Global Harm Reduction Efforts

1. Global Harm Reduction Efforts AMSA Aids Advocacy Network www.amsa.org/global/aids

2. Global Harm Reduction

3. HIV Transmission Transmission occurs through sharing syringes, drug solution & equipment High-risk sexual behaviors often accompany high-risk drug use: Including transmission through sex with injection drug users, the CDC estimates that injection drug use accounts for more than 1/3 of AIDS cases in the US

4. Injection Drug Use Globally • A 2008 Lancet study found 15.9 million (range 11.0—21.2 million) people use injection drugs worldwide. • Up to 3 million may be infected by HIV • The largest numbers of injectors were found in China, the USA, and Russia, where mid-estimates of HIV prevalence among injectors were 12%, 16%, and 37%, respectively

5. The What: What Access Rights Should This Population Have?

6. Why is harm reduction important? • The focus of current health interventions

7. Why is harm reduction important? • The focus of current health interventions • Harm reduction is a set of practical and evidence-based strategies to reduce negative consequences of drug use and other high risk activities.

8. Why is harm reduction important? • The focus of current health interventions • Harm reduction • Incorporates a spectrum of strategies from safer use, to managed use, to abstinence. • Meet drug users "where they're at," addressing conditions of use along with the use itself.

9. Syringe Access • Needle or syringe exchange programs (NEP/SEPs) • Ensures that IDUs have access to sterile syringes & equipment every time they inject. • Provides an avenue for safe disposal of used syringes. • Provides additional outreach services to populations often far removed from the health care system. www.housingworks.org

10. Safe Injection Sites • "Safe injection rooms" are legally sanctioned, supervised facilities designed to reduce the health and public order problems associated with illegal injection drug use. • Around 50 safer injection sites in cities in Europe. • The first and only safe injection site in North America, Insite, opened in Vancouver, in September 2003 & has faced continued controversy

11. Brazil • Model in its approach at addressing the AIDS epidemic through treatment & prevention. • Free combination antiretroviral therapy to citizens with HIV • Legal Needle Exchange programs • A survey of injection-drug users conducted in 2004 revealed that 76% did not engage in sharing of needles or syringes. • Newly reported cases of AIDS acquired through drug injection have declined over a decade from 28% to just 10%. • In 2001, 74% of Brazilian commercial sex workers reported consistent use of condoms with clients, and despite its large and thriving commercial sex trade (Okie, Susan. Fighting HIV — Lessons from Brazil. N Engl J Med 2006 354: 1977-1981)

12. The Netherlands • The core features of the Dutch system are rooted in the concept of harm reduction • Dutch drug policy gives priority to health care and prevention while, simultaneously, directing aggressive enforcement measures against organized crime • A key aspect is the notion of market separation. By classifying drugs according to the risks posed and then pursuing policies that serve to isolate each market, it is felt that users of soft drugs are less likely to come into contact with users of hard drugs. • Methadone maintenance. • In 1998, Dutch cities started experimenting with prescribing heroin, in combination with methadone, on medical grounds. • To prevent HIV/AIDS and hepatitis B and C, syringe exchange programs were developed in the 1980s • Today, 130 programs are operating in 60 Dutch cities • Result: Dutch rates of drug use are lower than U.S. rates in every category. • http://www.drugpolicy.org/global/drugpolicyby/westerneurop/thenetherlan/

13. Iran • In 2004, estimated 200,000 IDU • Began with a full criminalization policy • In the early 1990s allowed for the treatment of drug use • In early 2000. A national harm reduction committee has been established with representatives from various ministries, academic centers and NGOs. • Harm reduction programs are now implemented by both government and non-governmental facilities. • A program recognized as a best practice, is the triangular clinic which integrates services for treatment and prevention of STIs, injecting drug use and HIV/AIDS. • A new, evolving model to be implemented would see the provision of needle exchange, methadone maintenance treatment, general medical care, and referral for voluntary counseling and testing.

14. Resources • www.amsa.org/global/aids/ • www.harmreduction.org • www.cdc.gov/idu/ • CDC resources for IDU populations • www.drugpolicy.org/global • Drug policies around the world • www.harmreductionjournal.com/ • Peer reviewed research journal dedicated to harm reduction