UN Reference group on HIV and injecting drug use calls for evidence based approach

The 2010 Consensus Statement of the Reference Group to the United Nations on HIV and Injecting Drug Use calls for an evidence-based approach to control the spread of HIV among people who use drugs and their non-using partners. The Reference group identifies key issues and makes recommendations to respond to the dual crisis of injection drug use and HIV.

The Statement calls for a human rights, comprehensive, evidence-based approach that includes:

1. Needle and syringe programmes (NSPs)

2. Opioid substitution therapy (OST) and other drug dependence treatment

3. HIV testing and counselling (T&C)

4. Antiretroviral therapy (AR T)

5. Prevention and treatment of sexually transmitted infections (STIs)

6. Condom programmes for IDUs and their sexual partners

7. Targeted information, education and communication (IEC) for IDUs and their sexual partners

8. Vaccination, diagnosis and treatment of viral hepatitis

9. Prevention, diagnosis and treatment of tuberculosis (TB)

The report urges legislators to remove legal barriers to syringe exchange and calls for a cooperative effort among law enforcement and health workers in order to increase access to HIV prevention, treatment and care.

Needle exchange in Iran

Tina Rosenberg's opinion piece in the New York Times, "An Enlightenend Exchange in Iran," paints a compelling portrait of the power of treating drug abuse as health policy. Iran has successfully averted an HIV nightmare by aggressively embracing harm reduction and needle exchange. In Iran, 68% of HIV infections come from sharing a contaminated syringe. Despite its reputation as one of the most repressive regimes in the world Iran has adopted a policy of treating drug abuse as a disease, not a crime. And as health policy, drug abuse "is a health issue — not just for drug users, but for everyone" (see the follow up article, "How Iran Derailed a Health Crisis").

An excerpt from "An Enlightened Exchange in Iran":

"The rate of new H.I.V. infections in Iran rose until 2005, and has dropped ever since. A top drug control official, Saeed Sefatian, said in 2008 that 18 percent of injecting drug users were H.I.V.-positive, but estimated that if it weren’t for harm reduction, that number would have been 40 percent. New infections among drug users have continued to drop. Surveys at sentinel sites in pre-natal clinics have not yet turned up not a single pregnant woman with H.I.V. (UNAIDS report, p. 97) ─ an excellent indication that the epidemic has been contained.

By pointing out the success of this program, I do not mean to endorse Iran’s prisons, where political dissidents are being tortured. Nor does Iran’s modern approach to harm reduction redeem the government’s stone-age approach to just about everything else. The same ayatollah who told judges not to get in the way of harm reduction was the man who closed dozens of newspapers. The important point here is that even a theocracy as repressive and rigid as Iran ─ the anti-Amsterdam ─ managed to create policies that have likely saved the country from an AIDS and drug disaster."

If Iran can, why can't Texas?

World AIDS Day 2010

Today is World AIDS Day. The current World AIDS Day Campaign theme is Universal Access and Human Rights. Universal access includes the right to care, treatment and prevention. The Harm Reduction Coalition issued this World AIDS day statement:

"Responses to both the domestic and the global HIV/AIDS epidemics among people who inject drugs face similar challenges: drug-related stigma that underpins repressive policies, lack of political will, and limited funding. Moreover, access to care and treatment remains limited for HIV+ drug users, who face multiple obstacles to obtaining antiretroviral therapy along with the associated health risks of hepatitis C, tuberculosis, and overdose. The 2010 World AIDS Day theme of Universal Access and Human Rights has a special urgency for people who use drugs, signifying an unrealized promise and demanding immediate action. The Harm Reduction Coalition calls upon governments and civil society to recommit to making Universal Access and Human Rights a reality for all people who use drugs as a necessary foundation for ending the HIV/AIDS epidemic."

Dr. David Lakey, Commissioner of the Texas Department of State Health Services reminds us in a special article to the Star-Telegram that 1 out of every 387 Texans are HIV-infected. The rate of new HIV infections in Texas is stable, but not decreasing. In addition, Texas is a late to diagnose state: 1 in 3 people diagnosed with HIV will progress to AIDS within a year. Dr. Lakey urges 'know your status; protect each other.'

Syringe exchange is the second most effective intervention at reducing HIV transmission, next to only PMTCT (prevention of mother-to-child transmission). Yet, Texas continues to remain one of the only states in which access to sterile syringes is prohibited, which gets in the way of preventing new infections and saving lives. Please take a moment today to remember loved ones lost and continue to commemorate them by supporting sensible disease prevention programs that will protect others from needless pain and suffering.

Legislative briefing draws experts from across the U.S.

Today's briefing on syringe access occurred on the eve of the 8th National Harm Reduction Conference, the nation's leading gathering of harm reduction enthusiasts and experts from around the globe. A panel of six speakers convened in the Texas Capitol Legislative Conference Center to reinforce the importance of syringe access as a successful disease prevention tool that Texas has gone far too long without and paid too high a price.

Don Des Jarlais (pictured above), Director of Research at Beth Israel Medical Center, spoke about the safety and efficacy of syringe exchange. He is a leading researcher on AIDS and injection drug use. He reminded listeners that syringe exchange programs offer a low cost and cost effective way to reduce the burden on the public system of treating the expensive twin epidemics of HIV and hepatitis C.

