We Must Not Be Left Behind
“In most communities, people who inject drugs don’t have access to syringes to prevent infections, opioid substitution treatment, or naloxone to prevent overdose. Moreover, people who use drugs are denied basic health services. They have no access to non-judgmental primary care, mental health and drug treatment services, and the support they need to maintain stable, healthy lives. And yet, harm reduction has been proven time and again to be extremely effective in curbing HIV transmission. In settings where comprehensive harm reduction has been implemented, HIV rates among people who inject drugs are low—in some cases, almost negligible.” The Global State of Harm Reduction 2014
So why, why why are such effective solutions still being left behind on the political table? We can see the results of what being ‘Left Behind’ really means – burgeoning disease and death. It’s all so avoidable!
One of the sectors most useful and interesting reports released its 2014 data, last week. The report -The Global State of Harm Reduction which was first published back in 2008 by Harm Reduction International, provides independent analysis of the state of harm reduction across the world. This enabled a really useful baseline to be developed, against which we can now measure actual progress of harm reduction in its global march of common sense. It now allows us all to see much more clearly, the actual mapping of harm reduction policy adoption as it occurs, as well as programme implementation globally. It has also permitted the documentation of the various, associated responses to the HIV and hepatitis C epidemics that are related to injecting and non-injecting drug use and perhaps most importantly, we can see the results of implementing harm reduction practices on the health of drug users across the world.
About US $ 2.3 billion annually is estimated by UNAIDS to be required to fund HIV prevention among people who inject drugs in 2015. At the last estimate, only US$ 160 million was invested by international donors – approximately seven per cent of what is required. In contrast to the lack of funding for harm reduction, each year governments spend over $100 billion on arrest and imprisonment of people who use drugs, destruction of drug crops and other drug control measures. HRI argues that if just a tenth of this money were redirected to harm reduction, it could fill the gap in HIV and Hepatitis C prevention for people who use drugs twice over.
Eliot Albers, our Executive Director at INPUD, wrote the forward for the Global State of Harm Reduction 2014, and explained just how profoundly linked are the entwined issues of donor funding, prevention spending and the epidemiological spread of HIV and HCV disease. Investment in harm reduction as part of overall prevention spending is nowhere near proportionate to the reality affecting people who inject drugs on the ground, illustrating, Eliot says, that “donor priorities are out of alignment with epidemiological trends”.
It seems clear that as long as governments refuse to invest equally in prevention, those incredible strides forward during the last 30 years of HIV, end up being whittled away.
The INPUD Executive Director added, “Whilst the retreat from investment in harm reduction places the lives, health, and rights of millions of people who use drugs around the world in jeopardy, the international drug users’ movement has never been stronger, having successfully fought to occupy our rightful place as a vital partner in every debate that impacts upon our lives and health on the global, regional and national stages”.
However, he went on to say that success of this agenda is contingent upon investment in community systems, strengthening and empowering organisations, networks, and communities of people who use drugs. Eliot also stated “If [harm reduction] services are to be truly accessible, acceptable, and appropriate, they must be returned through a process of power-shifting to the communities they serve.”
We must fight to be seen as the solution to improving the health of our communities, and to never to be framed as the problem. And we must never accept the reality of what it means to be ‘Left Behind’.
“Every person left behind is a fellow human being – someone’s child, someone’s parent, someone’s friend, someone’s partner. Every one of them has a right to life and to health. Every one of them deserves compassion, and dignity, and love.” (David Furnish, Elton John Foundation: Forward in the Global State of Harm Reduction, 2014)
Some of the main points to emerge from this report over 2014 were (actually this report is a biennial document -all relevant links below)
Main Points to Emerge Over 2014:
- Good and Bad: In 2014, 90 countries and territories implement Needle and Syringe Programmes (NSPs) to varying degrees but another 68 countries with reported injecting drug use, do not provide any NSP services
- Good: Malaysia, along with Iran and Australia, had experienced the steepest increase in the number of NSP centres, from 297 sites in 2012 to 728 in 2014.
- Bad: The provision of NSP in prisons globally has declined since 2012 with only 43 countries provide OST in the prison setting;
- Good: In 2014, 80 countries and territories implement OST (Opiate Substitution Therapy/treatment -mainly methadone and buprenorphine);
- Bad: An estimated eight percent of the world´s injecting drug users can actually access opioid substitution therapy such as methadone or on a global average they are only able to access two clean needles per month.
- Worrying: New and emerging patterns of injecting drug use in sub-Saharan African countries such as Tanzania, Uganda, Senegal, Zanzibar and Kenya will require a further scaling up of the provision of opioid substitution therapy (OST) such as methadone and buprenorphine and needle syringe programmes (NSP) in order to effectively respond to the growing HIV/AIDS epidemic amongst people who inject drugs in the region. In 2012 the Kenyan government announced the initiation of NSPs within the country, resulting in ten newly operational sites in 2014.
- Worrying: It also notes the concerns over the documentation of high-risk injecting practices, including that of flashblood occurring in Tanzania and Zanzibar (see link) and the marked increase in stimulant use that is evidenced in research into increased risk behaviours for sexual transmission of HIV. It cites as an example, that in Western Cape Province, the proportion of admissions to drug treatment facilities for methamphetamine as the primary drug used increased from 0.8 per cent in 2001 to 52 per cent in 2011. The recent establishment and scale up of community based opioid substitution therapy (OST) in Tanzania is a significant step forward, rising from one site to three in the city of Dar es Salaam. This makes the OST programme in Tanzania the largest government-run programme in the region, with over 1,200 people receiving methadone in 2013. There has also been a scale up of NSPs in Dar es Salaam, Tanzania, increasing from one site in 2012 to seven in 2014.
- Good: In 2014 there were 88 drug consumption rooms (DCRs) operating worldwide – outside of Europe two DCRs are in operation, one in Australia and one in Canada. In Western Europe, Denmark saw the implementation of five DCRs, and both Spain and Switzerland, who had previous DCRs in operation increased their site provision by six each.
- Good: The provision of overdose prevention medication (e.g. Naloxone) has increased most markedly in North America.In the United States, as of June 2014, there are 30 states plus Washington DC that have at least one point of access for laypersons to obtain Naloxone for people who use drugs – or friends and family;
- Worrying: In the Middle East and Northern Africa region (MENA), one of only two regions in the world that continue to experience increases in HIV infection rates, harm reduction coverage is non-existent in many countries. However, small scale implementation of needle syringe programs now operate in Egypt and Jordan.
- Good: Iran continues to be word leader both in and outside the region – OST and NSP are widely available in the community as well as prisons;
- Worrying: The Eurasian region is home to an estimated 3.1 million people who inject drugs, with two of the largest populations living in Russia (1.8 million)) and Ukraine (310,000). Eastern Europe and Central Asia is one of two regions globally where rates of HIV infection are continuing to rise. Opioid substitution therapy (OST) is available in 26 countries of the region, with only three countries reporting evidence of injecting drug use not providing OST: Russia, Turkmenistan and Uzbekistan. In Russia it is a criminal offence to promote or supply methadone;
To download your copy of the Global state of Harm Reduction 2014, click here.
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