without taking into consideration the socio-economic factors underpinning drug use in the region, people who use drugs will continue to be harassed, marginalised and discriminated against, stereotyped as dangerous and imprisoned.

The constant oppression, persecution and human rights violation contributes to HIV and hepatitis vulnerability of people who use drugs, particularly those who inject. In Asia, up to 89% of new HIV and 92% of hepatitis C infections are occurring among injecting drug users (IDUs). On average IDUs account for 30-50% of new HIV infections and 40-60% of the IDU population is estimated to be living with hepatitis C virus (HCV) as well. Even though it is obvious that �drug users’ vulnerability to and experience with HIV and HCV make them one of the most important constituents in responses to HIV and HCV in Asia and the Pacific, the level of harm reduction, treatment, support services available as well as involvement of that particular community continues to be grossly insufficient.

If Asian and the Pacific governments, civil society, health care providers and other stakeholders are serious about halting the HIV/HCV epidemic, purposeful attention and action must be given to ensure evidence-based and non-oppressive approaches to address the needs and high vulnerability of the IDU population in Asia and the pacific. Policies on drug control need to be harmonized with HIV and HCV prevention, treatment, care and support efforts and standards of services for harm reduction would also be required in order to have an enabling environment for sustainable service delivery.

In this context, WE, the people who use drugs in Asia and the Pacific, thereby:

Call on governments, various agencies, bi- and multilateral organisations, civil society organisations (CSOs) and the general public to support in:

* Empowering our communities to advocate and protect our rights and to facilitate meaningful participation in decision making on issues affecting us;
* Promoting a better understanding of current drug policies that negatively impact on the lives and rights of people who use drugs, their families and communities;
* Acknowledging and enhancing our knowledge and skills to educate and train others, particularly our peers and members of our community;
* Advocating for Universal Access to harm reduction, HIV/HCV treatment and care programmes, including access to evidence-based and effective drug treatment, appropriate medical care, safer consumption equipment, safe disposal of syringes and needles, up-to-date information about drugs and their effects, and safer facilities for practicing harm reduction;
* Protecting and eexercising our right to evidence-based information on various drugs including their side effects and complications, access to equitable and comprehensive health and supportive social services, safe and affordable housing and meaningful employment opportunities;
* Establishing specifically designed program to address the issues of women who use drugs and allocate enough resources to ensure programs are sustainable while actively promoting their meaningful full participation in all policy, program design and implementation process.
* Supporting local, national and regional networks of people who use drugs are incorporated at all levels of decision-making and equitably remunerated for their contributions;
* Challenging laws, policies and programmes that disempower, oppress and prevent us from leading healthy and positive lives;
* Distinguishing drug dealers from people using drugs who need support, care and treatment instead of oppression and prosecution;
* Providing easy access to affordable antiretroviral medicines including second and third line treatments, TB and HCV treatment for all who need them; if necessary by enacting intellectual property laws to protect the rights of developing countries to implement the safeguards enshrined in the TRIPS agreement and Doha Declarations such as Compulsory Licenses, as endorsed by the 2007 WHO General Assembly;
* Advocating for development and adherence to harm reduction service delivery such as NSP, OST, residential care, ARV/HCV treatment etc.

Affirm our duties and responsibilities as responsible citizens in:

* Contributing to collective efforts against the HIV and HCV epidemics in Asia and the Pacific, including HIV and HCV prevention, and care and support of those already infected and affected;
* Seeking understanding of issues, challenges and needs of drug users in Asia and the Pacific;
* Promoting tolerance, cooperation and collaboration; fostering a culture of inclusion and active participation;
* Respecting the diversity of backgrounds, knowledge, skills and capabilities, and cultivating a safe and supportive environment within the drug user community regardless of the types and routes of drugs consumption;
* Supporting, strengthening and encouraging the development of organizations for people who use drugs in communities/countries where they do not exist.

State our position that:

* The most profound need to establish a network of people who use drugs arises from the fact that no group of oppressed people ever attained liberation without the empowerment and involvement of those directly affected; �
* Through collective action, we will challenge existing oppressive drug laws, policies and programmes and work with government and our constituents to formulate evidence-based drug policies that respect human rights and dignity of people who use drugs.

