Harm reduction/Methadone/HAART in Russia/Ukraine, Asia too
"In Russia drug addicts are seen as scum: the sooner they die, the better. In this second part of her story Irina tells of her life after prison.........Stocks of medication have been woefully inadequate for the last 4 years, which has irreversibly affected public health and put the lives of those living with HIV at risk"|
HIV medication crisis increases in Russia | International Harm ...
Dec 17, 2010 ... Following the world AIDS day HIV activists in Russia gathered in front of Russia White ... 2011 International Harm Reduction Association. ...
Harm Reduction Activism in Russia | AIDS and Social Justice
Jan 5, 2010 ... The Russian government is more attracted to taking repressive action against drug use than encouraging harm reduction measures. ...aidsandsocialjustice.wordpress.com/.../harm-reduction-activism-in-russia/
Eastern Europe's ostrich policy on HIV
By Jon Cohen
CARDIFF, Calif. - Russia and Ukraine account for roughly 90 percent of the 1.5 million people estimated to be infected with HIV in Central and Eastern Europe.
On a recent trip to these countries, and despite repeated requests, no politician or public-health official in either country would meet with me. None returned the phone calls, faxes, or e-mails that I sent after I returned home.
Both countries have epidemics driven by injecting drug users (IDUs) who share needles and syringes, the most efficient way to transmit HIV. Yet proven methods exist to slow the spread of HIV by IDUs.
If IDUs inject heroin or related opiates - as is primarily the case in Eastern Europe - establishing opiate substitution programs with methadone or bupenorphrine can dramatically slow HIV transmission.
The success of such programs also depends on establishing needle/syringe exchanges at convenient locations, both to provide clean equipment and to draw users into the healthcare system. As the third leg of the stool, IDUs need counseling.
This trio of policies forms the foundation of what's known among health-care professionals as the "harm-reduction package." Russia and Ukraine, however, spend no money on harm reduction.
International aid supports harm-reduction efforts in both countries on a modest scale: most of the money comes from the Global Fund to Fight AIDS, Tuberculosis, and Malaria. But Russia, owing to a rise in its national income, no longer is eligible for HIV/AIDS Global Fund grants.
A group of non-governmental organizations (NGOs) in Russia that has run a harm-reduction effort with Global Fund money received assurances from the government that it would continue to bankroll the work once that money ran out. But last fall the government reneged, and the Global Fund issued the group an emergency grant for two years.
Cash-strapped Ukraine, which remains eligible for Global Fund help to combat HIV/AIDS, also relies entirely on NGOs - most created by affected communities - to run its harm-reduction programs.
Aside from shaky funding, the harm-reduction efforts in Russia, and to a large degree in Ukraine, lack a fundamental tool: opiate-substitution treatment. Russia bans the use of methadone outright.
"There is no evidence that use of methadone and bupenorphrine facilitates treatment of drug addicts," declared Olga Krivonos, head of the Department of Medical Aid and Healthcare Development at Russia's Ministry of Healthcare and Social Development, in March 2009. Ukraine, which legalized the import of methadone only in December 2007, had a mere 5,000 people receiving it when I visited.
"There is a large body of scientific evidence on the effectiveness of substitution treatment vis-a-vis HIV/AIDS," concluded the World Health Organization, the United Nations Office on Drugs and Crime, and the Joint United Nations Program on HIV/AIDS in a 2004 policy brief.
The U.S. Institute of Medicine weighed in on the issue in a 2007 report: "Given the strong evidence of its effectiveness in treating opioid dependence, opioid agonist maintenance treatment should be made widely available where feasible."
The popular explanation for lack of action in Russia and Ukraine is that their governments view IDUs as criminals, rather than people with a disease, and adopt an informal let-them-rot policy. Indeed, police regularly harass users (and people who help them), making matters worse. Many countries outside the region take a similar stance.
But it's more complicated in Eastern Europe. A leftover Soviet distrust of outsiders colors many opinions, and there's an oft-repeated claim that the culture is different: an intervention that works in the West might fail in the East. There is also a suspicion that dirty capitalist pigs want to profit from the sale of opiate substitutes, regardless of whether they work.
This is as silly as contending that antiretroviral drugs won't work in the region, and that treating HIV is all a giant plot on the part of big pharmaceutical companies. Humans are humans. Harm reduction works everywhere, and the main financial benefactors are the countries themselves, which see reduced spread of HIV, drops in crime, and people returning to work.
