Global and Local Policy Initiatives on Injecting Drug Use  TUAX01

Oral Abstract Session Back
Venue: SR 9 (950)
Interpretation: None
Time: 11:00 - 12:30, 05.08.2008
Code: TUAX01
Co-Chairs: Ingrid Van Beek, Australia
Daniel Wolfe, United States

Presentations in this session:

First international network on drug consumption rooms (INDCR)
Presented by María Iriarte, Spain
J. Rio Navarro1, J.J. Pardo Serna2, A. Unzueta Sesumaga2, S. Evans3, E. Schatz4, I. Van Beek5, M. Iriarte6
1Munduko Medikuak, Drug Consumption Room, Bilbao, Spain, 2Munduko Medikuak, Bilbao, Spain, 3Insite, Vancouver, Canada, 4DeRegenbougAMOC, Amsterdam, Netherlands, 5MSIC, Sydney, Australia, 6Médicos del Mundo - Spain, Madrid, Spain

The role of Russia's drug dependence treatment system in fighting HIV
Presented by Diederik Lohman, United States
D. Lohman1, M. Ovchinnikova2, J. Amon1
1Human Rights Watch, HIV/AIDS Program, New York, United States, 2FrontAIDS, St. Petersburg, Russian Federation

Improving global estimates of injecting drug use and HIV among people who inject drugs
Presented by Bradley Mathers, Australia
B. Mathers, L. Degenhardt, B. Phillips, A. Roberts, The Reference Group to the United Nations on HIV and Injecting Drug Use
University of New South Wales, National Drug and Alcohol Research Centre, Sydney, Australia

A public health and human rights imperative: the case for prison needle and syringe programs
Presented by Sandra Ka Hon Chu, Canada
S.K.H. Chu, R. Elliott, R. Pearshouse
Canadian HIV/AIDS Legal Network, Toronto, Canada

Resist meth: a public health department, advertising agency, and community collaboration to develop a social marketing campaign to address methamphetamine use among MSM
Presented by Suresh Kunhi Mohammed, India
M. Paquette1, M. Das-Douglas2, M. Boland3, L. Pappas3, J. Leonard3, G. Colfax4
1HIV Prevention Section, AIDS Office, San Francisco Dept. of Public Health, San Francisco, United States, 2HIV Prevention Section, AIDS Office, SFDPH, Department of Medicine, HIV/AIDS Division, SFGH, UCSF, San Francisco, United States, 3Better World Advertising, San Francisco, United States, 4HIV Prevention Section, AIDS Office, SFDPH, Department of Medicine, UCSF, San Francisco, United States

Rapporteur reports

Track E report by Mandeep Dhaliwal

The UN Reference Group on HIV & IDU reviewed 11 000 documents to map global IDU/HIV epidemiology (Mathers)

·         IDU is established in many regions, and emerging in most

·         Prevalence of IDU is  <.25% in 18/61 countries with data; .25 - .5% in 22; .5 – 1% in 11 and >1% in 10

·         HIV prevalence among IDU ranges from <0.5% to >30% (10 countries reporting)

·         There are an estimated 15.8 m IDU globally, of whom 40% reside in China, USA and Russia; 3m of them are HIV+

The overriding theme was that, despite a convincing body of evidence demonstrating efficacy and safety, in many jurisdictions policy makers have not implemented or have actively opposed the implementation of programs and strategies to reduce HIV and HCV transmission.

·         Drug consumption rooms operate in only 8 countries and there is limited political will to scale up, despite evidence of effectiveness (Rio Navarro)

·         Prison Needle Syringe Programs (PNSP) operate in 60 prisons in 11 countries, ranging from low to high income.  Of 5 evaluations, none showed increased IDU or attacks with needles; all showed reduced rates of sharing and health improvements. Despite this, many countries deny prisoners access to prevention, in contravention of their human and health rights. (Chuh)

·         Despite a substantial body of evidence demonstrating the safety, efficacy and health impact of substitution therapy, Russian public health officials continue to deny the efficacy of OST, stifle open scientific debate and promote unproven and potentially harmful alternatives. Proponents of OST are branded ‘dissenters’ and risk criminal prosecution (Lohman)

“Russia’s refusal to let scientific evidence guide its drug treatment policies is bad public health policy. The price for these policies is paid in the life of young Russians”.

Leadership report by Richard McKay
Maria Iriarte, representing a Drug Consumption Room (DCR) in Bilbao, Spain, opened the session, speaking on the First International Network on Drug Consumption Rooms (INDCR).  DCRs have been shown to be an effective initiative in reducing risk in several countries.  This study aimed to facilitate a preliminary approximation of the most important areas of work of DCRs around the world, and improve knowledge sharing and intervention strategies.  Syringe exchange was seen to be the most important area of work for DCRs worldwide.

Diederik Lohman, of Human Rights Watch, next presented on the failure of Russia's drug dependence treatment system in fighting HIV, due to the absence of evidence-based practices.  The country bans substitution treatment, threatens promoters of substitution treatment with criminal prosecution, and maintains barriers which limit IDUs ability to access and continue with other treatment programmes.  

Bradley Mathers, representing the Reference Group to the UN on HIV & IDU, spoke on the need to improve estimates of injecting drug use and HIV among IDUs.  Following a preliminary literature review, the group found reports of IDUs in 148 countries worldwide, yet estimates of the prevalance of IDU were missing for 87 countries.  The study estimates that 11-21.2 million people are IDUs worldwide, with the largest bulk of users living in China, Russia, and the US, and a high level of non-reporting from sub-Saharan Africa.  The study also estimates the global number of IDUs living with HIV at between 0.7 million and 6.6 million.

Sandra Chu, representing the Canadian HIV/AIDS Legal Network, presented evidence from a comprehensive review of prison needle/syringe programmes (PSNPs).  She noted that prison populations in Canada endure HIV infection rates of 10 times that of the general population, and that a scarcity of needles and syringes in prisons encourages needle/syringe sharing, and increased risk of HIV and HCV transmission.  The programmes were found to function in well- and poorly-funded prison settings, are well accepted by IDUs in prison, and demonstrate significant effects in reducing HIV/HCV transmission, without any significant increase in injection drug use.

Moupali Das-Douglas, from the San Francisco Public Health Department (SFPHD), closed the session with a discussion of an initiative aimed at addressing metamphetamine use amongst MSM.  Das-Douglas noted that meth use was associated with increased sex partners, unprotected sex, risk of STDs, risk of HIV infection, and that previous SFPHD campaigns had been criticized as preaching.  Following the request of input from community members, ‘Resist meth’ was designed, and disseminated through traditional and creative means, and received a positive response from the community.

Audience members asked several questions, including why prisons remain a dark spot in harm reduction (answer: governments don’t want to be seen endorsing drug use), and why the SFPHD focused on meth as opposed to other health (answer: 20-40% of new HIV infections reported meth use).



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