Asians who use drugs: Nowhere to turn for HIV services

Photo by lucasreddingerDespite the well-documented benefits of harm reduction approaches to HIV prevention, particularly among injection drug users (IDUs), service coverage is abysmally low throughout Asia.

With about 30% of new HIV infections in the region associated with drug use, there is a very real and urgent need to scale-up harm reduction services. This is one of many issues being discussed by delegates at the first Asian Consultation on the Prevention of HIV Related to Drug Use being held this week in Goa.

“Injecting drug use has acted as a catalyst for HIV epidemics at the onset of the pandemic in many Asian countries. The sharing of injection equipment is a very efficient way to transmit HIV from one person to the next,” Dr JVR Prasada Rao, Director of the Regional Support Team of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said during the consultation.

“Once HIV enters the IDU network, it spreads very rapidly and an injecting drug use-related HIV epidemic kicks off in a country. This is what happened in China, Indonesia, Viet Nam and the north-east of India.”

With HIV prevalence rates of between 20 and 85% among IDUs in some Asian countries, governments have no excuse for not responding to the issue by integrating harm reduction approaches into HIV prevention and treatment programmes and scaling up interventions.

“Injecting drug use is increasing in many parts of [India] and its association with HIV is well documented,” said Dr Sujatha Rao, director-general of the National AIDS Control Organization (NACO) in India. But harm reduction approaches to HIV prevention, treatment and care are not being scaled up, even in India.

“About 3000 IDUs are receiving OST [opioid substitution therapy] in India,” Dr Sujatha Rao told a Key Correspondent during an interview on the sidelines of the Goa consultation, adding that “more than 40,000 IDUs may need to be put on OST in India.”

Although the World Health Organization (WHO) list of essential medicines includes both methadone and buprenorphine – commonly used opiate substitution drugs – many countries in Asia continue to list these drugs as illegal. India is one of them and methadone is still illegal in the country. “A policy stand on OST is yet to be taken,” Dr Sujatha Rao said.

Buprenorphine is legally available in India, Pakistan and Nepal. Methadone is legally available in only five Asian countries: China, Hong Kong, Indonesia, the Lao People’s Democratic Republic and Myanmar.

“The priority now is to see that all countries that report injecting drug use make methadone legal, include it in the list of essential drugs and expand access to drug substitution treatment,” said Dr Prasada Rao of UNAIDS.

Legal reforms that support policies for HIV prevention, treatment and care for communities at risk, especially IDUs, are another pressing need. The criminalization of injecting drug use has made it harder to reach many communities at risk of HIV infection. The revision of laws criminalizing injecting drug use is clearly vital, not only to improve HIV responses in the region but also to ensure the achievement of Universal Access targets by 2010.

All 189 signatories to the Declaration of Commitment at the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS, further committed in 2006 to expand harm reduction services to 80% of the IDU population by 2010. Currently, these services reach about 3% of those in need.

“It is riskier to access HIV prevention, treatment and care services for IDUs than to get illegal drugs,” one delegate at the Goa consultation said.

Harm reduction approaches to HIV prevention, treatment and care need to be scaled up significantly and rapidly. Without decisive action, it is not clear how Asian countries can achieve this.

Bobby Ramakant-CNS