It’s a cry the International HIV/AIDS Alliance strongly feels that governments who are gathering next week at the United Nations High Level Meeting in Vienna (11-12 March 2009) to set international drug policy for the next 10 years, need to hear.
We have a real opportunity here to tackle the HIV rates amongst injecting drug users but because of a conflict in policy approaches public health is being put at risk.
Harm reduction strategies such as needle and syringe programmes and substitution therapy (methadone) can help prevent the spread of HIV and are endorsed by UNAIDS and WHO. But some governments are blocking a more progressive approach to drug policy that would allow for a more health-centred approach to drug use. The UN Office on Drugs and Crime (UNODC) despite endorsing harm reduction, also does not actively support it, claiming it perpetuates drug use. All the available evidence points to the fact that harm reduction strategies do not increase drug use.
It’s this fundamental split in the policy approach to HIV and injecting drug use that is hampering efforts to contain the spread of HIV. In 2008, around 3 million of the nearly 16 million people who inject drugs were estimated to be HIV positive. Inadequate policy frameworks are the main reason that HIV prevention programmes still fail to reach most injecting drug users.
The Alliance supports some unique HIV prevention programmes around the world including in Ukraine, India and Cambodia that have former and current drug users at the heart of tackling HIV amongst their community. They are providing HIV prevention services, home detox services and support for women and young people vulnerable to HIV.
Susie McLean is our senior advisor on HIV and drug use at the Alliance. She is currently visiting Malaysia and sent this email back.
“I’ve just spent this morning with a group of tough, courageous, poor, talented drug users/ex drug users running one of the city’s busiest needle exchanges.
“It's hard work, and every other day it’s undermined by local police who beat up outreach workers, beat up and imprison drug users, beat up and arrest people caught with a syringe in their pocket, incarcerate drug users without treatment and without any judicial process. When I ask what challenges they have, they all chime in.....'drug policy'. 'We can't do our job because the police stand outside the exchange or follow the outreach workers and scare drug users away'. As you would imagine, there are really high rates of HIV amongst street drug users... Lots of sick people in the drop-in. Skinny, hungry, tired people getting a bit of respite from the harshness of life on the streets as a dependent drug user. “
This unfortunately is common. Drug users and outreach workers all throughout Asia and Eastern Europe are harassed by the police at needle exchange sites and drug users are arrested for carrying clean syringes. It simply makes users more likely to stay away from services and share needles.
The State of Manipur in India, has one of the highest HIV prevalence rates in the country. Putting HIV prevention efforts in place saw the HIV prevalence rate among injecting drug users drop from a peak of almost 80% in 1997 to around 20% in 2006.
Governments like the UK that introduced needle exchange and methadone in the 1980s have seen the epidemic among drug users remain low. HIV rates amongst injecting drug users are just 1.1% in England and Wales. In contrast in the USA the federal government has not supported harm reduction approaches and there is an estimated HIV rates of 16% among injecting drug users.
The Vienna meeting presents us with an opportunity to create policy an environment that ensures that harm reduction strategies are not undermined and people can receive all the support they need to prevent themselves from contracting HIV and passing it to others. Including support for harm reduction would be a real step forward.
Alvaro Bermejo, Executive Director of the International HIV/AIDS Alliance.