Ever since its foundation in 2007, the Middle East and North Africa Harm Reduction Association (MENAHRA) has worked to support harm reduction based on scientific data. Unfortunately, in our region, there are a limited number of empirical studies available besides the bio-behavioral studies conducted by individual countries. There is an apparent weakness in the epidemic surveillance systems for the proportions of HIV prevalence. This gap reflects a lack of priority in the region in providing harm reduction services. It also confirms that sharing needles is the second cause for HIV/AIDS transmission in the MENA region.

This study arises from within MENAHRA's course of work to search for the reality of the situation with an empirical approach in order to increase the level of response to HIV/AIDS in the region.

This report should allow decision-makers and civil society organizations to expand their knowledge in regards to the needs and weaknesses of available services by guiding programs in becoming more focused on harm reduction in the region. Therefore, this report shall assist stakeholders in providing a wider scope of HIV/AIDS prevention services among people who inject drugs.

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Assessment of situation and response of drug use and its harms in the Middle East and North Africa

Uptake of harm-reduction services among women is low in the Middle East and North Africa (MENA) region. A qualitative operational research was conducted to provide recommendations on how to improve the uptake of harm reduction services among women injecting drug users (WIDUs). By understanding the factors that influence service uptake, program managers can develop meaningful strategies to increase uptake of their services.

To explore the context of drug use among WIDUs

To identify barriers and facilitators to accessing harm-reduction services

To provide recommendations on how to improve access to harm-reduction services.

Women injecting drug users in the Middle East & North Africa Region 

In 2010, the 63rd World Health Assembly (WHA) adopted the first resolution on viral hepatitis (WHA63.18). A new resolution will be presented at the 67th WHA.

Globally, an estimated 185 million people have been infected with hepatitis C virus (HCV). Since 2010, more than a million people have died from HCV, although it is treatable and curable. Nine to twelve million people have been infected since 2010, although HCV is preventable. Most new infections occur among people who inject drugs (PWID), yet access to HCV prevention tools (such as sterile injection equipment) is woefully inadequate, reaching a tiny percentage of those who need it. This shocking public health failure allows the epidemic to continue spreading.

Only a tiny fraction of people who have been infected with HCV are aware of their status. Most live in low and middle-income countries (LMICs) and have no access to diagnostics, care, or treatment. Pegylated interferon (peginterferon, or PEG-IFN), the backbone of the current standard of care for HCV, is priced cruelly out of reach. Even in places where HCV treatment is available, injecting drug use is often used as a criteria for denying access: only 2-4 percent of people who inject drugs are currently receiving treatment.

We, people living with HCV, HIV/AIDS, people who use drugs and our advocates, urge United Nations Member
States to act strongly in order to tackle the hepatitis C epidemic; it is feasible!

Defuse hepatitis C, the viral time bomb!

This is a guide to regulating legal markets for the non-medical use of cannabis. It is for policy makers, drug policy reform advocates and affected communities all over the world, who are witnessing the question change from, 'Should we maintain cannabis prohibition?’ to ‘How will legal regulation work in practice?'

Just a few years ago, this book would have been largely theoretical. Now, however, the cannabis regulation debate has moved decisively into the political mainstream, and multiple cities, states and countries are considering, developing or implementing a range of regulated market models for the non-medical use of cannabis. So this book draws on evidence not only from decades of experience regulating alcohol, tobacco, and medicines, but also from Spain's non-profit 'cannabis social clubs', commercial cannabis enterprises in the US and the Netherlands, and Uruguay's government-controlled system of cannabis regulation.

This book will help guide all those interested in cannabis policy through the key practical challenges to developing and implementing an effective regulation approach aimed at achieving the safer, healthier world we all wish to see.

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How to regulate cannabis: A practical guide

The latest in the Global State of Harm Reduction series, when sex work and drug use overlap : Considerations for advocacy and practice examines the multiple and varied contexts within which drug use (including use of alcohol, hormones and image- and performance-enhancing drugs) and sex work overlap. It provides a snapshot of available evidence on the factors that contribute to vulnerability among people who sell sex and use drugs. Drawing on experience from the harm reduction and sex work communities, the report explores implications for practice, highlighting existing programmes that reach people who sell sex and use drugs around the world, and offering practical suggestions on how programmes can better serve this overlapping population.

When sex work and drug use overlap

Taking stock of an off-track AIDS response: During 2011-2012, Uganda attracted concern—and criticism—as a result of its troubling epidemiological trends, indicating an off-track response to HIV. The Uganda AIDS Indicator Survey showed that prevalence had risen from 6.4 to 7.3% between 2006 and 2012 and incidence also rose during the same period. Condom use by men and women declined starkly over the same period—reported condom use during sex with a non-cohabitating partner declined significantly between 2005 and 2011 from 47% to 29% and from 53% to 38% among women and men, respectively. Importantly, Uganda was the only PEPFAR “Focus Country” reporting rising HIV incidence—all other PEPFAR focus countries have consistently reported declines in incidence as well as prevalence in recent years.

At the same time, recent game-changing scientific advances in HIV prevention and clinical care are making it possible for all high-burden countries to begin to achieve an “AIDS Free Generation,” defined as a halt to sexual transmission, an end to disease progression for those who are HIV positive, and an end to perinatal transmission. In particular, recent data show that HIV treatment is not only life saving but is also one of the most powerful prevention tools available—groundbreaking new research shows that earlier treatment of HIV positive people—at CD4>350—results in 96% reduction in the risk of HIV transmission through sex with an uninfected partner,4 is highly cost effective, and provides significant clinical benefit.6 Uganda’s faltering response means an attaining an AIDS Free Generation will take stronger, more urgent action—with bolder leadership.

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Ending AIDS in Uganda: What will it take?