Playing ostrich about harm reduction does not harm only IDUs. HIV-infected IDUs of course have sex with non-users. Pregnant HIV-infected IDUs transmit the virus to their babies, and sometimes - shockingly often in Russia - abandon their newborns, relinquishing them to the state. The people infected by IDUs also can infect others sexually, further fortifying the bridge into the "general" population.
In July, Vienna hosted the 18th International AIDS Conference, attracting nearly 20,000 people. Speakers included Austrian President Heinz Fischer, Bill Clinton, Bill Gates, and South Africa's Deputy President Kgalema Motlanthe.
Organizers held the meeting in Vienna specifically because it is "the gateway to Eastern Europe," and they hoped to involve the region more than ever. For the first time, all proceedings were translated into Russian. But no high-level Russian or Ukrainian official attended.
A "Vienna Declaration," endorsing harm reduction - and emphasizing drug policy based on science, not ideology - was launched at the meeting, and gathered more than 10,000 signatories.
But the most influential Eastern European signatory was the first lady of Georgia, a country whose estimated 2,700 HIV-infected people account for just 0.018 percent of the regional total. Judging by their governments' indifference, the remaining 99.982 percent of the HIV-infected people in Eastern Europe - and all those they place at risk of harm - can just rot.
Jon Cohen is the author of "Shots in the Dark: The Wayward Search for an AIDS Vaccine and Coming to Term: Uncovering the Truth about Miscarriage." For more stories, visit Project Syndicate (www.project-syndicate.org).
95,000 drug users in China already receiving methadone treatment
China News Net
China News Agency, January 2 - As of late December of last year, 503 methadone maintenance clinics had been set up in 23 provinces, regions, and cities in China, and a total of 95,000 drug users had received treatment. This news was revealed today by Wu Zunyou, Director of the Chinese Center for Disease Control and Prevention's Center for STD/AIDS Control and Prevention.
As the leading secretariat of the Community-based Methadone Maintenance Treatment for Abusers of Opiate Substances National Working Group, Professor Wu Zunyou said that China is already expanding the community-based methadone treatment pilot started in 2004. Currently Yunnan, Shanxi, and Sichuan provinces already have more than 5,000 people on treatment, and Guizhou, Hunan, and Guangdong have more than 4,000 people on treatment. Clinics in Shanxi, Ningxia, Hubei, and Jiangsu on average treat over 200 people every day.
Professor Wu said that expert analysts confirm that community-based methadone treatment decreases drug abuse, cuts down on new HIV infections, reduces drug-related criminal activity, and restores the ability of patients and their families to function in society. According to statistics, the 12-month new HIV infection rate for drug users receiving methadone treatment is 0.7%, which is 4.3% lower than that of drug users who have not yet begun methadone treatment.
Harm Reduction in China - Where are we now?
September 9, 2010 5:05 PM | No Comments
By Gisa Hartmann
In response to the rise of drug dependence, China has begun to embrace harm reduction, scaling up policies such as methadone maintenance treatment (MMT) and needle exchange programs (NEP) in a growing number of areas. This shift in policy is expressed in the new Anti-Drug Law, which categorizes drug addiction as a medical condition rather than a criminal issue or moral failing. But how far along is the development of MMT and NEP in China, and what does the state plan for the future? How do current policies play out for drug users on the ground? This two-part blog will explore these and related issues.
According to government numbers (which some doctors and NGOs argue still minimize the number of people infected with HIV through blood sales and blood transfusions), China's HIV prevalence rates are highest among injection drug users (IDU): one article estimates that China has at least 2 million IDU, with an overall HIV prevalence of 12%. By the end of 2002, cases of HIV among IDU were reported in all provinces. In Yunnan and Xinjiang, HIV prevalence is as high as 80% among the IDU population.
The central government has made a commitment to a significant scale-up of both NEP and MMT: the China Action Plan for Reducing and Preventing the Spread of HIV/AIDS (2005-2010) commits to serving at least half of the IDU population by 2010 by establishing 1400 NEP sites and MMT clinics in cities or prefectures with more than 500 drug users.
