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July 2008 - International Harm Reduction Association | | | | | | | | | |
| 28th July 2008
| Network Update from the Middle East and North Africa
| In June 2007, IHRA – in partnership with the World Health Organization (WHO) and with funding from the Drosos Foundation in Switzerland – launched a new regional harm reduction network for the Middle East and North Africa, called ‘MENAHRA’. The network aims to build harm reduction capacity in the region, and is co-ordinated by a secretariat organisation in Lebanon – Soins Infirmiers et Developpement Communautaire (SIDC).
| SIDC’s secretariat role is supported by three inter-linked, sub-regional harm reduction ‘Knowledge Hubs’ that have been established across the region. In Iran, ‘KH-INCAS’ is hosted by the Iranian National Council on Addictions (INCAS) and is based in Tehran. In Lebanon, ‘KH-SIDC’ is co-ordinated by Soins Infirmiers et Developpement Communautaire (SIDC) in partnership with the Young Men’s Christian Association (YMCA), the International Management and Training Institute (IMTI) and the Lebanese AIDS Society (LAS). Finally, in Morocco, ‘KH Ar-Razi’ is the result of collaboration between ‘La Ligue de Rabat-Salé pour la Santé Mentale’ and the ‘Ar-Razi University Hospital’, and is based in Rabat- Salé.
In the last twelve months, the MENAHRA network has gone from strength to strength – developing a network ‘brand’, identifying members and partners from the region, establishing a ‘Project Management Group’ (which includes IHRA), and launching a new website – www.menahra.org – to highlight news and information on harm reduction in the region. MENAHRA and the three Knowledge Hubs have also held a series of training events and seminars for a range of audiences in all 22 countries of the region – including journalists, academics, doctors, law enforcers, prison staff, government officials, policy makers and civil society. These events have included a large-scale seminar on ‘Harm Reduction’ for about 800 participants from across Iran, a five-day training course on ‘Voluntary, Counseling and Testing for HIV’, a series of awareness and educational sessions for media agencies in Lebanon, a large press conference in Lebanon to update the region’s media on how MENAHRA was developing, an open meeting at Harm Reduction 2008: IHRA’s 19th International Conference in Barcelona for harm reduction experts from around the world to learn more about the project, and other courses in the region on issues such as harm reduction in prisons, street work, and opioid substitution treatment.
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| 25th July 2008
| Youth RISE Launch Fact Sheet for International AIDS Conference
| Ahead of the XVII International AIDS Conference in Mexico City (August 3rd to 8th 2008), the peer-led international harm reduction network for young people – Youth RISE – have launched a new fact sheet on the linkages
between HIV and AIDS, young people and injection drug use.
Youth RISE was established in 2007 with support and funding from IHRA and the UK Department for International Development (DFID). This fact sheet – available in English and Spanish – aims to highlight the evidence and issues around the global injection-driven HIV epidemic and the harm reduction responses that must be applied – especially in relation to young people. The fact sheet reminds readers of a quote from Stephen Lewis’s keynote speech at the XVI International AIDS Conference – “Harm reduction must be a central theme, it must not be an afterthought. The world has to awaken”. It also quotes the UN Secretary General’s claim that “92% of people who inject drugs in low and middle income countries have no access to HIV prevention services”.
The fact sheet – developed by Youth RISE in partnership with the World AIDS Campaign – is part of an increased focus on injecting drug use and harm reduction at the International AIDS Conference – which also includes a plenary speech from Professor Adeeba Kamarulzaman, presentations from Professor Gerry Stimson and Rick Lines, a ‘Youth Pre-Conference’ (on Friday July 31st 2008), and a ‘Youth Pavilion’ (on Tuesday August 5th 2008).
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| 22nd July 2008
| Drug User Meeting Organised for International AIDS Conference
| The Asian Harm Reduction Network (AHRN) and the Global Network of People Living with HIV/AIDS (GNP+) – with support from the International Community of Women Living with HIV/AIDS – have organised a ‘Drug User Affiliated Event’ as part of the pre-conference activities at the International AIDS Conference 2008 in Mexico City.
