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24th July 2009
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July 2009 Article of the Month
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Sharma M, Oppenheimer E, Saidel T, Loo V & Garg R (2009) A situation update on HIV epidemics among people who inject drugs and national responses in South-East Asia Region. AIDS, Volume 23 (11), pages 1405 – 1413.
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Over the last year, the team at the World Health Organization South East Asia Regional Office (WHO-SEARO) has been assessing the local situation in terms of HIV transmission, people who inject drugs, and the national policy and practice responses. This paper – in AIDS, the official journal of the International AIDS Society – presents the initial results of this work from seven “high-burden countries” in the region. Drawing data from published literature, routine surveillance systems, ‘key informants’ and other sources (including IHRA), this article is a good review of the situation in Asia in terms of HIV-related harm reduction interventions such as needle and syringe programmes and opioid substitution treatments.
The study estimated that there are 800,000 people who inject drugs in the region, with HIV prevalence among this population ranging from 0% in the Maldives to over 50% in Indonesia. There were “significant epidemics of HIV” in six of the seven examined countries, with three showing “high and stagnant” levels (India, Myanmar and Thailand), two showing rising prevalence (Bangladesh and Indonesia) and just one showing a measurable decrease over time (Nepal). One possible explanation for these concerning results is the poor coverage of evidence-based harm reduction approaches. The study estimated, for example, that only around 1.5% of the region’s injecting drug users have access to opioid substitution therapy, with around a quarter reached by needle and syringe programmes. When mapped geographically, there were clear gaps and weaknesses in programme reach, which was “not always in tune with the magnitude and trends of the epidemic”. In particular, the extent of harm reduction approaches in the region’s prisons was especially poor.
This is an important paper for the region and demonstrates that, even where countries accept and endorse harm reduction in policy and/or practice, people who inject drugs must have sufficient access in order to have the desired impact on national HIV prevalence. This means that political and programmatic barriers to achieving increased coverage – including issues around funding, advocacy and civil society capacity – must be overcome. The authors conclude that “HIV epidemics among PWID [people who inject drugs] remain uncontrolled in south-east Asia. Harm reduction interventions reach too few PWID. To make a dent in the HIV epidemics among PWID, national AIDS programmes should urgently scale up OST [opioid substitution therapy] and NSP [needle and syringe programme] services to cover at least 50-60% of the population”.
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WHO-SEARO has also produced an accompanying policy brief for this study, which aims to present the key messages and themes in an even more accessible manner.
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14th July 2009
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Bangkok Conference Added to IHRA Archive
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Over the past two years, IHRA has been developing an online Previous Conferences Archive for the previous 20 international harm reduction conferences. The archive now includes resources from Harm Reduction 2009: IHRA’s 20th International Conference in Bangkok, Thailand. It includes a comprehensive overview of this highly successful event and a range of documents and information – including:
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- The conference programme
- The conference abstracts (in both a PDF book and a searchable online database)
- The ‘Daily Update’ conference newsletters (in both PDF and ‘virtual magazine’ formats)
- Around 200 PDF presentations, videos and speeches – including the keynote addresses from Professor Michel Kazatchkine (Executive Director of the Global Fund) and Craig McClure (Executive Director of the International AIDS Society)
- A review of the 2009 Film Festival
- News of the 2009 IHRA Awards
- Photos and links
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Since the ‘1st International Conference on the Reduction of Drug-Related Harm’ in Liverpool, England in 1990, these conferences have been crucial to the promotion of harm reduction research, debate and best practice around the world. To document these events (and, by extension, some of the history of harm reduction), each of the 20 previous conferences has a dedicated page in the Previous Conferences Archive containing – where possible – overviews, reports, resources and photos. There are currently completed archives from the last eleven conferences – going back to the 1999 event in Geneva, Switzerland. Further archives will be developed for the remaining events as soon as possible.
In order to maintain and develop this valuable online archive resource, we ask all IHRA members and friends to send us any information that you may have from any of the past conferences, such as photographs and presentations. If you have any information that you would like to share, please contact Jamie Bridge.
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14th July 2009
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Drug Consumption Room Releases Comprehensive Review of Evidence
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 In 2003, the Canadian Government granted temporary permission for a ‘legal operating exemption’ to pilot North America’s first ‘medically supervised injection facility’ in Vancouver. The facility was called Insite, and the legal exemption was granted to allow rigorous and robust scientific evaluation of what remains a controversial harm reduction intervention.
Since 2003, the evaluation team at the University of British Columbia’s Department of Medicine and the British Columbia Centre for Excellence in HIV/AIDS have published a large number of peer-reviewed, scientific papers in some of the most prestigious scientific journals – including the New England Journal of Medicine, The Lancet, the British Medical Journal, and the International Journal of Drug Policy. Their research has demonstrated, for example, that ‘Insite’ has had a positive local impact on public injecting, HIV risk behaviours such as syringe sharing, and uptake of addiction treatments among the facility’s clients. Crucially as well, they have found no evidence of any negative impacts of the service.
