AIDS 2014: Harm reduction and drug policy — no one left behind

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20th International AIDS Conference (AIDS 2014), run by the International AIDS Society at the Exhibition Centre, Melbourne, Australia.AIDS2014postScience Speaks is live-blogging from AIDS 2014 in Melbourne, Australia through the week, with updates on research, policy and insights from the 20th International AIDS Conference.

MELBOURNE, AUSTRALIA – During the Wednesday opening plenary session, a medical doctor from Viet Nam presented a compelling overview of how her country’s policies regarding drug users evolved over the last decade from criminalization and compulsory detention to comprehensive harm reduction that includes sterile syringe access, opiate substitution therapy, as well as support and collaboration with drug user organizations.

Physician Khuat Thi Hai Oanh told how her thinking evolved as well, thanks to guidance she received nearly a decade ago from Australian physician and harm reduction advocate Dr. Alex Wodak. His public health approach and the Australian track record in 2003 of only 2-3 percent HIV incidence among people who inject drugs in that country helped make her a believer and a fierce advocate for sound and progressive policies governing drug users and drug use. She has since left clinical practice to work on these issues.

Much still remains to be done in Viet Nam and across the globe, she reminded her audience. HIV is not the only killer of people who use drugs,  she said, citing drug overdose, hepatitis B and C, and tuberculosis as other leading causes of death.

“Now it is not Hepatitis C that is killing people, it is the price of the medications,”  she said, noting that treatment for hepatitis C has become largely effective. She cited research showing that the 12-week treatment course could be manufactured for between $78-$166 per person by using the same methods of mass production of generics currently used for HIV antiretroviral drugs.

She flagged compulsory “treatment” for drug users  — the fate of almost a quarter of a million drug users — as ineffective and a violation of human rights.

Viet Nam has recently enacted a law to accelerate the movement away from these detention centers and has instituted some due process procedures for individuals before they can be remanded to these facilities. While she said she appreciates the condemnation of the United Nations and other international institutions for these detention centers, she called for affirmative support and resources for the development of a network of community-based voluntary drug treatment centers in Viet Nam and other countries where forced detention is now the norm.  She worried aloud about financing in light of the shift of Global Fund resources away from middle-income countries when these countries are the home of most of the world’s drug users at risk for HIV infection. She challenged notions that adequate resources are simply available when the world spends at least a $100 billion on drug enforcement activities.

She pointed to drug user organizations as an important component of the harm reduction paradigm and cited findings from a recent evaluation of these groups that found that members of these groups had better quality of life, less opioid use and more consistent use of sterile syringes than non-members.

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