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Invitation to tender for Harm Reduction organisations in Latin America
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The International Harm Reduction Association would like to invite Latin American organisations working on Harm Reduction to consider applying for the tender detailed below.
A recent grant from the UK Department for International Development has enabled IHRA to begin a new global harm reduction research and advocacy project. It will enhance the capacity of both IHRA and that of partner organisations to advocate for a harm reduction approach to preventing the spread of HIV/AIDS in drug using populations. The aim of the programme is to ensure that multilateral agencies such as the UN system, the EU, and major donors have in place, and implement, policies and programmes which promote and support harm reduction interventions, delivery and best practice at international, regional and national levels.
IHRA has agreements with regional networks in Asia, Central and Eastern Europe, Middle East and North Africa and the Caribbean, as well as an agreement with the International Network of People who Use Drugs (INPUD) to collaborate on the project. IHRA is now seeking the collaboration of harm reduction organisations in Latin America in this new venture.
Please click on the link below for full details on the project and how to apply. The deadline for applications is Saturday 14th July 2007.Submissions to be emailed to Catherine Cook at the International Harm Reduction Association.
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 Please click for full details on the project and how to apply [PDF: 110KB]
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Boost for Drug Consumption Room in Australia
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Australia’s only drug consumption room (DCR) facility has received a major boost in July, when the New South Wales Health Minister Reba Meagher introduced legislation to extend its trial status for another four years.
The Medically Supervised Injecting Centre (MSIC) has been open for six years, operating on temporary licenses, the latest of which was due to end on October 31st 2007. The decision to extend follows a report by the National Centre in HIV Epidemiology and Clinical Research, which concluded that the MSIC reduced the impact of overdose related events, instances of public injecting and community visibility of injecting drug use. The facility has dealt with over 10,000 visitors – mainly heroin users but with about 6% using it for methamphetamine – and has referred over 1 in 10 of these into drug treatment and provided treatment to over 2000 overdose cases.
According to Dr Ingrid van Beek, the MSIC Medical Director, "There is no doubt that if those cases had occurred in unsupervised, less safe situations, which they otherwise would have, that some of those cases would have resulted in death". The facts speak for themselves – there have been no fatalities or cases of serious brain or vital organ damage from overdose at the centre.
Additionally, the report discredits widespread concerns that the facility would create a ‘honey pot effect’ and attract drug users and drug dealers to the Kings Cross area. Despite the evidence, however, the new legislation stopped short of granting a permanent license following legal advice that if it was not regarded as a part-time medical trial, it could be challenged in the High Court using two United Nations anti-drug conventions that Australia had signed. In addition, the MISC will be reviewed and possibly closed in the future if demand for its services falls below 75 per cent of the current daily levels (over 200 visitors a day). However, Ms Meagher added, "This is considered part of our harm reduction strategy in a multi-faceted approach in dealing with drug abuse in our community".
This positive news from the Southern Hemisphere is in sharp contrast to the situation faced by ‘Insite’ in Canada. Despite overwhelming scientific evidence in its favour and a recent declaration of support from Vancouver City Council, this facility is facing closure by the Conservative Canadian Government and has been subject to a prolonged discrediting campaign by Drug Free America and its new magazine – the Global Drug Policy Journal. To show your support for ‘Insite’, please visit www.communityinsite.ca.
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Boost for Needle Exchanges in the USA
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In a landmark decision from the USA in June 2007, the state of California has recently announced that it will provide direct state funding to needle and syringe exchange programmes. A grant of $2.25US million has been awarded by the HIV Education and Prevention Services Branch of the Office of AIDS, which will fund ten programmes for three years.
The needle and syringe exchange programmes will be run by community-based organisations and local health jurisdictions. It is a massive development for the USA, where harm reduction services have often had to rely on charitable funds, international donors and individual and corporate donations.
However, bizarrely, Californian laws still prevent state funding being spent on needles and syringes themselves! In fairness, the needles themselves are one of the smallest costs for a needle exchange and this funding will be spent on improving access to services by increasing operating hours, and adding new locations, staff, and outreach workers. In addition, the money will be spent on purchasing materials other than needles and syringes, improving the pay and conditions for existing staff, and providing new services (such as testing for HIV and hepatitis, referrals into medical care, and wound care).