However, the evaluation team concede that many academic publications and journals are not openly available to (or widely read by) politicians, policy makers and the general public. Therefore, in June 2009, they released an accessible report in order to further support the intervention, communicate the research findings, and advocate for the continuation and possible expansion of the service. The report – entitled ‘Findings from the Evaluation of Vancouver’s Pilot Medically Supervised
Safer Injecting Facility’ – provides a brief description of the work that has been done since 2003, as well as plain language summaries of each scientific paper that has been released.
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 Click here to view the Insite report [PDF:4.16MB]
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In addition to this intervention in Canada, formal safer injection facilities (or ‘drug consumption rooms’) also exist in Sydney, Australia, and in 59 European cities across Germany, Luxembourg, the Netherlands, Norway, Spain and Switzerland. These sites are sanctioned environments where people can use pre-obtained drugs under medical supervision by trained staff and without the fear of harassment or arrest. The impacts on overdose and other injection-related harms around the world have been substantial.
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13th July 2009
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Harm Reduction 2010 Website and Registration Opens
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The International Harm Reduction Association (IHRA), the Conference Consortium and Liverpool John Moores University are pleased to announce the launch of www.ihraconferences.net – the official website for Harm Reduction 2010: IHRA’s 21st International Conference. This event will include high-profile keynote speeches, plenary sessions, major sessions, symposia, workshops, training events, a film festival, poster exhibitions, exhibition areas, satellite meetings, a ‘Harm Reduction Academy’, social and networking events, and the annual IHRA award presentations.
Harm Reduction 2010 will take place in April in Liverpool, England – a city with a proud history of public health and harm reduction and the host of the first event in this series in 1990. It will be an opportunity to reflect on the previous two and a half decades of harm reduction, and to look ahead to ‘Harm Reduction - the Next Generation’ (the official conference theme) – looking at issues such as the adequacy of existing harm reduction models for low and middle income countries, stimulant users and young people, the integration of harm reduction into health systems, and how harm reduction intersects with drug control systems and fields such as human rights, security and development.
The registration system for Harm Reduction 2010 is also now open. Due to continued re-investment from previous events, the delegate fees for 2010 have been reduced by between 6% and 12% before tax compared to the 2009 conference. This has been done to partially off-set the fact that UK ‘Value Added Tax’ (VAT) is payable for this year. There are further discounts available for payments before 30th November 2009 (when the UK VAT rises from 15% to the usual 17.5%), payments before the ‘early bird’ deadline of January 21st 2010, delegates from ‘Low’ or ‘Middle’ income counties, un-waged delegates (including students and those working in a voluntary capacity for drug user and service provider organisations), and group bookings.
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Since 1990, these conferences have grown in importance, been held in 17 cities across five continents, and become the main meeting point for all those interested in harm reduction around the world. The conference website contains all of the information you need to make the most of this event – including latest news, abstract submission, travel and visas, and an online accommodation booking service. By registering for the event now, you will also recieve newsletters and latest information about the conference.
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13th July 2009
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USA Moves Towards Removing Funding Ban for Needle Exchange
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US politicians have reversed a decision by President Barack Obama and removed a ban on federal funding for needle and syringe programmes from the 2010 budget. The move follows a series of activist protests in America in July 2009, after the President went back on one of his campaign pledges and continued with the funding ban which has existed in the USA since the 1980s. The ban means that needle and syringe schemes across the country cannot be funded by the Federal Government in order to operate, and also means that the Presidents Emergency Plan for AIDS Relief (PEPFAR) cannot be spent on similar programmes around the world.
When President Obama came to power, his official website stated that “The President also supports lifting the federal ban on needle exchange, which could dramatically reduce rates of infection among drug users”. However, he appears to have backed away from this position and, at the time of his decision to leave the Federal ban in the 2010 budget, a spokesman revealed that this was “because we want to work with Congress and the American public to build support for this change”.
The issue is far from resolved, but the move by House Democrats is certainly a step in the right direction. According to Allan Clear, Chief Executive of the Harm Reduction Coalition, “This is a major positive development. We are optimistic the ban will stay out – we don't think Democrats would do this unless they thought they could keep it out”.
Despite the Federal ban, the USA was one of the first countries to formally establish needle and syringe programmes in the 1980s – first through unofficial, activist-based projects and later through community partnerships and local government support in many States. According to IHRA’s Global State of Harm Reduction 2008 report, there were 185 needle and syringe programmes operating across 36 States and the District of Columbia by November 2007. Across the world, these programmes have been proven to save lives, reduce injecting risk behaviours, increase referrals into treatment and support, and reduce a range of drug-related harms – not least the spread of HIV among injection drug users. They have also repeatedly been shown not to increase drug use or local drug-related crime. The US Federal ban has been the subject of fierce national debate for many years – representing to many a fundamental conflict between science and populist politics.