The epidemiological reality of HIV infection in Egypt favours prioritizing efforts to the high risk groups rather than the general population. Hence, harm reduction should be at the core of interventions targeting HIV.

The current study revealed that there is still a long way to go to enhance the role of these interventions in influencing a significant behaviour change among target group.

Harm reduction in Egypt: The insight of injecting drug users

Responses to problematic drug use continue to improve in Scotland. Service provision is more coherent, waiting times are down and there is a clearer understanding that all steps in the recovery journey need to be supported.

Commissioners and services are focusing on raising standards at a time when resources are at a premium. SDF’s Big Lottery-funded National Quality Development Programme has helped in excess of 80 projects to implement changes aimed at improving recovery outcomes – often identifying ways to make better use of existing resources.

This is an evolving process. Needs identified by managers and frontline workers have led to the development of SDF’s well-received Sexual and Reproductive Health Initiative and intensified our focus on New Psychoactive Substances through training, events and collaborative working at local and strategic level.

We hope to attract further funding for our Quality Development initiative to help services implement the recommendations in the Opiate Replacement Therapies Review and the new Quality Improvement Framework, both of which underline the need for the wider psycho-social supports.

Scottish Drugs Forum: Annual report 2012/13

A new study published in the British Medical Journal Open finds that the prices of illegal drugs have generally declined while their purity has increased over the past twenty years, raising questions about the effectiveness of international law enforcement efforts to reduce drug supply. Researchers from the International Centre for Science in Drug Policy reviewed two decades of global drug surveillance data, finding that the supply of major illegal drugs has increased, as measured through a decline in the price, while there has been a corresponding general increase in the purity of illegal drugs.

“These findings add to the growing body of evidence that the war on drugs has failed,” said study co-author Dr. Evan Wood, Scientific Chair of the International Centre for Science in Drug Policy and Canada Research Chair in Inner City Medicine at the University of British Columbia. “We should look to implement policies that place community health and safety at the forefront of our efforts, and consider drug use a public health issue rather than a criminal justice issue. With the recognition that efforts to reduce drug supply are unlikely to be successful, there is a clear need to scale up addiction treatment and other strategies that can effectively reduce drug-related harm.”

Researchers reviewed indicators of drug supply in consumer markets such as Europe, the United States, and Australia, and drug seizures in drug-producing regions such as Latin America, Afghanistan, and Southeast Asia. Data were derived from government surveillance systems. The study found that:

With the exception of powder cocaine, the purity and/or potency of illegal drugs in the U.S. generally increased during the study period;

The price of illegal drugs, with few exceptions, generally decreased globally; and,

Seizures of cannabis, cocaine, and opiates generally increased in major drug production regions and major domestic markets.

The temporal relationship between drug supply indicators: An audit of international government surveillance systems

This set of brochures provides information on HIV and hepatitis prevention and treatment, harm reduction services and safer ways of injection.

Skoun Brochures on harm reduction

Kabul, the capital of Afghanistan, consists of 7 million populations from original Kabuli and from different provinces and returnees from neighbor’s countries. Kabul is known as heroin transient smuggling way, consist of more than 1000,000 people who use drug countrywide and more than 20,000 injecting drug users, there is increment of drug users.

Since April 2006, MdM has been running a model Harm Reduction (HR) program targeting Injecting Drug Users (IDUs) in Kabul within the Afghan National HIV/AIDS framework. This program was designed to introduce HR in the country. Two of the major services introduced were ART (AntiRetroviral Therapy) in April 2009 and methadone (used as Opioid Substitution Therapy) in February 2010, to mitigate and reduce HIV/AIDS and other blood borne viruses (BBV) among IDUs.

For many years detoxification was the only intervention available, some authorities were opposite for the Harm Reduction Program even, much still to MMT. As detoxification has 90% relapsed (WHO), HIV prevalence and other BBV are increased day by day, and that’s why MDM attempted to start a Pilot MMT program in Afghanistan-Kabul for People who use drug particularly for injectors. Finally after much more attempts and struggling against Ministry of Counter Narcotic and DRC, MDM succeed to start Methadone Maintenance Therapy Practically in Kabul February 2010.

Drug users and methadone maintenance therapy impact

As with many western countries, New Zealand’s drug laws are out of date and are causing more harm than was originally intended. The laws carry the shadow of a prohibitionist past, have failed to keep up with innovations in drug production and supply and do not relate well to modern understandings of harm reduction and health protection.

The challenge of Benzylpiperazine (BZP) ‘party pills’ in the late 1990s and early 2000s made deficiencies in New Zealand’s drug law abundantly clear. No framework for controlling BZP and other party pills could be found within existing laws and regulations. An endless cat and mouse game began between the Government and the ‘legal high’ industry, with new psychoactive substances (NPS) coming onto the market as quickly as existing substances could be banned.

This prompted the New Zealand Government to order a review by the New Zealand Law Commission of the Misuse of Drugs Act 1975 (MODA).

The recommendations from this review led to New Zealand’s ground-breaking and worldleading Psychoactive Substances Act 2013.

New Zealand’s small population and remote location make for a poor and risky market for international drug rings. Drugs like heroin and cocaine, which are present in other parts of the world, are relatively rare. The creation of NPS continues a long history of New Zealanders making the most of available resources to create
substitutes for drugs that are unavailable.

It is fitting then, that New Zealand has become the first country to pass legislation that seeks to regulate NPS to ensure they are low risk, rather than to control them through prohibition and punitive measures.

The Psychoactive Substances Act 2013 has been generally well-received by politicians, the ‘legal high’ industry and the public. It is also receiving considerable attention from like-minded jurisdictions around the world.

As we shall see, if is far from a perfect or final solution, but it bodes extremely well for future drug policy development and reform, both here and overseas.

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Publications from IDPC Members