Source: http://www.healthdev.net/site/post.php?s=1268

Don't give us false illusions of hope: injecting drug users

By, Bobby Ramakant, Healthdev, January, 2008

Repeated calls for harm reduction approaches to HIV prevention, treatment and care, particularly for injection drug users (IDUs), were answered with a reality check on the second day of the first Asian Consultation on Prevention of HIV Related to Drug Use, in Goa.

During a session that brought together parliamentarians, civil society activists and IDUs, the voices of several users provided delegates with a stark reminder of the reality on the ground.

“Drug users are treated as criminals, as sub-human beings” said Bijaya Pandey from Nepal.

“For the past few years we have been hearing about ‘3 by 5’ and ‘2010’– please, please, don’t give us a false illusion of hope,” Pandey said, referring to the World Health Organization’s (WHO) failed initiative to provide antiretroviral drugs (ARVs) to three million people by end of 2005, and the promise of universal access to prevention, treatment and care by 2010.

Opioid substitution therapy (OST) and needle syringe exchange programmes are not operating or even legal in some Asian countries. Only a handful of states in the region have government-supported OST or syringe exchange programmes.

The combination of the criminalization of injection drug use and a lack of a coherent legal and policy framework on drugs, means that not only are IDUs are at risk while accessing existing services, but service providers are also at risk of being penalized for offering them.

“Bijaya, Tamara and I are the lucky survivors of the war – the war on drugs,” said Fredy Edi, a board member of the International Network of People who Use Drugs and the Indonesian Drug User Network, referring to IDU representatives Pandey and Tamara Speed from Australia.�“The war on drugs is also war on health,” Fredy added.

There is evidence to suggest that ‘war on drugs’ has caused a rise in HIV infections, particularly among IDUs, across the region. The number of new hepatitis C (HCV) infections has also increased since the war on drugs was launched. HCV infection rates are believed to have reached epidemic proportions in many parts of Asia, such as Manipur in India.�

“We have buprenorphine but distribution is limited to less than 10% of people who need it,” a delegate from Manipur said during the meeting.�

Another delegate raised the issue ARV treatment for IDUs. Many IDUs are reportedly being told that they must stop taking drugs before they can receive treatment from ARV centres.

Delegates also expressed concern over the lack of programmes designed to tackle inhaling drug use and the lack of programmes tailored towards women, transgendered users or the partners of male users.

“It is very difficult to find female drug users in public spots,” Dr Tasnim Azim from Bangladesh told the session. About 15% of female IDUs in Bangladesh become pregnant within two years of developing a habit, Dr Azim said, adding that there were no antenatal clinics or services for female drug users.

While we eye the goal of Universal Access for 80% of IDUs, Bijaya’s plea ‘not give a false illusion’ serves as a grim reminder of the reality faced by those who need these services the most.

Source: http://www.healthdev.net/site/post.php?s=1227

Harm reduction is easy: Put your money where your mouth is

By, Pascal Tanguay, HDN, January, 2008

"Aren’t you ashamed of yourselves?" demanded a European couple stumbling on the opening ceremony festivities here in Goa. "You should be, enjoying parties and conferences that cost millions, while people living with HIV can’t even afford to buy their medication!”

“We pay our taxes and when we get home we are going to contact our member of parliament.”

While many probably share their views about the costs of HIV-related conferences in general, the tirade points to a deep-seated misconception: that taxes in rich nations provide for high quality and comprehensive HIV prevention, care, treatment and support for people living with HIV (PLHIV) throughout the world. The fact is, they don't.

Sources of support for HIV work get even more muddy in relation to the needs of marginalized populations, such as drug users. Injection drug use is driving the HIV epidemic in Asia, and while harm reduction approaches have proven effective at reducing the spread and impact of the epidemic among injecting drug users (IDUs), progress in addressing IDU's needs and priorities moves at glacial pace.

