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.