The event has been modelled on the International Network of People who Use Drugs (INPUD) ‘Drug User Congress’ - held each year at the IHRA conferences. The event seeks to bring together people who use drugs and people who are living with HIV to coordinate their advocacy efforts at the International AIDS Conference and beyond.
The International AIDS Conference is a huge biennial event for the release and discussion of scientific, programmatic and policy developments from around the world. As such, it is a critical platform for people who use drugs to engage and advocate with the leading professionals in this field, and offers a unique opportunity to ensure meaningful engagement and participation in the global AIDS response.
The ‘Drug User Affiliated Event’ will take place in the Fiesta Americana Reforma Hotel, Avenida Paseo de la Reforma 80, Colonia Juárez, Mexico City 06600 from 10:00 – 15:30 on Saturday 2nd August 2008. It aims to provide participants with guidance on conference logistics and access to methadone in Mexico, identify key advocacy issues to be raised and promoted throughout the conference, and link key stakeholders together through networking.
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| 22nd July 2008
| 300 NGOs Agree Declaration at ‘Beyond 2008’
| In July 2008, over 300 NGOs from around the world – including IHRA – met in Vienna for Beyond 2008 - A Global Forum on the 1998-2008 Review of the United Nations General Assembly Special Session on Illicit Drugs. The purpose of the Forum was to develop, by consensus, a civil society declaration and three resolutions for submission to the Commission on Narcotic Drugs (CND) and the United Nations Office on Drugs and Crime (UNODC) as part of the ongoing UN review process on drug policy that will conclude in 2009.
The Forum opened with reports from nine regional NGO consultations that had taken place over the two years leading up to the global Vienna meeting. Harm reduction and the need for expanded access to harm reduction interventions received support from NGOs in all nine regions. The need to prioritise human rights was also emphasised in a number of the regional reports, as were concerns that a focus on supply reduction and enforcement has produced unintended negative consequences (such as barriers to implementing harm reduction programmes and an imbalance in funding between enforcement approaches and health-based approaches).
Despite this broad support for harm reduction in the regional reports, however, the issue remained controversial in the Vienna meeting – due mainly to a small but vocal contingent of primarily US-based anti-drug NGOs at the meeting who consistently opposed references to harm reduction and the participation of people who use drugs. However, after numerous side-discussions between the pro-harm reduction and anti-harm reduction organisations, the Forum agreed that statements that included 'harm reduction' should be developed and adopted. As a result, the term 'harm reduction' was successfully added to the resolutions in many places as the text evolved.
In the end, and after much effort and compromise, the Forum concluded by approving the declaration and resolutions by consensus on July 9th 2008, with the final text containing strong harm reduction and human rights language. The declaration and resolutions have now been formally submitted to the Chair of the 52nd session of CND, the President of the International Narcotics Control Board (INCB) and the Executive Director of UNODC. The ‘Beyond 2008’ civil society consultation was an ambitious and complex project, organised by the Vienna NGO Committee on Narcotic Drugs to demonstrate that NGOs around the world – despite differences in opinion – can meaningfully and democratically contribute to UN processes and the review of the international drug control system.
|  Click here to view the Beyond 2008 declaration and resolutions [PDF:192KB]
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| 22nd July 2008
| July 2008 Article of the Month
| Schottenfeld RS, Chawarski MC & Mazlan M (2008) Maintenance treatment with buprenorphine and naltrexone for heroin dependence in Malaysia: A randomised, double-blind, placebo-controlled trial. The Lancet, 371(9631), 2192-2200.
| This paper reports the results of a randomised controlled trial of 126 detoxified heroin-dependent patients in Malaysia, and directly compares three treatment options - naltrexone, buprenorphine, and a placebo. The results clearly demonstrated the significant effectiveness of buprenorphine compared to placebo in terms of a range of outcomes (including ‘days in treatment’, ‘days in treatment without heroin use’, ‘days in treatment without heroin relapse’ and ‘maximum consecutive days abstinent’). In fact, the superiority of buprenorphine over the other treatment options was so marked that the study was terminated after only 22 months (when 70% of the participants had completed their six month courses). Predictably, the outcomes were worst for placebo, although the differences between naltrexone and the placebo were not statistically significant. For all three treatment options, drug-related HIV risk behaviours were significantly reduced after the study, with no significant differences between the treatments.
