UNGASS: Universal Access "Fair Play" (The Network of Drug users in Nepal)

Written by Prem K Limbu

UNGASS: Universal Access "Fair Play"

It's amazing to see that IDU's are enjoying universal access to harm reduction services or at least nearly to it (reaching 76% at present, with UNGASS target being 80%) in Nepal. Technically right, according to the Methodologies that has been developed by UNGASS which considers various program indicators and this has resulted in showing 78% coverage (first website publication) and changed to 76% (in the dissemination day) in the IDU's component.

"This situation is a situation that we all should have been proud of, only if it was true" said Mr. Anan Pun a Chairman of International Network of People Using Drugs and also an Executive Director Recovering Nepal "a Network of Organizations Led by Drug users in Nepal" during the UNGASS report dissemination which was held in 18th April 2008. "Instead in reality, only about 2500- 3000 drug users are receiving Harm Reduction Services that are effective and really matters to them i.e Methadone, Buprenorphine, needle syringe exchange and rehabilitation treatment. It is reported that more than 46000 drug users are estimated to be living in Nepal, out of them, it is stated that more than 20000 are injecting. Service coverage is at its minimum in Nepal. These inflated figures in UNGASS report will not be helpful in addressing the issues that drug users are facing at present. Therefore on the grounds of absurdity, we cannot accept this outcome." said Anan.

It was also emphasized by other civil society members, who were present in the UNGASS report dissemination event that these reports, which have already been submitted to the UNGASS, does not at the least, reflect the current situation facing drug users in the country. Some members working directly with drug users even added that the statistics will be held against the IDU's in future, in times when the country is preparing Global Fund Proposal or making National Action Plans.

It's a well known fact that without preventing HIV among the drug users it is not possible to halt and reverse the HIV epidemic. Reports like these will merely ignore the existence of the problem and will become a mean of satisfaction to the donors and the top UN officials which might make them feel that they have fulfilled their UNGASS commitments when the truth is entirely different. As Anan later on put it "These are Technical illusion that is we all should be aware of, if our intentions clearly are to halt and reverse HIV in the world".

Picture, a drug user "who is in need of Methadone program" but can't get in one, since the methadone program is running a full house beyond its capacity, but he instead is provided a condom by an outreach worker. As per the UNGASS report, he is marked as "IDU reached with services", job well done. How is it that indicator such as, "How many drug users are enrolled in Methadone program?" is not used for coming out with the service coverage? Or for that matter "Drug user's in Buprenorphine program?" or "Drugs treatment or Detox?" These services are completely ignored in fears of high service gaps that can be reflected in the UNGASS report, which may not look good for many.

During the event, it was explained by the representatives of National Center for AIDS and STI Control (NCASC) and USAID that the country has just been following the guidelines provided by the UNGASS, to accumulate the data's to be considered in the report. If these methodologies and guidelines are designed to virtually inflate the existing service coverage, how effective can this be in reality to efficiently address the threat of HIV in the society?

As we all are aware that the drug users are a hidden population and usually the best estimates provided by the Government statistics are only tip of the iceberg. Drug users are a marginalized population. If we are to attract these hidden populations towards the mainstream services, we need a service package that are worth going through the trouble of exposing themselves in the service centers, attractive enough to get them out of their room. Considering these services are the best tools in reducing HIV among the drug users, these services should be major indicators for drug users component in UNGASS, if the commitments are truly intended to be fulfilled, keeping the promise with Fair Play in mind.

Regards

Prem k Limbu

--
Prem K Limbu
Advocacy Officer
Recovering Nepal
The Network of Drug users in Nepal
Ph (Mob):+977-98510-10158
(Off): +9771-2111107

DrugWarLog
ArtCoreFromTheHardCore

www.HaRdCOREhARMREdUCER.be

Don't give us false illusions of hope: injecting drug users

www.INPUD.org

HardCore INPUD : Bijay Pandey (Nepal)

Written by Bobby Ramakant (bobby)
Orgininal Article Published on HealthDev.net, January 30, 2008

Repeated calls for harm reduction approaches to HIV prevention, treatment and care, particularly for injecting drug users (IDUs) and Universal Access, were answered with a reality check on the second day of the first Asian Consultation on Prevention of HIV Related to Drug Use, in Goa.

During a session that brought together parliamentarians, civil society activists and IDUs, the voices of several users provided delegates with a stark reminder of the reality on the ground.

“Drug users are treated as criminals, as sub-human beings” said Bijaya Pandey from Nepal.

“For the past few years we have been hearing about ‘3 by 5’ and ‘2010’—please, please, don’t give us a false illusion of hope,” Pandey said, referring to WHO’s failed initiative to provide antiretroviral drugs to three million people by end of 2005, and the promise of Universal Access by 2010.

Opioid substitution therapy (OST) and needle syringe exchange programs are not operating or even legal in some Asian countries. Only a handful of states in the region have government-supported OST or syringe exchange programs.