According to Hilary McQuie from the Harm Reduction Coalition, "This funding represents a positive sea change in terms of support for needle exchange in California. However, there are over 30 other needle and syringe programmes that don't get any state funding and courageously survive on a shoestring”. In California, sharing contaminated injection equipment accounts for one in five new AIDS cases and more than 1,500 new HIV infections annually.
Elsewhere in the USA, a congressional ban on funding for needle exchanges in Washington DC is close to being lifted. "The moment may have come. The stars may have aligned," said Walter Smith - Executive Director of the DC Appleseed Center for Law and Justice. In Washington DC, intravenous drug use accounts for about one-third of new AIDS cases annually.
Across the USA, there are more than 210 needle and syringe exchange programmes in place across 36 states. About half of these currently receive local or state funding according to the North American Syringe Exchange Network, with the other half having to scrape around for less reliable funding sources.
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IDPC Launch New Position Papers
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The International Drug Policy Consortium (IDPC) launched its first position papers this month – covering three of the five ‘Policy Principles’ that the group has agreed to promote in advocacy work with governments and international organisations. The IDPC is a global collaboration of NGOs and professional networks that specialise in issues related to illegal drug production and use – including IHRA.
The IDPC aims to promote objective and open debate on the effectiveness, direction and content of drug policies at national and international level, and supports evidence-based policies that are effective in reducing drug-related harm. It disseminates the reports of its member organisations about particular drug-related matters, and offers expert consultancy services to policymakers and officials around the world.
In March 2007, the IDPC announced the five ‘Policy Principles’ that they would promote. These principles are that:
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1. Drug policy decisions should be more informed by the best available evidence;
2. Drug policies should shift focus and priority from reducing the scale of the drug market, to reducing its negative consequences;
3. Efforts to reduce the supply of drugs should not focus on the punishment of growers;
4. Efforts to reduce the demand for drugs should not focus on the punishment of users;
5. The UN system should develop a more co-ordinated and cohesive approach to drug policy issues.
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Click here to view the IDPC Policy Principles in English
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Click here to view the IDPC Policy Principles in Spanish
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Click here to view the IDPC Policy Principles in French
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In June 2007, the group released their agreed position papers for Policy Principles 2, 3 and 5. Each of these expands on the principle itself and outlines the arguments and evidence on which the IDPC position is based. The first paper explains the rationale for a refocusing of high-level drug policy objectives. The second paper outlines how programmes that criminalise the cultivation of illicit crops are ineffective and counterproductive compared to source-country strategies that focus on development and poverty reduction. The third paper describes the many ways in which the current UN system for dealing with problems related to illegal drugs is incoherent, and sets out suggestions on how the system could become more co-ordinated and effective.
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Click here to view “IDPC Position Paper: Drug policy objectives should increasingly focus on the consequences of drug use.”
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Click here to view “IDPC Position Paper: Efforts to reduce the supply of drugs should not focus on the punishment of growers.”
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Click here to view “IDPC Position Paper: The UN system should develop a more co-ordinated approach to drug policy issues.”
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In addition to these reports, the IDPC website also includes links to all of its members documents and resources. Please visit www.idpc.info for more information.
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Response Beyond Borders
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The ‘Asian Consortium on Drug Use, HIV, AIDS and Poverty’ is organising a major harm reduction event in Asia – “Response Beyond Borders: The First Asian Consultation on the Prevention of HIV Related to Drug Use”. The Consortium is a voluntary network of prominent national and international organisations and service providers in Asia – including the Asian Harm Reduction Network (AHRN) and the International Network of People who Use Drugs (INPUD). Their main objective is to engage with decision makers from Asia (such as key figures in terms of drugs policy and law, international and regional donor organisations, and corporate partners). The event will review the existing gaps and shortcomings in Asian drug strategies and policies, and present viable and effective solutions to prevent and manage HIV among drug using populations.
Asia is facing an epidemic of HIV and AIDS driven primarily by unsafe injecting drug use practices. This consultation event is the result of an increasing acknowledgement by all sectors working with HIV and drug abuse that new thinking is required to develop sufficient and effective responses to the impact of HIV within injecting drug use communities. An Asian context will bind the consultation together, creating a framework for dialogue, debate, and consensus. Attendees at this event will include key politicians, policy makers, practitioners, managers and frontline workers from national HIV/AIDS programmes, drug control agencies, NGOs, international donors, UN agencies, and drug using communities from across the continent.