This study is particularly important due to its setting, as it is one of very few major, high-quality scientific studies conducted in the developing world in order to demonstrate the effectiveness of harm reduction interventions. It was also one of the first Malaysian studies to directly compare opiate ‘agonist’ treatments (direct substitutes for street heroin – such as buprenorphine) as opposed to opiate ‘antagonist’ treatments (which deter street heroin use rather than replacing it – such as naltrexone). On the basis of their findings, the authors claim that the “expansion of access to effective treatments for heroin dependence is a worldwide health priority”, and recommend the widespread dissemination of buprenorphine maintenance treatment in developing countries to reduce the problems associated with heroin dependence.
According to IHRA’s recent Global State of Harm Reduction report, there are an estimated 195,000 injecting drug users in Malaysia, with an adult HIV prevalence amongst this group of between 10% and 40% (there was a HIV prevalence of 22% reported amongst the participants in this particular study – and a prevalence of 95% for hepatitis C). Despite this, however, key opiate medications are currently illegal in the country (and many other countries in the region) and treatment programmes are limited. This issue of the Lancet also includes an accompanying editorial comment by Wayne Hall & Richard Mattick (pages 2150 – 2151), which recommends that prudent health authorities in developing countries such as Malaysia should offer methadone and/or buprenorphine as the preferred maintenance treatments (rather than providing no treatment or relying on naltrexone alone).
| Click here to view The Lancet (Volume 371, Number 9631)
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| 22nd July 2008
| UNODC Launch Harm Reduction Programme in Romanian Prisons
| The ‘National Administration of Penitentiaries’ and the UNODC country office in Romania have launched a programme of evidence-based harm reduction, HIV prevention services for people who inject drugs in prison. The move comes after it was revealed that nearly 7.5% of the Romanian prison population use drugs, with the number of inmates declaring their drug use prior to detention having doubled in the last five years.
The harm reduction programme - initially launched in three Romanian penitentiaries – includes the provision of opiate substitution treatment and the distribution and exchange of injecting equipment. The programme is being implemented through inmate peer educators (under the co-ordination of the medical and social department), and is fully supported by the prison management teams, staff and inmates. A co-ordination team has also been established to provide specific harm reduction training for all involved, develop working protocols for the new services (outlining the roles and responsibilities of those delivering services, and the rights and responsibilities of the service users), and facilitate networking with existing harm reduction programmes in the community.
In the global efforts against HIV and hepatitis C, the provision of harm reduction services is particularly important for people who use drugs in prison. According to IHRA’s Global State of Harm Reduction report – launched in May 2008 – “HIV prevalence among prison populations is typically higher than that found in the population outside of prisons”, probably due to the global “incarceration of significant numbers of people who use drugs”. In closed settings, and with limited access to services such as needle exchanges and opiate substitution treatments, many prisoners will continue to inject or use drugs and will therefore engage in high-risk behaviours and practices.
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| 8th July 2008
| Harm Reduction 2009 Website Launched
| IHRA and the Conference Consortium are pleased to launch the new website for ‘Harm Reduction 2009: IHRA’s 20th International Conference’, which is scheduled to take place from 19th to the 23rd April 2009 at the Queen Sirikit National Convention Centre in Bangkok, Thailand. The website – www.ihraconferences.net – will be updated regularly over the next ten months and is the first port of call for any information and enquiries about the event itself.
