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Future of HIV/AIDS in Asia Depends on Harm-Reduction Policy for Injection Drug Users, Opinion Piece Says
In many Asian countries, HIV is spreading among injection drug users "much more rapidly" than "harm-reduction" interventions -- including needle exchanges, drug substitution treatments and condom distribution -- are being implemented, Alex Wodak, director of alcohol and drug services at St. Vincent's Hospital in Sydney, Australia; Robert Ali, director of clinical policy and research at the University of Adelaide in Australia; and Michael Farrell, senior lecturer in addictions at the Addictions Resource Center in London, write in an opinion piece published in the Sept. 25 issue of BMJ. "Several" Asian nations are reporting that more than 60% of injection drug users are HIV-positive, and UNAIDS estimates that Asia will surpass sub-Saharan Africa in the number of HIV-positive people by 2010, the authors say. A "common but unwarranted fear" exists in many Asian nations that inclusion of harm-reduction approaches in overall drug policy "will conflict with efforts to control the supply of and demand for illicit drugs," the authors say. In addition, "countries often look to the United States for leadership" on the issue, but the "timing and scale of implementation of HIV prevention measures for injecting drug users in the United States has been anything but impressive," the authors say, adding that approximately 36% of new HIV cases in the United States are "directly or indirectly associated with injecting drug use." HIV prevention strategies for injection drug users have proven to be safe and effective "for almost two decades" and "have long been put to good effect in many countries of the European Union and Australasia," according to the authors. "Encouragingly pragmatic approaches" recently have been seen in Indonesia, Vietnam, Myanmar and China, but "the health and well-being of the most populous region of the world will depend a lot on the speed with which Asian countries adopt, adapt and fully implement harm-reduction interventions," the authors conclude (Wodak et al., BMJ, 9/25).
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