The event will be held from the January 28th - 31st 2008 at the Kala Academy in Panaji, Goa. For more details (such as registration and abstract submission), please visit the conference website www.responsebeyondborders.com.
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Conference Videos and Media Projects
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During the highly successful 18th International Conference on the Reduction of Drug Related Harm, there were a number of groups compiling video diaries and web logs about the event. Many of these diaries, including interviews with many of the key presenters at the conference, are now available online.
The Hungarian Civil Liberties Union (HCLU) is a non-profit human rights watchdog NGO from Budapest. It was established in 1994 with the goal of building and strengthening the civil society and rule of law in Hungary and across Central and Eastern Europe. During the conference, the HCLU cameras captured interviews with several key delegates – including Annette Verster (World Health Organization), Ethan Nadelmann (Drugs Policy Alliance, USA), Stijn Goossens (International Network of People who Use Drugs), Mauro Guarinieri (International Harm Reduction Development programme), as well as Alex Wodak and Danny Kushlick from the IHRA Executive Committee.
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Click here to view the HCLU Videos and Reports
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From the UK, Erin O’Mara – Editor for 'Black Poppy Magazine’ - has documented the experiences of a group of 12 UK drug user activists who were funded to attend the conference by the National Treatment Agency for Substance Misuse (NTA). This web log includes information on the ‘Free Hemp Rally’ in Warsaw before the conference, as well as interviews with the UK group, Milena Naydenova (International Network of People who Use Drugs), and Marianna Iwulska (Liberation, Poland) – who submitted a petition with signatures from over 400 delegates to Zbigniew Religa (the Polish Minister of Health) calling for the scaling-up of methadone treatment in Poland.
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Click here to view the Black Poppy ‘blog’
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Finally, a series of videos have also been made by Dinamo - a Brazilian NGO created to contribute to the debate about the production, distribution and use of psychoactive substances. These videos are in Portuguese, and include interviews with Diane Widdus (UNICEF), Simon Baldwin (Centre for Harm Reduction), Marjana Martinic (International Center for Alcohol Policies) and Jamie Bridge (IHRA).
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Click here to view the Dinamo videos
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Many of these videos are also featured on the International Network of People who Use Drugs web log at http://artcoreharmreducer.blogspot.com
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Delegate Feedback from the IHRA Conference
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The 18th International Conference on the Reduction of Drug Related Harm took place in May 2007 and was attended by over 1,200 delegates from 89 countries. Over 100 feedback forms were received at the end of the conference (in English and Russian) and these have been analysed to help IHRA and the Conference Consortium identify the strengths and weaknesses of the event in order to make ‘Harm Reduction 2008’ (11th – 15th May 2008, Barcelona) an even better conference.
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Conference Strengths
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The majority of delegates who completed feedback forms enjoyed their conference experience. Overall, the delegates had a lot of praise for the conference programme, which included over 70 sessions and 300 oral presentations covering a wide range of topics. As the table below demonstrates, the vast majority of delegates either ‘Agreed’ or ‘Strongly Agreed’ that the “the session topics were well chosen and relevant”, “the speakers were knowledgeable and informative”, the “topics were covered in sufficient detail”, “there was enough time in sessions for questions and discussion”, “the sessions and topics were useful for my work”, and that they had “gained new knowledge about harm reduction” at the conference.
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In addition, many of the feedback forms praised the conference for the networking opportunities and the diversity in attendees (both in terms of professional background and nationality) – and 85% of delegates either ‘Agreed’ or ‘Strongly Agreed’ that they had “made new contacts with harm reduction colleagues” at the conference. The organisational logistics provided by the Conference Consortium were also highly rated – including the printed materials, registration system, social events and staff.
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Successful Sessions
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On the feedback forms, delegates were asked to list the ‘most valuable’ sessions which they attended, and certain sessions clearly stood out:
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- ‘Regulatory Frameworks: Alcohol, Tobacco and Illicit Drugs’ - the final day plenary session featuring Mark Haden and Dave Sweanor
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- The sessions on drug user involvement - including the ‘Users Choice’ major sessions organised by the International Network of People who Use Drugs
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- ‘Opiate Substitution Therapy in Eastern Europe’ – organised by WHO Europe
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- The sessions on sex work harm reduction - supported by the Open Society Institute’s Sexual Health And Rights Project (SHARP)
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- The plenary and major sessions on harm reduction in prisons
- ‘Involving Law Enforcement in Harm Reduction’
- ‘National Drugs Policies’
- ‘Harm Reduction and Ethics’
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Sessions Ideas for 2008
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Many of the feedback forms included suggestions for sessions in next year’s conference (‘Harm Reduction 2008’; 11th – 15th May 2008 in Barcelona). Common ideas were for sessions on legalisation versus prohibition (and possibly repeating the session from Warsaw on regulatory frameworks), harm reduction in resource-limited settings (such as the developing world), harm reduction for non-injecting drug use (such as recreational stimulant use, alcohol, cannabis, tobacco and ‘party drugs’), harm reduction education for young people, and more regionally-focussed sessions.
