What if there were an evidence-based, cost-effective approach to prevent HIV infections by tackling a risk that accounts for roughly one out of three HIV infections outside of sub-Saharan Africa, and an increasing proportion of HIV infections everywhere?
You might think, in the budget-challenged times that donors and recipients in the global health landscape grapple with now, that such an approach would be embraced, even if it meant examining assumptions, challenging misinformation, and overcoming bias.
The answer is more complicated, and, as introductory comments from UNAIDS Executive Director Michel Sidibe put it, alarming, according to the recently released 2012 report on The Global State of Harm Reduction.
The third edition of the report mapping responses to drug-related HIV and hepatitis C epidemics worldwide finds advances, but also setbacks, including the 2011 reinstatement by Congress of the United States’ ban on federal funding for needle and syringe exchange, and a continuation of restrictions in recipient countries that interfere with efforts to provide sterile injecting equipment.
“It is paradoxical,” Eliot Ross Albers, executive director of INPUD (International Network of People who Use Drugs) said. “Some donors don’t get harm reduction at all. Some recipient governments don’t want to implement harm reduction.” Albers, who also wrote introductory comments to the report, spoke with Science Speaks to highlight some of the findings.
“Kenya is a classic example at the moment,” he said. Although HIV prevalence is estimated at about 18 percent among people who inject drugs there, the government has been slow in the face of donor efforts to bring opioid substitution therapy and obstructive in response to efforts to bring clean needle and syringe programs, he said.
In Kenya, and other countries, he said, “the thinking is that if you give needles to drug users, you will encourage drug use.”
The response in Tanzania is one of the latest to overturn that thinking, according to the report.
Tanzania, where HIV prevalence among people who use drugs is estimated to exceed 42 percent, accepted efforts from Medecins du Monde-France, and has both needle exchange and opioid substitute treatment programs, now. “It’s legal and it’s going well,” Albers said.
The report also notes that the United States’ 2011 reinstated ban on federal funding for needle and syringe exchange programs “greatly undermined bourgeoning efforts to expand harm reduction” in the sub-Saharan region.
Globally, the harm reduction landscape continues to be inconsistent, the report, which includes overviews of nine regions around the world, shows.
“What’s interesting to me is the number of countries providing harm reduction is going up,” Albers said, “while Russia, which has an HIV prevalence among drug users as high as 75 percent in some regions, continues to refuse to provide needle exchange or OST.”
A separate report, due to be released in June, will examine harm reduction efforts among sex workers.