Accepting drug realities to save lives<\/p>\n
Dr. Alex Wodak, Director of Alcohol and Drug Service, St Vincent's
\nHospital, Sydney, Australia, and President of The International Harm
\nReduction Association. Joyce Djaelani Gordon Chairperson, Yayasan Kita
\nAddiction Treatment and Community Recovery Center, Cipayung, West Java,
\nJakarta<\/p>\n
Indonesia now faces a serious threat from HIV among its
\nrapidly increasing number of injecting drug users (IDUs). A
\nrecent report from Monitoring the AIDS Pandemic (MAP) Network
\nnotes a stark increase of HIV levels among Indonesian IDUs from
\n15 percent in 1999 to 40 percent in 2000, followed by an
\nequivalent increase of HIV levels among sex workers.<\/p>\n
It will soon be followed by an increase of HIV among the
\ngeneral population, including pregnant women, just like in
\nThailand.<\/p>\n
In 1987, HIV in Thailand grew from less than 1 percent to more
\nthan 40 percent of IDUs in just 10 months. Within five to six
\nyears in the northeast of Thailand, one in six male military
\nrecruits and one in eight pregnant women had become infected.
\nNow, almost 2 percent of the Thai population is infected.<\/p>\n
Similar epidemics have occurred in other parts of the world.
\nYet countries which adopted harm reduction approaches such as
\nAustralia, New Zealand and the Netherlands have managed to either
\navoid these epidemics altogether or bring small epidemics quickly
\nback under control.<\/p>\n
In contrast, countries that focused on eliminating illicit
\ndrug use, such as the U.S., have not only failed to create drug-
\nfree nations, but have also seen HIV spread rapidly among IDUs
\nand their general populations. More than a quarter of the 40,000
\nnew HIV infections in the U.S. each year involves IDUs.<\/p>\n
Harm reduction refers to policies and programs that primarily
\naim to reduce complications of mood altering drugs; be healthy,
\nsocially or economically. Most often, it is used to ensure that
\nHIV does not spread rapidly among the IDU communities, and from
\nthem to the general population.<\/p>\n
Harm reduction approaches started becoming established in the
\ndeveloping world from early 1990s. Nepal, India, Bangladesh,
\nVietnam and some other Asian countries have now established harm
\nreduction programs to control HIV among IDUs. The problem is that
\nthey are not established fast enough to control the spread of
\nHIV.<\/p>\n
As a pragmatic way to respond to illicit drug use, harm
\nreduction recognizes that we do not know how to ensure that IDUs
\nwould stop injecting immediately. Some drug users do not want to
\nstop, while others badly want to, but are unable to.<\/p>\n
Harm reduction deals with those who are unable or unwilling to
\nstop. It includes explicit education about the risks of sharing
\nneedles and syringes, preferably with active involvement of drug
\nusers in designing and implementing education campaigns.<\/p>\n
Also, sterile needle and syringe utilization programs are
\nrequired to try and ensure that as many injecting episodes as
\npossible involve the use of sterile injecting equipment. Needle
\nand syringe exchange or distribution programs are at the center
\nof this work.<\/p>\n
Drug treatment is required which is attractive, readily
\navailable and based on evidence of effectiveness. While a diverse
\nrange of options work best, methadone programs for heroin users
\nhave been shown to be most effective in attracting and keeping
\nlarge numbers in treatment and slowing the spread of HIV.<\/p>\n
Finally, community development among drug users is needed to
\nensure that they become part of the solution rather than part of
\nthe problem.<\/p>\n
There are many parallels between a harm reduction approach to
\ninjecting drug use and traditional public health responses to
\nmany common health problems. Attempts to control sexually
\ntransmitted infections cannot be based on efforts to achieve
\ntotal abstinence from sexual activity. That is unachievable.<\/p>\n
Use of the term \"harm reduction\" and interest in the
\nphilosophy increased substantially in the early 1980s, following
\nrecognition of the AIDS epidemic and the realization that the
\nsharing of injection equipment was a major risk for the
\ntransmission of HIV. When attempts to reduce risk episodes have
\nbeen pursued to their maximum, sensible public policy requires
\nthat attempts are also made to reduce the hazardousness of each
\nremaining risk episode.<\/p>\n
The defining characteristic of the major alternative approach
\nto harm reduction is an overriding emphasis on reducing or even
\neliminating consumption. The level of adverse consequences then
\nbecomes very much a secondary consideration. However, reducing
\nthe consumption of drugs does not necessarily reduce harm and has
\noften inadvertently exacerbated it.<\/p>\n
The well-intentioned closure of opium dens throughout Asia one
\nor two generations ago saw opium smoking in elderly men
\ndisappear, only to be replaced by heroin injecting among young
\nand sexually active men. This has prepared the fertile soil for a
\npublic health catastrophe of unimaginable proportions.<\/p>\n
Some mistakenly regard harm reduction and abstinence as
\nmutually exclusive options. True, abstinence is the most complete
\nform of harm reduction, however, abstinence is often the least
\nfeasible and sustainable option. Relapse is very common,
\naccompanied by increased risk of adverse outcomes.<\/p>\n
The single-minded pursuit of abstinence can have serious
\nunintended negative consequences and exacerbate harm.<\/p>\n
Attempts to reduce the demand or supply of drugs are not
\nincompatible with harm reduction, provided that the overriding
\nobjective remains the reduction of harm, rather than the
\nreduction of consumption per se.<\/p>\n
The way Indonesia responds to the threat of HIV infection
\namong IDUs will affect the health and well being of several
\nfuture generations.<\/p>\n
If Indonesia responds by attempting to create a drug-free
\nnation, there will be many unnecessary deaths, much misery,
\noccupied hospital beds and extremely high social and economic
\ncosts. A burden Indonesia can do without in the light of its
\ncurrent economic and financial condition.<\/p>\n
If Indonesia is to avoid such high costs, it must adopt harm
\nreduction strategies immediately. If we respond pragmatically,
\nacknowledging that injecting drug use cannot be eliminated, many
\nof the serious adverse effects of drug use can be minimized.<\/p>\n
Dave Purchase, who founded the first needle syringe program in
\nthe U.S., said \"we may not be able to stop young people being
\nsilly, but we can stop them being dead\".<\/p>",
"url": "https:\/\/jawawa.id\/newsitem\/accepting-drug-realities-to-save-lives-1447893297",
"image": ""
},
"sponsor": "Okusi Associates",
"sponsor_url": "https:\/\/okusiassociates.com"
}