The combination of the criminalisation of injecting drug use and a lack of a coherent legal and policy framework on drugs, means that not only are IDUs are at risk while accessing existing services, but service providers are also at risk of being penalised for offering them.

“Bijaya, Tamara and I are the lucky survivors of the war—the war on drugs,” said Fredy Edi, a board member of the International Network of People who Use Drugs and the Indonesian Drug User Network, referring to IDU representatives Pandey and Tamara Speed from Australia. “The war on drugs is also war on health,” Fredy added.

There is evidence to suggest that ‘war on drugs’ has caused a rise in HIV infections, particularly among IDUs, across the region. The number of new hepatitis C (HCV) infections has also increased since the war on drugs was launched. HCV infection rates are believed to have reached epidemic proportions in many parts of Asia, such as Manipur in India.

“We have buprenorphine but distribution is limited to less than 10 percent of people who need it,” a delegate from Manipur said during the meeting.

Another delegate raised the issue of antiretroviral therapy (ART) for IDUs. Many IDUs are reportedly being told that they must stop taking drugs before they can receive treatment from ART centres.

Delegates also expressed concern over the lack of programs designed to tackle inhaling drug use and the lack of programs tailored towards women, transgendered users or the partners of male users.

“It is very difficult to find female drug users in public spots,” Dr Tasnim Azim from Bangladesh told the session. About 15 percent of female IDUs in Bangladesh become pregnant within two years of developing a habit, Dr Azim said, adding that there were no antenatal clinics or services for female drug users.

While we eye the goal of Universal Access for 80 percent of IDUs, Bijaya’s plea ‘not give a false illusion’ serves as a grim reminder of the reality faced by those who need these services the most.

WWW.HaRdCOREhARMREdUCER.BE
DrugWarLog
ArtCoreFromTheHardCore

REQUEST FROM Reference Group to the UN on HIV and IDU

WWW.INPUD.ORG

Reference Group to the UN on HIV and IDU

We are looking for data from around the world on the number of injecting drug users and HIV prevalence among IDUs.


Do you have data from your country?

The Reference Group to the United Nations on HIV and injecting drug useadvises UNODC, UNAIDS and WHO on injecting drug use and on effective approaches to HIV prevention and care for IDUs to help guide strategies for scaling up these activities.
See www.idurefgroup.unsw.edu.au for more information about the work of the Reference Group, the international experts who currently make up the group and the Secretariat which is currently based at the National Drug and Alcohol Centre in Australia.

One of our major activities is to report on the global extent of IDU and HIV.

We are in the process of updating estimates for every country around the world on:
1. the number of people who inject drugs in each country
2. the prevalence of HIV among these injecting drug users

Many of you may be familiar with the estimates that were released several years ago by the previous Reference Group.

Producing these estimates is difficult because in many countries there are no data measuring the extent of injecting drug use or HIV among injecting drug users. In other countries data may exist, but are not widely available.

So far we have conducted a very large search of the peer-reviewed literature and have tried to gather as much greyliterature (such as NGO and government reports) as possible. However we know that there will be some material that our search would have missed.

Below is a list of countries that we do not currently have sufficient data on. This lack of data means we will be unable to make direct estimates on the size of the IDU population or the prevalence of HIV among IDUs for these countries.

Do you have any information on these countries that may be of use to us?

Any assistance you are able to provide will be acknowledged in the reports of the Reference Group. We have only a limited amount of time in which to complete this work. Because of this we will only be able consider material that is sent to us before Friday 15 February 2008

More data is needed for the following countries:
Eastern Europe and Central Asia:
Bosnia and Herzegovina, Georgia, Lithuania

South Asia:
Bhutan, Maldives, Sri Lanka

East and South East Asia
Brunei Darussalam, Democratic People’s Republic of Korea, Japan, Lao People’s Democratic Republic, Mongolia, Republic of Korea, Singapore, The Taiwan Provence of China, Timor Leste

Caribbean
Antigua and Barbuda, Bahamas, Barbados, Cuba, Dominica, Dominican Republic, Grenada, Haiti, Jamaica, Saint Kitts and Nevis, Saint Lucia, Saint Vincent & Grenadines, Trinidad and Tobago

South America
Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Guyana, Honduras, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, Venezuela

Oceania and the Pacific
American Samoa, Federated States of Micronesia, Fiji, French Polynesia, Guam, Kiribati, Marshall Islands, Nauru, New Caledonia, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu

Western Europe
Albania, Andorra, Belgium, Iceland, Italy, Finland, France, Liechtenstein, Monaco, Montenegro, San Marino, Serbia, Spain, Switzerland, The Former Yugoslav Republic of Macedonia

Middle East and North Africa
Algeria, Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Morocco, Occupied Palestinian Territories, Oman, Qatar, Saudi Arabia, Sudan, Syrian Arab Republic, Tunisia, Turkey, United Arab Emirates, Yemen

Sub-Saharan Africa
Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comoros, Côte d’Ivoire, Democratic Republic of the Congo, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Niger, Nigeria, Republic of the Congo, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, Somalia, Swaziland, Togo, Uganda, Zambia, Zimbabwe


If you have any information you can share with us or you have any further questions please send an email to:
IDUreferencegroup@med.unsw.edu.au

We would greatly appreciate any help you can offer us.

