Needle exchange vital step in containing spread of HIV

Medics are calling for addicts to be viewed not as criminals but as patients.

AT THE Ganslwirt needle exchange in Vienna’s sixth district, users of heroin and other opiate drugs from across the city, like 20-year-old Stefan, come to drop off their used needles and get clean ones.

“It’s very important for me to be able to change needles here,” Stefan said. “Otherwise I’d have to ask friends to use their needles which would be very dangerous.”

Needle exchange and treatments like opiate substitution therapy (OST) form the core of what is called “harm reduction”. They have become a central element in the strategy of many western governments – including Ireland’s – in fighting HIV transmission through intravenous drug use over the past two decades. But outside the West, it’s a different picture.

“Right now, almost one-third of all HIV infections outside of sub-Saharan Africa are associated with the sharing of drug injection equipment,” said Don Des Jarlais, director of the Baron Edmond de Rothchild Chemical Dependency Institute in New York, “and that leads to sexual transmission from drug users to the general population”.

Dr Des Jarlais is at the global HIV/Aids conference in Vienna this week to launch the Vienna Declaration, a two-page document he has drafted along with 30 other leading HIV scientists and specialists around the world.

The declaration’s core demand is that governments reform their drug policy, moving away from policies that view drug users as criminals and toward policies that see them as patients.

This, Dr Des Jarlais and his colleagues argue, will help western countries drive down their stabilised HIV infection rates even further and enable states in eastern Europe, Russia and Central Asia to put the brakes on a burgeoning HIV epidemic among drug users there.

Russia has an estimated 1.6 million intravenous drug users, according to the United Nations; 37 per cent of them are thought to be HIV positive. They make up some 80 per cent of Russia’s total HIV epidemic and this grim picture is replicated throughout eastern Europe and Central Asia.

The framers of the Vienna Declaration and other HIV experts directly attribute these statistics to what they describe as draconian drug laws in the region.

“People are afraid to use health services. They are afraid to go to the hospital because they don’t want to be exposed to the fear of police arrest or abuse from police and so on,” says Anya Sarang, president of the Andrey Ryklov Foundation for Health and Social Justice, in Moscow.

“In this atmosphere of fear and terror and risk, it will be impossible to achieve very high level of activeness of HIV treatment or prevention programmes.”

The success of needle-exchange and drug-substitute programmes in the West have all but removed the issue of HIV infection via shared needles from discourse on the epidemic. The Vienna Declaration is an effort to reintroduce the subject, not only in terms of the explosion in infections in eastern Europe, Russia and Central Asia, but also in terms of drug policies in the West, which still require reform, the declaration says.

Last week, the Obama administration announced a new strategy in the fight against HIV in the US – setting a target of reducing infections by 25 per cent in five years. Ethan Nadelmann, executive director of the Drugs Policy Alliance, a reform advocacy group, says this new attitude will bring federal funding to existing harm-reduction services across the country which have been typically funded on the state level.

This is a positive move, he says, but it is tempered by America’s enormous incarceration rates. In America today, as elsewhere, the war on drugs is locking horns with the fight against Aids.

“In the US, we have less than 5 per cent of the world’s population but almost 25 per cent of the world’s incarcerated population,” he said. “We’ve gone from 50,000 behind bars for drug offences in 1980 to half a million today, almost a tenfold increase. We lock up more people in the US for violating a drug law than all of western Europe locks up for everything.”

In western European states, including Ireland, seen as the most advanced in evolution from a law-enforcement-based drug policy to a public-health-oriented one, the declaration calls for reform in the area of harm reduction. Techniques and treatments such as supervised injecting facilities and the provision of pharmaceutical heroin and morphine in the treatment of drug addiction are highly successful methods of ending drug dependence and limiting HIV infection.

They are used in countries such as Switzerland and Canada but have been discounted as viable options elsewhere, often on ideological grounds.

Despite this room for improvement, western Europe, Canada and Australia can, for now, serve as case studies of successful policy alternatives to strict criminalisation for the US and, more urgently, for Russia, eastern Europe and central Asia, drug policy reform activists say.

Back at the Vienna needle exchange, Stefan says he feels fortunate to live in Austria. He’s nearing his third year of addiction to heroin but, he says, recovering from it would be impossible – and dangerous – if it weren’t for facilities such as the needle exchange.

“I don’t want to die from this,” he said. “My brother already died from drugs and I was silly enough to start taking them. I want to stop, and facilities like this can be very helpful on my way out. There should be facilities like this in every country.”

Source: Don Duncan, The Irish Times, 22/07/2010