As discussions at the International Harm Reduction Association Conference take place this month on how to expand harm reduction services, it remains a fact that in developing countries, drug users trying to protect themselves from getting HIV and accessing treatment and care if they are HIV positive continues to be a serious problem.
The Alliance hears many stories of young and old, men and women who use drugs who are needlessly affected by HIV because they do not have access to basic harm reduction services such as clean needles and syringes, methadone substitution therapy and psychosocial support.
Worldwide access to basic HIV services for drug users is very low. In many countries with a high HIV burden amongst injecting drug users, 80-90% don’t have access to clean injecting equipment, methadone or antiretroviral treatment.
Scaling up harm reduction
To successfully stem the growth of HIV in the injecting drug use population, small scale, niche needle and syringe programmes won’t do it. It will need programmes operating at a national level to make the difference.
So how do we successfully scale up the level of harm reduction support available to people who use drugs?
Use available infrastructure
We have much experience to draw upon in the AIDS sector. There is an infrastructure already in place through organisations working with communities on HIV/AIDS which can be used to get harm reduction services to people who need them.
The Alliance has a track record of reaching people who use drugs in Asia and Eastern Europe through our linking organisations and their relationships with communities at a grassroots level.
We are excited at the possibilities of the new Community Action on Harm Reduction (CAHR) project that means we will reach an estimated 180,000 people who use drugs across five countries with harm reduction services to prevent the spread of HIV.
Involve people who use drugs
Another important component for success is to involve people who use drugs. In this edition of the Loop you can read a story from China where trained peer educators are supporting and educating other users to access methadone programmes.
Respect human rights
Acknowledging and respecting the human rights of people who use drugs is critical. Whilst there is violence, harassment and discrimination, people who use drugs will remain hidden and underground, making it much harder to provide them with services.
Even as we write, drug users in Cambodia are facing challenging situations with the police who are arbitrarily arresting users and peer support workers. It is making the job of reaching users with HIV prevention and harm reduction services very difficult.
Don’t forget women
Frequently forgotten are women who use drugs. For a long time women were not recognised as vulnerable to injecting drug use but the Alliance through its HIV work is uncovering a chronic lack of support for these particularly vulnerable women. Frequently marginalised by their families and communities they are left without services such as sexual and reproductive health services and so are at particular risk of HIV.
There is good news however. We know what works. For example, in Ukraine, we see the results of where harm reduction work taken to national scale has contributed to a reduction in HIV incidence from 18% in 2006 to 6% in 2009.
What is needed now is the will to learn the lessons and apply them.
The Alliance has produced a good practice guide on HIV and drug use, drawing on our community experiences of responding to injecting drug use and HIV work. It aims to support the scale up of community-based HIV and harm reduction programmes in developing countries.
The International Harm Reduction Conference is calling for acknowledgement that people who use drugs, as a key population group affected by HIV and AIDS, have not reached universal access to HIV prevention renewed commitment, action toward this goal and commitment to removing legal and policy barriers to achieving this. Join the global call to action here.