I look forward to hearing from you.

Regards,

Benjamin.

Benjamin Phillips
Research Officer, Secretariat of the Reference Group to the UN on HIV and IDU
National Drug and Alcohol Research Centre
University of New South Wales
Sydney, Australia

Ph: 9385 0264 (direct)
Ph: 9385 0333 (switch)
Fax: 9385 0222
Web: http://ndarc.med.unsw.edu.au

WWW.HaRdCOREhARMREdUCER.BE
DrugWarLog
ArtCoreFromTheHardCore

"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

WWW.HaRdCOREhARMREdUCER.BE
DrugWarLog
ArtCoreFromTheHardCore

New CEEHRN research, hepatitis C among injecting drug users

HaRdCOREhARMREdUCER
ArtCoreFromTheHardCore

HaRdCOREhARMREdUCER
ArtCoreFromTheHardCore

New CEEHRN study on hepatitis C among injecting drug users:
need for improved evidence-based and non-discriminatory policies and services

A new report entitled “Hepatitis C Among Injecting Drug Users in the New EU Member States and Neighboring Countries: Situation, Guidelines and Recommendations” shows that inadequate political commitment, prevention and neglected treatment interventions exist in the new EU member states, Russia and other Eastern European countries. In 13 of these countries, home to an estimated 2.1–3.3 million injecting drug users (IDUs), the prevalence of hepatitis C is as high as 70%-90% among IDUs, depending on the setting. At the same time, most IDUs do not have access to evidence-based prevention services and are systematically denied hepatitis C treatment, care and support.

The report, developed by the Central and Eastern European Harm Reduction Network (CEEHRN) in partnership with medical professionals and civil society representatives, summarizes the epidemic as well as governmental and local responses in 13 countries as well as evidence for hepatitis C prevention, treatment and support targeting drug users.

The growing hepatitis C epidemic could be managed by a commitment to address the needs of IDUs. The report calls for strengthening national advocacy efforts by raising awareness about the issue and building the capacity of health care specialists and service providers in order to enhance their knowledge and ensure non-discriminatory services and treatment practices. “Governments must take much more effective action now to prevent unnecessary deaths from this serious, but treatable disease. The biggest hurdle we are facing is that hepatitis C has not been made a priority”, said one of contributors Charles Gore of The Hepatitis C Trust. In order for hepatitis C to be put on the public health policy agenda, the report also calls on EU-wide hepatitis C actions.

***

Hepatitis C spreads rapidly among IDUs due to the high infectivity of the virus (about 10 times higher than HIV). Unlike HIV, it can be transmitted by sharing not only needles and syringes but also other injecting equipment (which comes into contact with and carries infected blood particles). Hepatitis C often presents no symptoms, and the vast majority of infected people are not aware of their status. This is even more common among IDUs, since a large part of this group is not reached by services and remains outside of the health care system. At the same time, hepatitis C presents a critical public health problem. Hepatitis C becomes chronic in about 85% of those infected, leading to liver disease like cirrhosis, liver failure and cancer. An estimated 250 000 people die annually of hepatitis C-related causes. Morbidity and mortality from HCV infection are expected to continue to risiein the coming decades. Yet only 2 out of the 13 countries studied have a strategy/program to manage hepatitis.

Access to prevention services for IDUs, including outreach, needle exchange and opioid substitution therapy varies across Europe and although better in Central than Eastern Europe, is still inadequate; in Russia the coverage might be as low as 2%. HCV testing and counseling is poorly linked to already established services for IDUs and is available at needle and syringe exchange and substitution therapy programs in only 5 countries, which also results in low hepatitis C literacy in IDUs communities.

In at least 9 out of 13 countries drug use is indicated as contraindication to hepatitis C treatment in treatment guidelines, with the exception of Slovenia, where hepatitis C treatment for drug users is recommended in cooperation between specialists in infectious diseases and drug addiction treatment. Even people undergoing drug substitution therapy are often declined treatment, while international guidelines state that drug users can not be excluded from treatment.

Further information:

Simona Merkinaite, Vilnius, Lithuania

Phone: +370 5 2609007

E-mail: simona@ceehrn.org

The electronic version of the report in English as well as Fact sheet with key facts and issues in English and Russian can be found at CEEHRN website at www.ceehrn.org/hepatitis.

Russian version of the report will also be available shortly. The information will be distributed separately. For printed copies, please write to simona@ceehrn.org.

With kind regards,

Simona Merkinaite

Central and Eastern European Harm Reduction Network

Address: Pamenkalnio 19-6, Vilnius 01114, Lithuania

Tel.: +370 5 2609007, 2691600

Fax: +370 5 2691601

Mob.: +370 6 8254401

E-mail: simona@ceehrn.org

Web: www.ceehrn.org

HaRdCOREhARMREdUCER
ArtCoreFromTheHardCore