According to Swarup Sakar, senior regional HIV adviser to the Asian Development Bank, only about one-fifth of the resources needed to achieve the agreed target of 80% at-risk population coverage by 2010 has been made available. That means something in the order of 100 million USD is needed every year in the Asia region alone for the so-called 'universal access' targets to be reached.

A similar scale of funding requirements was echoed by the UNAIDS regional chief, JVR Prasada Rao, who told the meeting that over 200 million USD per year is needed for harm reduction approaches to be effectively deployed on a global scale.

In 2006, less than half of that amount found its way into harm reduction programmes across the world – about 0.5% of the total resources invested in curbing the HIV epidemic. That lack of investment translates directly into the sobering figures being repeated in just about every session here in Goa: Outside of Africa, about 30% of new HIV infections are found among drug users; an estimated 18% of drug users have access to harm reduction services (2005 data); and less than 5% of injecting drug users have access to comprehensive HIV prevention, treatment, care and support services.

It is a case of 'one step forward, two steps back' with harm reduction in Asia, where service coverage is even lower than global averages, and falling: from 5.4% in 2003 to an estimated 3% in 2005. This is while across the region, between 30 and 50% new HIV infections are found among IDU communities and in some countries that rises as high as up to nearly 90%.

Although resources to address HIV have been significantly increasing overall, there is a mis-match between where resources are being spent and where they are needed. In Asia, the epidemic is continuing to accelerate and even in countries where the epidemic is showing signs of slowing or leveling off, HIV levels remain high among IDU communities.

Stigma, discrimination and criminalization of drug use contribute to the overall lack of action and practical thinking of governments and high level officials when it comes to drugs and associated issues. The common approach to drug use and drug users is from the public safety perspective instead of health and human rights. Even funds that are destined for harm reduction services may be diverted to other programmes that are deemed more socially desirable and deserving.

There are also specific donor restrictions in place that limit the flexibility of non-governmental organizations (NGOs) and community based organizations (CBOs) in providing effective services to IDUs. "Multilateral agencies have operational costs that constitute 20-30% of their budgets," said Shiba Phurailatpam, regional coordinator of the Asia Pacific Network of People Living with HIV (APN+). "Yet civil society organizations are told to cut their organizational costs below 10% and service delivery suffers as a result."

Although guidelines for effective harm reduction includes a 10% budget allocation for creating 'enabling environments', this investment is usually neglected. NGOs are often prevented from using donor funds to advocate for policy change and the creation of enabling environments for drug users.

The bottom line is that sustainable harm reduction needs political buy-in and commitment, and yet few Asian governments have committed to harm reduction policies and programmes. In fact, most have active legislation that criminalizes harm reduction activities as well as drug use. Where those commitments have been made, drug users are often not involved in the design, deployment and evaluation of such programmes in order to make sure they are appropriate. Further, high-level political commitment rarely translates into implementation at the provincial or community levels. As most of the harm reduction funding comes from external sources, governments do not have the incentive for genuine commitment.

Despite the challenges, there are champions for harm reduction in the Asia region. Launched in July 2007, the HIV/AIDS Regional Project (HAARP) spreads its eight-year budget (56 million Australian dollars) fairly thinly over six countries. But HAARP promotes harm reduction as a key approach to respond to HIV in Asia. It is mainly funded by the Australian government (AusAID) with contributions from the Netherlands government (for Vietnam-based activities). These two donor countries are field leaders in progressive policy-making founded on evidence; as opposed to stigma, discrimination and marginalization of drug users. The HAARP programme draws on comprehensive reviews of current evidence, and is being developed in consultation with civil society including drug users, as well as governments in programme countries.

According to Bijaya Pandey, a drug user activist based in Nepal, "HAARP's donors are putting their money where their mouth is."

Source: http://www.healthdev.net/site/post.php?s=1233

30% of new HIV infections in Asia associated with injecting drug use

By, Media for Freedom, January 30, 2008

Thirty percent of all new HIV infections in Asia are associated with injecting drug use, estimates the joint United Nations Programme on HIV/AIDS (UNAIDS).