Allan Clear, Executive Director of the Harm Reduction Coalition and a nationally and internationally renowned harm reduction expert, spoke about the decision of the U.S. Congress to end a twenty year ban on the use of federal funds for syringe exchange in December 2009. He noted that cities such as New York, that offered syringe exchange early on, were able to avert large-scale HIV epidemics in drug users. He reminded us that while there may have been reason to be skeptical about syringe exchange twenty years ago when no one knew or understood what these programs were, we now know that syringe exchange is the second most scientifically proven effective HIV prevention method, next to only prevention of mother-to-child transmission.

Ruthie Burich, Prevention Specialist at AIDS Resource Center of Wisconsin (ARCW), spoke about her experience providing syringe exchange services and HIV testing and counseling to injection drug users in a state that has successfully reduced rates of HIV in this high risk population. ARCW operates Lifepoint, one of the nation's leading statewide needle exchange programs. Lifepoint serves clients and families in eleven cities throughout the state. Ruthie explained that programs not only offer access to sterile syringes, but also often provide primary health care services and referral to drug treatment.

Heather Edney, a marketing consultant from Southern California shared how syringe exchange programs saved her life after she became addicted to drugs at the age of fifteen and throughout her high-achieving teenage and college years. She explained how access to sterile syringes kept her from getting HIV, hepatitis C and other deadly blood borne infections until she was ready and able to successfully seek drug abuse treatment services. She pointed out that one syringe may cost as little as 0.08 cents, which seems reasonable compared to the price of doing nothing.

Jill Rips (left), Deputy Executive Director at San Antonio AIDS Foundation, has supported establishing syringe exchange programs in San Antonio where rates of hepatitis C and AIDS in injection drug using populations remain alarmingly high. Clients in Texas who continue to struggle with addiction and disease are left with very few options and resources, despite a willingness to protect themselves and loved ones from further transmission of HIV and other infections.

Tracey Hayes, Field Organizer at the ACLU of Texas and Project Director of The Access Project for over six years, spoke about the success of syringe exchange legislation in the 81st legislative session. She reminded the audience that the issue continues to bring together parties on both sides of the aisle and maintains a strong bipartisan coalition of supporters who support these sensible programs that save lives and taxpayer dollars.

A very special thank you to our panelists and guests today! Here's to hoping the legislature is poised and ready in 2011 to pass legislation that will immediately begin saving the public system from continuing to pay millions of dollars in expensive emergency room visits and chronic HIV and hepatitis C treatment costs, which is where drug users end up when we choose to do nothing.

8th National Harm Reduction Conference comes to Texas Nov. 18th-21st

Dear friend,

As we reflect upon history made by the Texas Legislature in 2009 and prepare for the 2011 82^nd Legislative Session, we are happy to report that the ban on the use of federal funds for syringe exchange programs has finally come to an end in the interim. As proposed in 2009, Texas Senate Bill 188 would have allowed local options for disease prevention programs including syringe exchange. Senate Bill 188 made history by making it farther through the legislature than any similar legislation filed since 1993, inspiring the largest bi-partisan coalition of House and Senate bill authors and supporters ever on this issue, and bringing together an unprecedented and diverse coalition of supporting organizations from around the state. We are optimistic that in 2011 Texas will follow the lead of the U.S. Congress and keep pace with the nation in allowing programs that effectively save lives and taxpayer money.

As of 2008, 14,147 Texans were living with HIV/AIDS as a result of having acquired this deadly disease directly from injection drug use, or indirectly as a partner or child of an injection drug user. An estimated 300,000 Texans are infected with hepatitis C virus (HCV), the leading cause of liver disease. Injection drug use is the number one risk factor for HCV. Syringe exchange programs safely and effectively reduce the transmission of these diseases and save the state from bearing the burden of millions of dollars in treatment costs.

Austin is fortunate to host the 2010 8^th National Harm Reduction Conference, Harm Reduction Beyond Borders, November 18 - 21. The conference takes place at the Renaissance Hotel at 9721 Arboretum Boulevard. Please visit the website for further details (www.8thnationalharmreductionconference.com). We invite you to join like-minded Texans at a special conference session hosted by The Access Project, Texans Mobilizing for 2011: Syringe Exchange in the 82nd Texas Legislative Session, on Thursday, November 18^th, 2010 at 7:15 p.m. The Access Project looks to bring stakeholders to the table to organize and plan advocacy action steps for the upcoming legislative session.

For further information on the history, safety and effectiveness of these lifesaving programs please visit The Access Project website (www.texasaccessproject.org) or contact Jenny Panzo, Education Coordinator at The Access Project, at jenny@texasaccessproject.org. The Access Project looks forward to seeing you at the conference!

Kind regards,

Jenny Panzo, MPH

Legislative briefing at the Capitol

Join The Access Project for an interim legislative briefing at the Texas Capitol as we prepare for what is sure to be an extra fun-filled and jam-packed 82nd Legislative Session. Let's make sure that with redistricting, immigration and a budget crisis on the table disease prevention programs don't get left behind!