The registration system for the conference will open in the summer of 2008 – alongside the abstract submission system and information about delegate fees and accommodation. In the meantime, the conference website contains lots of information about the event and visitors can also sign-up for the Harm Reduction 2009 e-newsletter to ensure that they keep up to date with the latest conference news and announcements.
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| IHRA’s harm reduction conferences (formerly known as the ‘International Conference on the Reduction of Drug Related Harm’) have been held around the world each year since 1990. They have become key events for the harm reduction field and have helped to put harm reduction on the map and to coordinate advances, innovations, evidence and advocacy in this field. The conference website also features an archive of the previous 19 conferences in this series. This archive is a work in progress and will eventually contain overviews, presentations, photos and reports from every conference since 1990.
The Previous Conferences archive also contains resources from the most recent event – Harm Reduction 2008 in Barcelona, Spain. This conference attracted over 1,200 delegates from around 80 countries, and the archive page includes over 100 presentations from the five days, as well as news, reports, conference resources and photos.
Year on year, the numbers of delegates submitting abstracts and attending the IHRA conferences continues to grow, as does the event itself in terms of scope and impact. Please circulate the conference website address – www.ihraconferences.net – to your colleagues and contacts to ensure that Harm Reduction 2009 is bigger and better than ever! IHRA aim to make the conference website as accessible and user-friendly as possible, and would like to hear from you if you have any feedback.
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| 8th July 2008
| International Drug User Remembrance Day
|  On July 21st each year, drug user organisations and advocates around the world host events and meetings to remember peers and colleagues who have passed away. The Remembrance Day has become a unique opportunity for a wide range of different organisations to come together and focus on people who use drugs and promote the prevention of drug-related deaths as an essential public health and human rights issue around the world.
The first Remembrance Day was organised in Germany a decade ago (July 21st 1998) by a group of parents and relatives who had lost loved ones as a result of drugs. They wanted to raise awareness of their losses, of the difficulties and dangers facing people who use drugs, and of the need for changes in drug policies in order to protect their health and human rights. July 21st was chosen as, in 1994, this was the date when Ingo Martens – a young drug user from Germany – died. After her death, her mother decided to make an unprecedented stand against the repressive German drug policies of the time.
Since 1998, with the support of drug user organisations, drug treatment services, HIV/AIDS organisations and parent groups, the Remembrance Day developed from a series of small local meetings into the largest country-wide action day for people who use drugs. It also grew from a day of mourning into an opportunity for awareness building, activism and political lobbying – with demonstrations organised each year to highlight a key theme such as drug decriminalisation, substitution treatments or needle and syringe exchanges in prisons.
In the last few years, the Remembrance Day has also grown beyond the German borders and become an international occasion – with events in Australia, Belgium, Canada, Denmark and Switzerland (to name a few). For example, on July 21st 2007 in Vancouver, Canada, over 100 members of the Vancouver Area Network of Drug Users (VANDU) gathered and carried a symbolic coffin into Oppenheimer Park for a remembrance ceremony, which included poems and speeches from people who use drugs and politicians.
In Germany, International Drug User Remembrance Day 2008 will be used to urge the Government to change the law and allow diamorphine (pharmaceutical heroin) to be prescribed as a normal medication to those in need. It is anticipated that more than 40 German cities will arrange events, with over 150 different organisations involved. In Berlin, for example, a tree planting will take place and a memorial plaque will be installed in order to commemorate the drug users who have died as a result of inhumane living conditions, insufficient treatment, and drug prohibition in Germany.
In the UK, Black Poppy and partners are organising an event for July 21st 2008 in Kennington Park, London (2pm – 4pm) to remember those who have died as a result of illicit drugs and alcohol, and to raise awareness of overdoses, overdose prevention and the harms associated with repressive drug policies. The event will include a presentation by Rick Lines, IHRA’s Senior Policy Adviser, poetry readings, and other tributes.
