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Asia - Regional Overview
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Significant developments in policy and practice in parts of Asia have signalled a shift towards harm reduction in recent years. Over half the countries in this region now have some form of needle and syringe programme (NSP) provision and are prescribing opioid substitution therapy (OST) of some sort. However, coverage remains far below levels necessary to have an impact on HIV epidemics. A lack of supportive legal and policy frameworks in many countries further impedes the harm reduction response. Several states prohibit possession and/or provision of needles and syringes, methadone and/or buprenorphine. Drug use is highly criminalised in many Asian countries and over half of Asian countries retain the death penalty for drug offences. Despite a large proportion of prison populations being people who use drugs, no Asian prisons have NSP and only India, Indonesia and Malaysia provide very limited OST to prisoners.
Another key element of the response to drug use in Asia are compulsory ‘drug treatment’ centres, often characterised by arbitrary detention without due process of law, followed by forced detoxification and forced labour. In some countries, entry into OST programmes is dependent on having spent a number of months in such a facility. Reports from numerous countries document a range of human rights concerns related to inadequate health care in compulsory drug treatment centres. For example, lack of access to anti-retroviral treatment (ART) for detainees has been reported in compulsory ‘treatment’ centres in China, Malaysia, Cambodia and Vietnam. Forced or involuntary testing for HIV of persons in compulsory ‘treatment’ centres has been reported in China, Malaysia and Vietnam.
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Injecting Drug Use, HIV and Hepatitis C
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The following maps and table outline the current available data on injecting drug use, as well as the prevalence of HIV and hepatitis C among injecting populations in Asia.
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The map below illustrates HIV prevalence among injecting drug users in countries and territories of the region.
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The map below illustrates hepatitis C prevalence among injecting drug users in countries of the region.
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The following table provides the latest estimates of HIV and hepatitis C prevalence within injecting populations, as well as the estimated total number of injecting drug users in countries and territories of the region.
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Countries/territory with reported injecting drug use
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| | Adult HIV prevalence amongst people who inject drugs**
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| Adult HCV prevalence amongst people who inject drugs***
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*Mathers, B. et al. Reference Group to the United Nations on HIV and injecting drug use (2008)
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The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet 2008, Volume 372.
**Mathers, B. et al. Reference Group to the United Nations on HIV and injecting drug use (2008) The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet 2008, Volume 372.
***Cook, C & Kanaef, N (2008) The Global State of Harm Reduction: Mapping the global response to drug-related HIV and hepatitis C epidemics. International Harm Reduction Association, UK
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Harm Reduction Policies
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Many Asian countries have an explicit supportive reference to harm reduction in their national policies on HIV and/or drugs. These are illustrated in the map and table below.
Although policy wording is not necessarily indicative of the implementation of effective harm reduction measures in a country, it does indicate governmental commitment to tackling drug related harms and is therefore an important advocacy target.
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| Explicit reference to harm reduction policies in official documents*
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*International Harm Reduction Association (March 2009) Harm Reduction Policy and Practice Worldwide: An overview of national support for harm reduction in policy and practice [PDF:2.59KB]
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Harm Reduction Programmes
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Key harm reduction interventions (including needle and syringe exchange and opioid substitution therapy) are available in over half the countries in this region, as illustrated in the maps and table below. Crucially however, coverage is extremely low in the majority of countries. Most have fewer than ten sites where people can obtain sterile injecting equipment and very low numbers accessing methadone or buprenorphine as substitution therapy.
In addition, the lack of supportive legal and policy frameworks present a substantial barrier to effective harm reduction implementation exist in this region.
Drug use is highly criminalised in many Asian countries and over half of Asian countries retain the death penalty for drug offences. Despite a large proportion of prison populations being people who use drugs, no Asian prisons have needle and syringe programmes and only India, Indonesia and Malaysia provide very limited opioid substitution therapy to prisoners.
The following table indicates which countries have a) one or more needle and syringe exchange sites operational both in and outside prisons, b) prescription of opioid substitution therapy for maintenance in and outside of prisons c) one or more drug consumption rooms in countries of the region.
A tick in this table does not indicate the scope, quality or coverage of services. Also it should be noted that in some countries, harm reduction services, NSP in particular, are NGO-driven and may be operating without governmental support.
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*International Harm Reduction Association (March 2009) Harm Reduction Policy and Practice Worldwide: An overview of national support for harm reduction in policy and practice [PDF:2.59KB]
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The map below shows which countries have operational needle and syringe programmes and opioid substitution therapy programmes.
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The map below shows which countries have prison-based needle and syringe exchange programmes and opioid substitution therapy prescription.
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