OTTAWA — More can be done to provide better access to prevention, harm reduction and treatment services for drug users and alcoholics, the city’s public health unit heard during a survey of community agencies and addicts.
Between January and October 2012 nearly 63,000 people tested positive for HIV in Russia, and has recorded nearly 4,400 children infected with HIV in 2012, and 529 deaths.
But it has also resisted so-called harm reduction strategies including funding needle exchange programmes, angering health workers and global HIV prevention groups.
Activists say social stigma is impeding the fight against HIV in Russia.
Critics say Russia’s budget for HIV is misplaced despite seeing an increase. UN funding for awareness training and medication has also stopped.
UNAids figures released last week on the global HIV/Aids epidemic confirm the very encouraging trend of the past five years: fewer new infections, fewer deaths and increasing coverage (55 per cent globally) of those in need receiving antiretrovirals. In many parts of the world we are “getting to zero” HIV and Aids (the slogan for World Aids Day), but the UN figures offer unsettling evidence that achieving this target will require the world’s fastest growing epidemic, in eastern Europe and central Asia, to be overcome.
Only a decade ago some 150,000 people in this region were living with HIV. Today, that figure is 1.4m, with Russia and Ukraine accounting for 90 per cent of infections. Aids-related deaths have almost quadrupled in the past 10 years and the number of people receiving treatment is a lowly 23 per cent. If urgent and measured action based on scientific evidence is not taken here, we will be heading for a major human tragedy. The epidemic is characterised by escalating HIV infection and startling hepatitis C, tuberculosis and multi-drug-resistant TB prevalence.
The region has the highest rate of injecting drug use in the world, accounting for two-thirds of new HIV infections there. It is mainly heroin-based, but increasingly involves the use of cocaine, amphetamine-type stimulants, psychotropic substances and home-made cocktails such as krokodil (desomorphine), a mixture of codeine-based painkillers and other cheap household ingredients.
There is understandably much cause for hope in the current talk around an AIDS-free generation and Ending AIDS. As last week’s UNAIDS World AIDS Day Reportpointed out, intensive scale-up of treatment, prevention and care has now resulted in dramatic reductions in AIDS-related deaths and new HIV infections in most parts of the world, including in sub-Saharan Africa. Scientific advances such as the demonstration that treatment may suppress transmission of HIV have also fueled this wave of optimism.
Yet as the report also acknowledges, reaching the UN General Assembly targets of decreasing by half the number of new infections and having 15 million people on AIDS treatment by 2015 still faces formidable challenges. Not the least among those is overcoming the barriers in accessing marginalized and stigmatized groups such as injecting drug users and men who have sex with men.
Injecting drugs is a major driver of H.I.V. transmission in many countries in Asia. According to UNAIDS, about 16 percent of people who inject drugs in Asia are living with H.I.V. In some countries, this estimate is considerably higher: in the range of 30 to 50 percent in Thailand, 32 to 58 percent in Vietnam and 22 to 28 percent in Malaysia.
Strong campaigns around clean needles and opioid substitution therapy (O.S.T.) by the Malaysian government over the past five years have proven hugely successful in driving down new infections among drug users, and are evidence that harm-reduction programs are key to reducing new infections.
It is simply unacceptable that less than one in 10 injected drug users in the region have access to prevention services and fewer still are able to access anti-retroviral treatment.
From the University of British Columbia:
A new study from the BC Centre for Excellence in HIV/AIDS (BC-CfE) shows highly active antiretroviral therapy (HAART) reduces new HIV diagnoses, deaths and HIV prevalence, suggesting that the made-in-Canada Treatment as Prevention strategy should be implemented across the country.
HIV care transformed by Dr. Peter’s legacy
When Peter Jepson-Young died of AIDS on November 15, 1992, the man better known to British Columbians as “Dr. Peter” had one last wish: that a foundation created in his name be used to help people living with HIV/AIDS who were less fortunate than him. “There is no substitute,” the host of CBC’s AIDS Diary said in a final statement, “for the ongoing involvement and support of caring people. Persons living with HIV and AIDS have needs greater than just survival.”
Is the Commonweath ready for an Aids-free generation?