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| 4th July 2008
| Overdose Awareness Day 2008
| Each year on the 31st of August, people are invited to remember those who have died or are suffering permanent injury from drug overdoses. In Australia, silver badges are distributed to those who wish to acknowledge the day and show their support, understanding, and commitment to lower stigma and create global awareness of overdose from both licit and illicit substances. Since 2000, calls for better harm reduction policies and services – including supervised injecting facilities – have gone hand-in-hand with the activities and rhetoric expressed in the lead up to this important day.
For the last eight years, organisations and individuals around the world have arranged events and ceremonies to acknowledge the loss and grief associated with the drug-related overdose of a loved one. Different groups may choose to mark the occasion in different ways – from simple tree plantings, candle lightings and tribute readings, to larger marches and banner signings. For many individuals, participation in Overdose Awareness Day can be as simple as distributing crucial educational information to people who use drugs, spending time talking to those affected, or just wearing a badge to show their support. Regardless of the size of the event, however, awareness about drug-related overdoses continues to build year-on-year, both in communities and amongst politicians and policy makers.
Research on drug use around the world demonstrates the importance of overdose prevention, education and removing the stigma associated with death or injury from overdose. For a parent, child, life-partner, friend or sibling this has always been the case and is the reason why Overdose Awareness Day holds so much significance. For the people who use drugs, this event shows them that people care, which is helpful in reminding them to take care of themselves.
To launch Overdose Awareness Day 2008 in Australia, the Hon. Jenny Macklin (the Federal Minister for Families, Housing, Community Services and Indigenous Affairs) has accepted an invitation to attend a special event organised by The Salvation Army, who are also encouraging people to post a tribute to people that they have lost through overdose on their website.
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| 3rd July 2008
| Conference Addresses Global Methamphetamine Use
| The use of methamphetamines and other amphetamine-type stimulants (ATS) is spreading on a global basis, and there is an emerging consensus among experts that such stimulant use is a unique and complex problem that presents significant challenges to existing harm reduction approaches. In September 2008, the 1st Global Conference on Methamphetamine will provide an arena for the world’s foremost harm reduction scientists, advocates and professionals to come together and discuss how harm reduction must adapt to this phenomenon. The conference is the first event of its kind and will take place in Prague (Czech Republic) on the 15th and 16th September.
Research has shown that methamphetamine use is widespread and well-established in North American, Australasia, and parts of Asia. There are also a number of emerging markets or areas of perceived risk, such as India, Pakistan, Eastern Europe, Western Europe the Russian Federation, and Sub-Saharan Africa. According to estimates by the United Nations Office of Drugs and Crime (UNODC) and the World Health Organization (WHO), more individuals worldwide now use these stimulant drugs than opiate drugs and cocaine combined. IHRA’s ‘Global State of Harm Reduction’ report states that, globally, there are 26 million people who regularly use these amphetamine-type stimulant drugs.
Despite this, however, the development of appropriate and effective harm reduction responses to stimulants is lagging. In most cases, harm reduction services are inappropriately modeled on those for drugs such as opiates and alcohol treatment - ignoring the important differences between these substances and methamphetamines in terms of both the physical properties of the drug itself, and the fact that the typical patterns of use vary widely. In order to be effective, harm reduction responses for methamphetamine must be tailored to the unique needs of regions, cultures, and individual users.
Globally, a lack of funding, research, capacity, infrastructure, and experts trained specifically in methamphetamine responses, compounds the problem further. As nations struggle to develop appropriate responses to methamphetamine, it is crucial that the most current scientific research, information, and best practices be available to those seeking to implement solutions. The primary goal of the ‘1st Global Conference on Methamphetamine’ is to provide a context against which this important work can take place.
This conference is a collaboration between the Czech Republic, Charles University, the City of Prague, Cranstoun Drug Services, Network Environmental Systems, and The Thorne Group. It will take place in Prague’s historic City Hall, with speakers and delegates attending from more than 20 nations. Delegates will have access to over fifty panel, breakout, and plenary sessions - and the unique opportunity to interact with local, national and international organisations, researchers, service providers, advocates, activists and professionals.
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