Preventive programs 'most pragmatic to combat HIV'

By I Wayan Juniarta

NEW DELHI, India (JP): Experts and NGOs activists attending the 12th International Conference on the Reduction of Drug- Related Harm held here last April sent two urgent messages to governments all over the world.

First, injecting drug users' (IDUs') risky behavior has played an important role in the sharply increasing number of HIV/AIDS infections and transmissions; second, that prevention efforts based on harm reduction principles were the most rational and pragmatic way to avoid an HIV/AIDS catastrophe.

The December 2000 UNAIDS Report on the global HIV/AIDS epidemic stated that IDUs were the main mode of HIV/AIDS transmission in seven regions, including South East Asia, of ten regions surveyed.

In that single year an estimated 5.3 million new HIV infections occurred, 95 percent of which took place in developing countries. Furthermore, during that period more than 6,500 young people aged 15 to 24 became infected with HIV every day, about five people every minute. And HIV/AIDS-associated illnesses caused the death of approximately 3 million people worldwide, including an estimated 500,000 children.

At the end of 2000, an estimated 36.1 million people worldwide -- 34.7 million adults and 1.4 million children under 15 years old -- were living with HIV/AIDS.

The close relationship between IDUs and AIDS has actually been known about for years. Various discrete research carried out in numerous countries all over the world confirmed that HIV/AIDS recently took only several months to infect 40 percent to 70 percent of the total population of IDUs in one area.

"In 1992, HIV among IDUs was reported in 65 percent of countries where injecting drug abuse was known to occur; this increased to 80 percent in 1998, and 84 percent in 1999. We have therefore witnessed a jump of 20 percent in the occurrence of HIV among countries reporting injecting drug abuse, which underscores the need for preventative activities to start early, before an epidemic takes hold," Associate Professor of Johns Hopkins University, Steffanie Strathdee PhD stated.

"So here we are not only talking about IDU-to-IDU transmission, but also IDU-to-non-IDU, be it their sexual partners or their offspring. So, the notion that the HIV/AIDS explosion among IDUs is an isolated phenomenon, and will not affect the general public, is not only totally unacceptable, but also scientifically incorrect," a researcher at the prestigious Macfarlane Burnet Center, Gary Reid pointed out.

To be able to contain this explosion, many experts believed that the implementation of a full-scale harm reduction program, namely the Needle Exchange Program (NEP) was the most realistic way.

"But actually you need to start this program early before you have the problem (of explosion). Because one you have this problem, it can spread like wildfire. Take for example what happened in Manipur, India, where in 1998 only 10 percent of the IDU population was infected with HIV/AIDS, but the percentage soared to 80 percent in 1999," Strathdee said.

Yet, she also noted that in Asia the response to the HIV/AIDS explosion among IDUs was too little, too late. Government support had not reached the expected level yet, and most of the work was carried out by non-governmental organizations (NGOs).

"Even the idea of teaching the drug users how to clean and sterilize their own needles was met with heavy resistance and prejudice, let alone an idea of a government-sponsored NEP," an Indonesian NGO activist noted.

Thus cultural, religious, and legal barriers have made the introduction of NEP, especially in Asia, very difficult, if not impossible.

"We should look at NEP from a public health perspective, instead of from a moral or religious one. It is not only about protecting drug users but also about protecting their families, wives and offspring, and in the end protecting the whole community," she highlighted.

Recently, she said, NEP only existed in less than half the countries reporting HIV/AIDS among IDUs.

Besides NEP the drug substitution program was another alternative solution based on harm reduction principles. The program provided orally-taken drugs, such as methadone and buprenorphine, and in doing so encouraged the users to stop injecting at all. This substitution program proved quite successful in Australia and India.

Like it or not, in Indonesia, the NEP and drug-substitution program must be given thorough consideration: the number of people living with HIV/AIDS had reached 52,000 by 1999, and HIV/AIDS-related deaths in that single year reached 3,100, while 1 percent - 2 percent of the total population were active IDUs, and around 70 percent of IDUs were regularly sharing needles.

"We must immediately launch a pilot harm reduction program, and at the same time also immediately acknowledge the problem and develop the necessary policy instruments, reviewing and improving the law, such as the law that prohibits pharmacists from selling syringes and needles to unauthorized personnel," said Irwanto PhD of Atma Jaya University.

But, before these programs can be implemented at all, the greatest challenge the Indonesian NGOs and government must face is not the lack of funds or limited manpower, but the suspicion and prejudice against drug-users that exists among the general public. The prejudice and suspicion that somehow, in their mind, drug users or people with HIV/AIDS are something less than human, something that must be looked down upon.