Additionally, many delegates would like to see more interactive, participatory sessions at the conference (such as workshops and debates), as well as more innovative, visionary presentations. We would like to thank all of the delegates for their suggestions, which have been recorded for the Executive Programme Committee to consider for 2008. This conference, however, relies heavily on the abstracts that are submitted by researchers, practitioners, advocates and people who use drugs. If you have a pioneering service or news on any new developments in the field, we would encourage you to submit an abstract for 2008 (the abstract submission process will be open from August to mid-November 2007).
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Room for Improvement
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As with any international conference on this scale, there is room for improvement for ‘Harm Reduction 2008’. Since the conferences began in 1990, they have grown steadily in size, scope and impact – and they will continue to do so for the foreseeable future. In terms of conference weaknesses, there were several themes in the feedback forms – including the venue location, service and facilities, the amount of time for questions and answers in each session, the perceived absence of governmental officials and the UN Office on Drugs and Crime, and the harm reduction services provided for drug user delegates. Again, all of these comments have been recorded and taken on board and we will do our up-most to address these in time for May 2008.
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July 2007 Article of the Month
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Leon DA, Saburova L, Tomkins S, Andreev E, Kiryanov N, McKee M & Shkolnikov VM (2007) Hazardous Alcohol Drinking and Premature Mortality in Russia: A population based case-control study. The Lancet, 369, pages 2001-2009.
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This article reports on hazardous drinking in Russia and its role in the low life expectancy for Russian men. In particular, it explores the high-risk behaviour of drinking alcoholic products that are not designed for human consumption (such as perfumes, cleaning products, and aftershave lotions) – referred to as “non-beverage alcohol”. The authors examined case notes and interviewed the families and friends of 1,750 Russian men who had died aged 25-54 years (and compared results against a similar sized group of living Russian men in the same age bracket). Their results revealed that over half of the deceased men were either problematic drinkers or were reported to have drunk non-beverage alcohol prior to their deaths (compared to just 13% of the control group). The authors went on to calculate that men who had drunk non-beverage alcohol in the last year were more than 9 times more likely to die than those that had not.
This article clearly demonstrates that the consumption of non-beverage alcohol is a serious problem for Russia and is a likely contributing factor in the sharp fluctuations seen in Russian mortality over the last two decades. The authors, however, do not go on to speculate why this behaviour may be so widespread in Russia – a country which has had a long-running, complex relationship with alcohol and which has seen a great deal of social, economic and political change in the last decade. In the 1980s, President Mikhail Gorbachev launched a population-level anti-alcohol campaign – including a sudden and sharp rise in alcohol taxation, sales restrictions and a workplace ban – which was very successful at the time in reducing alcohol production and increasing life expectancy and the price of alcohol. However, this has since been credited with the development a burgeoning Russian black market in alcohol and may well have also opened the doors for the levels of consumption of unregulated alcohol which this article found.
The case of Russia’s alcohol problems is an extremely complex one, and the consumption of non-beverage alcohol highlighted in this article is just one contributing factor to the low life expectancy of Russian men. International alcohol policies often overlook the problems of black market, illicit, home-produced or non-beverage alcohol consumption (which “may account for as much as 50% of total alcohol consumption worldwide” according to Moruf Adelekan at the 18th International Conference on the Reduction of Drug Related Harm. There is no simple solution to this problem, and the huge complexity of trying to change drinking culture and deter high-risk patterns of alcohol consumption requires a combination of approaches encompassing population-level, supply and demand interventions alongside targeted harm reduction interventions. In Russia, as elsewhere in the world, effective alcohol policy should be the art of the possible.
This article is available to purchase on the Lancet website, where you can also register to view the article summary.
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