Methadone maintenance treatment and needle exchange programs
The Chinese government approved a trial of the first eight methadone clinics in early 2004. As in other countries, these clinics were successful in reducing frequency of injection and high risk behavior. Clients also reported that clinic clients engaged in less drug-related crime and were better able to secure jobs. However, drop-out rates were up to 51%.
One possible reason for the high drop-out rates may have been the dosage used in China at that time, which was lower than the levels found to be optimal in other countries. China's early clinics also lacked other services that are included in a comprehensive treatment approach and which help to build retention, such as psychological counseling, additional referral services, health education, group activities, social support and skills training.
In the same year, China also established 750 needle exchange programs in seven provinces. A study published in 2007 found that needle turnover was most successful where local police supported efforts by NEP service providers. The number of NEP sites run by the Center for Disease Control (CDC) has expanded since 2004. These facilities mainly operate during normal working hours and rarely provide night services, vending machines or mobile clinics - innovations that have proven successful in other countries.
Bureaucratic obstacles hinder higher enrollment in MMT programs. These include a requirement that IDU complete compulsory detoxification at least once before becoming eligible for MMT, and that IDU have a local household registration (hukou ) in the town where they take methadone. MMT service providers also complain about a lack of adequate resources, lack of institutional support, and the need for more professional training to provide the quality and quantity of care needed by their clients.
While Beijing recently lifted the provision that obliged IDU to provide hukou residence permits to enroll in MMT, the barrier remains in place for China's thousands of migrant workers in other parts of the country. Before any in-country travel, MMT participants need to obtain referral prescriptions from their local service station, because methadone is only dispensed in daily dosages and has to taken in liquid form on-the-spot at the clinic to ensure clients' compliance with the program. While in some cases it is possible to obtain exceptions, as in many other countries, it is illegal to take methadone out of the country on international travel.
Drug dependence treatment vs. drug control
As in other countries, the most positive results of harm reduction policies have been in those rare areas where health workers are able to establish cooperation with the police. One study published by the Chinese National Center for AIDS/STD Control and Prevention in 2007 revealed that few Chinese police see drug dependence as a medical condition rather than a criminal offense, and some cited an individual's enrollment in MMT or NEP as a legitimate cause for arrest. The study noted some cases where police have followed peer educators to meetings with IDU in order to arrest the person who received the needle after the peer educator left. Naturally, fear of arrest can keep IDU away from available services.
As the same study by observes, "Even in areas where police may show passive support (inasmuch as they do not arrest NEP users), when local or central governments launch crackdowns on drug use, they need to fulfill their arrest quotas and NEP attendees are easy targets."
Despite the harm reduction policies that are also in place, China has severe policies against drug use, treating drug use as a "social evil" which needs to be countered by mass arrests, crackdowns and forced detoxification. Police can arrest and conduct urine test on anyone suspected of drug use, and those who test positive may be sentenced to a minimum of two years in a forced detoxification center.
Wolfe and Saucier estimate that over 330,000 Chinese IDU are currently detained in such centers. The centers fall under the administrative detention system run by the Ministry of Public Security, and meaning detainees are usually sentenced without a trial. Compulsory detoxification centers in China have been criticized for abusive "treatment" measures and use of forced labor. In some cases, IDU may be kept beyond their expected release date in order to generate enough money to cover expenses related to their stay. Other punishments can include withholding of adequate food, sleep deprivation and forced HIV testing, results of which may not be shared with detainees. Furthermore, harm reduction services such as methadone are not available in prisons or detoxification centers.
The Drug Control Law which went into effect June 1, 2008 made changes to this system. While the forced detoxification centers persist, the new law eliminates the even harsher reeducation-through-labor sentence (formerly between 1-3 years) as a sentencing option. The law categorizes drug dependence as a disease requiring treatment, and allows IDU arrested for the first time to recover in local residential communities for up to three years. According to the law, compulsory detoxification will be reserved for for people who relapse.
While these steps are positive, numerous challenges remain. First, since sentences are handed down in police stations and not in court, it will be difficult to monitor implementation of the new law, or to challenge a sentence. Worse, the revised law increased the minimum forced detoxification sentence to two years.
Additionally, the new law does not clearly define the terms drug use, abuse and drug addiction or dependence. A "drug addict" can be anyone registered by law enforcement agencies as a drug user after a previous offense, as well as recreational drug users; just one single positive urine test can be the basis for classification as a "drug addict".