(Prasada Rao for The New Statesman)
A serious obstacle for reducing infection rates among vulnerable communities is the adverse legal environment they face which criminalises their behaviour and makes them a target for harassment and violence at the hands of law enforcers in most Commonwealth countries. All but six of these countries still classify same sex conduct as illegal. Since the first UN General Assembly Special Session on Aids the international community and UN member states have repeatedly called for amendment of laws that criminalise the behaviour of vulnerable populations to protect their human rights and fundamental freedoms, in particular access to health care and legal protection. But very little progress on reform has been reported from many Commonwealth countries in the last decade.
The Global Commission on HIV and the Law recently presented incontrovertible evidence that criminalization enhances HIV-related risks among men who have sex with men and transgender populations in Commonwealth countries. In Commonwealth countries in the Caribbean, one in four MSM are infected with HIV while in non-Commonwealth countries the ratio is one to fifteen.
From The Huffington Post:
“One of the first videos we received at the Here I Am campaign was from a young man named Yevhen Selin who lives in the Ukraine (see below). Yevhen begins by telling us that his risk to contracting HIV infection increased because he injected drugs. Like many others who are at risk of contracting HIV or are living with HIV, people who inject drugs (PWID) too often face stigma and increased discrimination.”
here is no such thing as a drug-free prison; never has been, never will be. According to CSC’s own figures, one in every nine prisoners injects drugs regularly – this despite all rules, the searches and the guards.
Drugs are easy to smuggle, but hiding a six-pack of needles in an orifice is a little more tricky. So injection drug users do two things: They fashion needles out of any material they can find, and they share. To access those needles they use the common prison currency: sex.
All these practices entail serious health risks. Dull needles cause wounds and infections. Sharing homemade, unsterilized needles spreads infections with incredible efficiency, and transactional sex is almost as efficient.
Lack of access to clean needles is one of the principal reasons that infection rates for HIV and hepatitis C are 10 to 30 times higher in the prison population than in the general population.
In her column on addiction, Barbara Kay demonstrates a profound misunderstanding of harm reduction. She should spend a day at Insite, or at the very least further educate herself on what she’s criticizing.
Harm reduction does not subscribe to the disease model or any other model of addiction. Put simply — the set of policies and programs that fall under the harm reduction model aim to reduce the negative health, social and economic consequence of drug use. One of these risks is the spread of HIV/AIDS and Hepatitis C; a very serious public health issue that Ms. Kay fails to mention.
It is true that people often mature out of addiction, but far from surrendering to addiction, harm reduction accomplishes just the opposite — it creates a supportive space for people to move past drug use when they are ready. And contrary to Ms. Kay’s mischaracterization, harm reduction does not in any way conflict with rehabilitation. Insite, for instance, is connected to a detox centre, and use of its supervised injection facilities is often the first step towards recovery.
The issue of drug addiction is far too complicated for sweeping generalizations and easy answers — it calls for a variety of approaches, and harm reduction is central to helping those who use drugs and the public health at large.
- Donald MacPherson, executive director, Canadian Drug Policy Coalition,
This weekend marked the one-year anniversary of Insite’s Supreme Court victory - congratulations to everyone who helped make it happen.
"The lack of clean needles has resulted in skyrocketing HIV and hepatitis rates in federal prisons, with HIV rates 15 times higher, and hepatitis rates 30 times higher, in prisons versus the general population."
People do not surrender their human rights when they enter prison. Instead, they are dependent on the criminal justice system to uphold their human rights — including their right to health. Prison health is public health.
These statements may seem self-evident to some, but the right to adequate health care services is the basis of a new legal case brought against the Canadian federal government.
Time: You practice a harm-reduction approach to addiction, in which you provide clean needles and safe spaces for addicts to inject drugs. Americans have long tended to see this as “enabling” and typically view it as a bad thing because it doesn’t require addicts to be abstinent to receive care.
Dr. Gabor Mate: "The question is, Is it better for people to inject drugs with puddle water or sterile water? Is it better to use clean needles or share so that you pass on HIV and hepatitis C? This is what harm reduction is. It doesn’t treat addiction, it just reduces harm. In medicine, we do this all the time. People smoke but we still give them inhalers to open airways, so what’s different? You’re not enabling anything they’re not already using.