Nearly half of the world's estimated 13 million drug users live in Asia where injecting drug use is a major factor fuelling HIV transmission. Most of the global supply of opium and heroin is produced in Asia where vulnerable groups who inject drugs form a significant population engaged in high risk behavior such as sharing contaminated injecting equipment and unprotected sex leading to HIV infection.

Some Asian countries report HIV prevalence among injecting drug users (IDUs) as high as 85% while others that previously reported little or no HIV transmission relating to IDUs have now detected the virus among this population.

For the first time in Asia, AIDS experts, parliamentarians, civil society and drug user organizations come together for a consultation in Goa, India, on HIV prevention and treatment for drug users. Organized by the Asian Consortium on Drug Use, HIV, AIDS and Poverty, the consultation draws more than four hundred delegates from 27 countries to address political, legal and social barriers to HIV interventions for IDU communities and to advocate for expanded harm reduction programs promoting drug substitution treatment, access to needle and syringe exchange and peer education that has proven effective in stemming the spread of HIV.

"We will address the vulnerability related to drug use and HIV/AIDS affecting millions of people in Asia and the related social hazards including criminalization, incarceration and their linkages to poverty," said Luke Samson, Co-Chair of the consultation and Executive Director of the New Delhi based advocacy group SHARAN.

Across the region, criminalization of drug use, severe stigma and discrimination and law enforcement that marginalize and penalize drug users have driven them underground and deterred their access to life-saving HIV prevention and treatment services.

Gary Lewis, Representative United Nations Office on Drugs & Crime (UNODC) stressed successful models of community-based HIV prevention through outreach and counseling need to be adopted to address AIDS as a social as well as public health issue. "In Asia, the need of the hour is to scale-up interventions to reach out to populations at risk and to save lives. We know what to do, but we need to do more of it."

The consultation is reviewing the alarming spread of HIV in prison and custodial settings and advocate for reformed legislation, engagement with law enforcement and narcotics agencies and national AIDS policies that include services for incarcerated people and those in compulsory rehabilitation programs.

"We must ensure access to prevention and treatment services and protect the rights of most at risk populations such as people who inject drugs by involving them and their communities in every stage of the AIDS response," said UNAIDS Asia Pacific Regional Director, Prasada Rao.

"Regional collaboration for HIV preventions is the most effective mechanism to combat the growing pandemic. This consultation is a unique opportunity to generate enduring solutions to HIV and AIDS issues affecting drug users across Asia," said Shri Oscar Fernandes, Minister of State for Labour and Employment, Government of India, and Convener of Parliamentary Forum on HIV/AIDS in India.

The Asian Consortium on Drug Use, HIV, AIDS and Poverty is a voluntary network on collective issues of HIV prevention, access to health, food, harm minimization and mainstreaming towards poverty alleviation among drug using populations in Asia.

(Citizen News Service)

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Law Enforcement Attempts To Stop Injection Drug Use Undermining HIV Control Efforts Among IDUs in Southeast Asia

By, Kaisernetwork, October 26, 2007

Efforts by police to stop injection drug use are undermining attempts to curb the spread of HIV among injection drug users in Southeast Asia, law enforcement and health experts said Wednesday at the opening of a conference in Bangkok, Thailand, on reducing health risks for IDUs, AFP/Yahoo! News reports (AFP/Yahoo! News, 10/24).

According to the Open Society Institute, which is sponsoring the conference, HIV is fueled by injection drug use in at least 20 countries in Asia and Eastern Europe (AP/Yahoo! News, 10/24). Daniel Wolfe, deputy director of OSI's International Harm Reduction Program, said that efforts to reduce the spread of HIV among IDUs "can only work if law enforcement understands" harm-reduction measures and "helps to enforce them" (AFP/Yahoo! News, 10/24).

IDUs often are forced to use dirty needles because they are harassed or arrested at needle-exchange centers and drug treatment clinics, the AP/Yahoo! News reports. According to Aditya Anugrah Putra, a human rights researcher at the Indonesian Drug Users' Network, police harass and extort IDUs at methadone clinics and needle-exchange centers throughout the country. Police "wait outside methadone clinics to search patients for drugs, and they arrest syringe exchange clients at will," Putra said (AP/Yahoo! News, 10/24). Precha Knokwan of the Thai Drug Users' Network added that police in Thailand often confuse IDUs and people who sell drugs, hindering efforts to provide treatment to IDUs (AFP/Yahoo! News, 10/24).

