"Coming of Age": What it means for Asia

Eurasian INPUD:
Fredy (Indonesia) and Stijn (Belgium)

Pascal Tanguay, Thailand

From May 12 to 17, I attended the International Conference on the Reduction of Drug Related Harm in Warsaw, Poland. The theme for this year’s event was "coming of age" - fitting indeed for 18-year-old conference.

But what exactly did "coming of age" mean? And what, in particular, did it mean for Asia? I asked the opinion of many people at the conference and also discussed the matter with many who didn’t attend.

In the words of International Harm Reduction Association (IHRA) executive director, Gerry Stimson, the conference represented "an opportunity to reflect on the many harm reduction achievements, to examine the existing problems and failures, and to look forward to the next decades of harm reduction on a global basis."

According to Stimson’s remarks during the opening ceremony, "coming of age" means facing a bigger and brighter future.

"IHRA is pleased to announce at this conference a major new programme of policy analysis and advocacy, funded by the UK Department for International Development. This collaboration between IHRA and harm reduction networks aims to create a global environment conducive for harm reduction," Stimson said.

IHRA’s overall strategy for activities under a generous DID grant was discussed with representatives from the most important global harm reduction organisations. The association’s thrust to widen the harm reduction agenda to incorporate issues related to human rights and development as well as sex work, stimulant drugs, alcohol and tobacco was also a focus.

A mechanism under the new program will seek to provide support to, and work more closely with, existing regional and other harm reduction networks and coalitions all over the world, including the possibility of developments in sub-Saharan Africa.

Jamie Bridge, IHRA’s communications and development officer, said that the conference discussions reflected the fact that the harm reduction movement had reached a significant crossroad.

"At the moment, the movement has the opportunity to innovate or become complacent and die . . . In the past few days alone, we’ve seen the International Youth Harm Reduction Network, the International Network of People Who Use Drugs, the Middle East North African Harm Reduction Network as well as the International Network of Harm Reduction Nurses emerge and take a seat at the table with us and other key stakeholders," Bridge said.

While the IHRA is barely 10 years old, Bridge said the 'coming of age' slogan was relevant to the new drive for cooperation, which could be likened to a brand new social experience.

But for some Asian advocates and harm reduction workers, the term 'coming of age' has a completely different meaning. Fredy, an Indonesian member of the International Network of People who Use Drugs said that he could not in good conscience celebrate this coming of age with his fellow confeence participants.

He said "harm reduction for Asian drug users is still in the dark ages," he said, adding that very few drug users were being involved in the development, implementation and evaluation of public health and social care services.

Arun Vrik from India was quick to back up Fredy’s argument. "Well, I don’t think we have come of age in Asia. How many countries in Asia have achieved substantial results? Asia has a long way to go and I would say that harm reduction in our region is just coming out of infancy and taking its first baby stepsinto childhood."

Arun said that to truly come of age, stakeholders in Asia would have to broaden their understanding of harm reduction to incorporate human and economic development as well as humanitarian aid and public health rather than rely on a naïve conception of drug control.

But one of the Universal Access in Asia and the Pacific plenary panelists at the conference confidently declared that "The need for policy advocacy in the Asian region is over. Now we need a good scale-up",

Earlier, in the sme presenter’s slides covering the "Regional Overview of Scaling Up Harm Reduction Towards Universal Access in Asia", a generic statement about "coverage and quality of services" was listed as a key challenge for the region. Throughout the conference not one of the presenters mentioned, acknowledged or explained the decrease in harm reduction service coverage in South East Asia from 5.4 percent in 2003 to three percent in 2005, as recorded by UNAIDS.

According to Bijay Pandney, from Nepal, coverage goes straight to the heart of defining our coming of age. "Harm reduction has to become a way of life for Asian drug users – services must flood the community so that the principles and practices of harm reduction become second nature," he said.

Throughout Asia, programs reach an infinitesimal proportion of drug users and thus can rarely generate a critical mass in the community to affect transmission rates. Stimson’s opening speech exposed a long list of problems and challenges harm reduction is still facing globally.

An overwhelming focus on repression and prohibition reinforced by policy inconsistencies and outright contradictions that lead to an ever increasing number of casualties of the war on drugs; opposition to harm reduction from influential countries; ignorance and dismissal of epidemiological evidence; and a lack of funding are ust some of the problems that still need to be tackled.

Idle or counterproductive UN bodies; increasing prison populations; more corruption; disproportionate numbers of injecting drug users (IDUs) affected by HIV and other blood-borne viruses such as hepatitis C; inadequate service coverage; the execution of drug users and flagrant human rights abuses and violations are also key issues.

These are all very valid points when reflecting on the past few decades of harm reduction work. But despite a difficult struggle, progress has been made, achievements have been recognised and more voices have lent themselves to the support of drug users. The conference was an event where colleagues, friends and family came together to mark almost two decades of collaboration.

If harm reduction programs have come of age then we should celebrate the birth of the heirs to the movement. The Youth Network for Harm Reduction and the International Network of People who Use Drugs, both founded at last year’s event in Canada, represent concrete mechanisms through which additional efforts can be channeled

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