Gisa Hartmann is administrative coordinator at Asia Catalyst.
HARM REDUCTION IN ASIA
Harm reduction interventions have been shown to slow the course of HIV among IDUs in many developed countries but in Asia the concept of harm reduction is
Transnational Institute | Asian Harm Reduction Network (AHRN)
Asian Harm Reduction Network (AHRN) is TNI's partner in Southeast Asia cooperating in the informal drug policy dialogues and research missions and exchanges ...www.tni.org/network/asian-harm-reduction-network-ahrn
Asian drug users unite to form regional organization
21 October 2009
Over twenty-five drug users from nine different countries met in Bangkok on 16th and 17th October 2009 to finalize the Asian Network of People who Use Drugs (ANPUD) Constitution and elect a Steering Committee for the first regional network of people who use drugs. Based on the principles of Meaningful Involvement of People who Use Drugs (MIPUD), ANPUD has been setup by people who use drugs to advocate for the rights and unify the voices of their communities across Asia. ANPUD has over 150 members throughout the Asia region who are collaborating to influence decisions that affect their lives.
Despite being the region with the largest number of people using drugs in the world, access to effective services such as needle and syringe exchange programs and opioid substitution therapy to prevent HIV and hepatitis C transmission, the Asia region has the lowest coverage of harm reduction services across the globe. The lack of affordable HIV and HCV prevention, treatment, care and support services is largely driven by the stigma and discrimination associated with drug use..
Jimmy Dorabjee, a key guiding figure in ANPUD's development, explained the raison d'etre for ANPUD: "People who use drugs are stigmatized, criminalized and abused in every country in Asia. Our human rights are violated and we have little in the way of health services to stay alive. If governments do not see people who use drugs, hear us and talk to us, they will continue to ignore us."
By forming ANPUD, people who use drugs in Asia will be able to work together to engage organizations and policymakers involved in the Asian response to HIV and drug use. ANPUD's existence is critical to efforts to improve policies and services that affect the lives of drug using communities, and can contribute expertise, resources and peer support to strengthen national responses and build drug user networks. ANPUD will also focus its advocacy efforts on improving the quality of lives for people who use drugs, harmonization of policies, decriminalization, access to evidence-based, locally-driven harm reduction services, HIV prevention and treatment services and increased access to hepatitis C treatment for drug users in Asia.
The Director of the UNAIDS Regional Support Team, Dr. Prasada Rao, spoke of the urgent need to engage with drug user networks and offered his support to ANPUD, saying that "for UNAIDS, HIV prevention among drug users is a key priority at the global level. I am very pleased today to be here to see ANPUD being shaped into an organization that will play a key role in Asia's HIV response. It is critical that we are able to more effectively involve the voices of Asian people who use drugs in the scaling up of HIV prevention services across Asia."
By 31st December 2009, ANPUD will be officially registered as an organization. In the meantime, the constitution and governance documents have been approved. An interim Steering Committee composed of six representatives was formed, with Mohamad Firdaus (Apit) from Malaysia, Bun Bong from Cambodia, Ekta Thapa Mahat from Nepal, Hadi Yusfian from Indonesia, Myo Kyaw Lynn (Tom) from Myanmar and Yvonne Sibuea from Indonesia as elected representatives.
The Steering Committee is supported by a Technical Support Team who will mentor the members of the Steering Committee over the next few months.
At the end of the meeting, Ekta was proud to be taking back something concrete to Nepal: "When I go back home, I am now responsible for sharing the experiences with the 250 or so drug users who are actively advocating for better services at the national level. It will be a great way for us to work together and help build the capacity of people who use drugs in Asia."
Ele Morrison, Program Manager, Regional Partnership project, of Australian Illicit and Injecting Drug Users League (AIVL), said that "the results of the meeting exceeded my expectations. The participants set ambitious goals for themselves and they have achieved a lot in just two days to setup this new organization.
The building blocks for genuine ownership by people who use drugs is definitely there." This meeting was organized by drug users, for drug users, with financial support from the World Health Organisation (WHO), the United Nations Regional Task Force and AIVL.
For more information, please contact Ekta at Abhiyan06@gmail.com / +977-98411 63331 or Jimmy Dorabjee at Jimmyd@burnet.edu.au / +61-419 354892.