Comparing harm reduction advocacy approaches in the Middle East, Central Asia, and Southeast Asia
By Dave Burrows
For more than three decades, harm reduction initiatives for people who inject drugs (PWID) have focused on preventing the spread of HIV. The objectives of harm reduction activities have gradually expanded to include reducing the number of PWID through education programs, stopping the spread of hepatitis C and other infections, and preventing overdoses. However, the single greatest rationale for introducing or scaling up harm reduction remains HIV prevention and (to a lesser extent) treatment, care, and support for PWID living with HIV.
I have been involved in harm reduction advocacy since 1987, first in Australia, then in the United States and other Western countries, then in a number of Asian countries, then in Eastern Europe and Central Asia, and more recently in the Middle East and Africa. In each country or region, the goal is the same: to ensure PWID can access the comprehensive package of services required to prevent HIV and provide HIV treatment, care, and support.
In 2009, the World Health Organization (WHO)—in collaboration with the UN Office on Drugs and Crime (UNODC) and the Joint United Nations Program on HIV/AIDS (UNAIDS)—published the “Technical Guide for Countries to Set Targets for Universal Access to HIV Prevention, Treatment, and Care for Injecting Drug Users.” The guide united previously issued guidance from all three agencies, outlining an international standard for a comprehensive package of services for PWID based on the most recently available evidence. In 2010, the U.S. president’s Emergency Plan for AIDS Relief (PEPFAR) issued an updated guidance titled “Comprehensive HIV Prevention for People Who Inject Drugs,” which affirmed PEPFAR’s support for the technical guide’s approach. Both documents advise that the following ten interventions should be included in a comprehensive package, to which all people who inject drugs should have access:
- Community-based outreach
- Needle and syringe programs
- Opioid substitution therapy and other drug dependence treatment
- HIV counseling and testing
- Antiretroviral therapy (for PWID who are living with HIV)
- Prevention and treatment of sexually transmitted infections
- Condom programs targeted specifically at PWID and their sexual partners
- Targeted information, education, and communication (IEC) materials and campaigns for PWID and their sexual partners
- Vaccination, diagnosis, and treatment of viral hepatitis (including HAV, HBV, HCV)
- Prevention, diagnosis, and treatment of tuberculosis
Advocacy Successes and “Holes”
It takes time for policymakers to understand the need for harm reduction. Many factors play a role in preventing governments from adopting comprehensive approaches to HIV and injecting drug use. Some are understandable: It often seems counterintuitive to politicians and bureaucrats that the best way to help drug users survive an HIV epidemic is to provide them with syringes and heroin-like drugs (methadone and buprenorphine).
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