Wolfe said that the result of law enforcement arresting or harassing IDUs at needle-exchange centers and clinics is "increased HIV infections, missed treatment opportunities and lost lives" (AP/Yahoo! News, 10/24). According to experts, it has become more difficult to determine the number of IDUs in Southeast Asia because police have caused them to go underground. Some experts say that as many as 50% of IDUs in the region are HIV-positive (AFP/Yahoo! News, 10/24).

Asia: Drug users face extra dangers

By, IRIN PlusNews, October 25, 2007

Public health experts and rights groups at a conference for community groups working on HIV/AIDS prevention among drug users in Bangkok, Thailand, have warned Asian governments that abuse and persecution by police are undermining harm reduction initiatives by deterring drug users from accessing vital services.

Many local police still saw drug users as engaged in "social evils" and deserving of harsh punishment, said public health expert Daniel Wolfe, deputy director of the Open Society Institute's International Harm Reduction Development Program.

Police abuses often "drive drug users away from life-saving care, and fuel the spread of HIV," he noted. "No HIV prevention measure can be effective if people are afraid to use it; it only takes a few times of somebody being arrested in front of a clinic before drug users don't want to go there anymore."

All Southeast Asian countries have committed to eradicating drug use by 2015, and Asian governments have increasingly endorsed methadone treatment and needle exchanges to reduce HIV transmission among injecting drug users, who are at high risk of contracting the virus by sharing needles.

But many countries have mass round-ups of drug users and other marginalised groups prior to national holidays or big public events. Wolfe, speaking in Bangkok on the sidelines of the conference, said regional health officials and regional law enforcement authorities often worked at cross-purposes.

"There is a tension between what ministries of health plan for and what law enforcement agencies actually do, so you have one hand doing, and another hand undoing effective programmes for HIV/AIDS among injecting drug users," he said. "Until one hand works with the other, the result will be increased HIV infections, missed treatment opportunities and lost lives."

Some of this apparent "schizophrenia" stemmed from a lack of coherence at the highest level of policy-making. But even when high-level law enforcement policies were formally aligned with harm reduction programmes, beat cops on Asian streets did not always pay much heed. "There is this disconnect between law enforcement goals and health needs," Wolfe commented.

Communist-ruled Vietnam, for example, has committed to harm reduction programmes as part of its national AIDS strategy and has allowed needle exchange programmes in several areas with relatively large populations of injecting drug users. Yet many Vietnamese drug users were still reluctant to use these services, as carrying a syringe could leave them liable to arrest and imprisonment.

While Vietnam is due to begin its first methadone programme soon, the country also has over 50,000 people in 'forced treatment centres', where programmes consist of heavy labour, military-style drills and chanting slogans.

China has seen a rapid scale-up of harm reduction projects, with nearly 30,000 people put on methadone treatment, up from virtually nil three years ago. But at the same time, Wolfe said, an estimated 100,000 Chinese were in compulsory detoxification centres for as long as year.

The Indonesian government has five public clinics in Jakarta that supply methadone as part of their overall strategy to promote harm reduction, and police and the National AIDS Commission signed a memorandum of understanding in 2002, agreeing to work together.

But Aditya Anurag Putra, a human rights research with the Indonesian Drug Users Network, complained at the conference that police extortion and harassment of drug users outside HIV testing facilities and methadone clinics was rampant. "It's very difficult for us to engage [with] drug users for [them to use] services in Indonesia," he said. "The situation is not a conducive atmosphere for drug users to access treatment."

Wolfe suggested that raising police salaries, which were low across Asia, could also help end the rampant petty extortion of money from drug users, a major disincentive to accessing services.

"Police wages are often extremely low, and police frequently use drug users as a kind of supplemental income because they can say to drug users, 'either you give me some money or you go to these very punitive treatment centres, or you go to jail for a long time.'"

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