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7th July 2009
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Increasing Impact for the International Journal of Drug Policy
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The International Journal of Drug Policy (IJDP) – IHRA’s official academic journal – has been given an increased ‘Impact Factor’ for 2008 of 2.278. This is nearly double the previous ‘Impact Factor’ of 1.272, and demonstrates an increasing importance in the field. These scores are calculated as a measure of the citations received by scientific journals, and are calculated every year. The large increase for the IJDP positions it fourth out of the 21 titles in the category of substance misuse in the Institute for Scientific Information (ISI) Web of Knowledge. This positive news reflects the quality of papers that the journal is now attracting – in only in its second year in the ISI rankings.
The IJDP is a bi-monthly journal which provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use, harm reduction and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. It has a global and broad readership drawn from the variety of disciplines working in the area of licit and illicit drug use and drug policy, and typically features guest editorials, commentaries, reviews, research papers, letters and short reports. The IJDP’s academic base is the Centre for Research on Drugs and Health Behaviour in London, and it has two Editors-in-Chief – Professor Gerry Stimson (the IHRA Executive Director) and Professor Tim Rhodes. A free annual subscription to the journal is available to all ‘Premium’ and ‘Institutional’ IHRA members.
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7th July 2009
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INPUD Delivers Speech to UNAIDS Programme Coordinating Board
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In June 2009, representatives from the International Network of People who Use Drugs (INPUD) delivered a powerful speech about injecting drug use to delegates at the Programme Coordinating Board (PCB) of the Joint United Nations Programme on HIV/AIDS (‘UNAIDS’). The speech was part of a debate at the meeting to try and urge explicit support for the term 'harm reduction'. It was prepared by Mat Southwell and Erin O’Mara and read out during the plenary session. It calls upon UN Member States to support the drug using community and engage them in discussions around HIV policy and harm reduction – asking them to follow the lead set by the UK Department for International Development (DFID), which provided INPUD with initial funding through their grant to IHRA.
The speech then states that “People who use drugs, and our organisations, are part of the solution not the problem” – and calls upon UN agencies to develop integrated responses on HIV and hepatitis C, research into effective treatments for people who use stimulant drugs, and “holistic engagement” in harm reduction. It concludes that “The inclusion of our voices in the planning and review of services is likely to lead to better value for money and more effective outcomes”.
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Click here to view the complete INPUD Statement [PDF:31KB]
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The speech is one of many features on the new INPUD Blog on international advocacy and events. The blog is written by INPUD members who are attending international events and conferences – such as the UNAIDS PCB – and is managed by Erin O’Mara.
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6th July 2009
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Call for Papers: Conference Special Issue of the International Journal of Drug Policy
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In 2010, Harm Reduction 2010: IHRA’s 21st International Conference is returning to Liverpool, England – the city which hosted the first event in this series (the ‘International Conference on the Reduction of Drug Related Harm’) in 1990. This inaugural event was attended by around 250 people, and was the start of this highly successful conference series – which has been to 17 different cities across five continents since and has helped to put harm reduction on the map.
We therefore have a lot to celebrate in 2010 - with 21 years of the conference and over 25 years of harm reduction around the world. Harm Reduction 2010 will be an opportunity to mark these achievements and to look forward to the challenges for ‘Harm Reduction - the Next Generation’ - the official conference theme as we take stock of what has happened during the last two and a half decades, and assess what is needed in order to move through to the next decades of harm reduction. This includes questions about the adequacy of the models of harm reduction that have been developed, whether the comprehensive package of harm reduction for HIV is sustainable in lower in middle income countries, the relevance of harm reduction research, how to better engage and support young people, how harm reduction can address all psycho-active drugs, the implication of the scaling up of harm reduction for health systems, how harm reduction intersects with and changes drug control systems, new opportunities for harm reduction in terms of human rights, security and development, and what lessons can be learnt from the history of harm reduction.
To mark this 21st conference, a special issue of the International Journal of Drug Policy will be released - including key reflections on what has happened and on the future of harm reduction. Therefore, the Editors are currently soliciting:
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- Review Papers: these will be a maximum of 5,000 words and will review systematically a particular area of harm reduction research, history, implementation, intervention or policy
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- Editorials or Short Commentaries: these will be a maximum of 1,500 words, one table (if applicable) and no more than fifteen references
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All submissions will be subject to the normal journal review process, and must be submitted online at http://ees.elsevier.com/drugpo/. In your covering letter, please mention that this is submission is for the attention of Professor Gerry Stimson, and is intended for the conference issue. If you would like to discuss an idea – or require further information – please email Professor Stimson. Contributions need to be submitted by September 10th 2009 for review, as all accepted papers need to be sent for production by the end of December 2009.
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