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June 2007- International Harm Reduction Association | | | | | |
| Over 1,200 people attend 18th IHRA Conference in Warsaw
| IHRA’s 18th International Conference on the Reduction of Drug Related Harm took place in May 2007 in Warsaw, Poland. The five-day event was attended by well in excess of 1,200 people from over 80 countries around the world (a record high number of countries). There were around 90 sessions (containing around 300 oral presentations and 300 poster presentations) covering a wide range of topics including illicit drugs, alcohol, tobacco, sex work, HIV/AIDS, young people, and prisons. The speakers at the conference covered major international organisations and donors (such as UNAIDS and the World Bank), and leading academics, advocates and practitioners from around the world.
Even before the conference had officially begun, there were countless meetings and satellite events taking place – including the 2nd Congress of the International Network of People who Use Drugs (INPUD), and meetings organised by the World Health Organization, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the International Youth Harm Reduction Initiative, and the International Nursing Harm Reduction Network There was also a meeting between all of the regional harm reduction networks to discuss future coordinated campaigns and advocacy efforts.
The overall theme of the conference was “Harm Reduction Coming of Age” – a title which, in the words of Professor Gerry Stimson (the IHRA Executive Director) in the opening session, “reminds us of what has been achieved so far, what is still left to achieve, and how to take harm reduction forward”. Also in the opening session, JVR Prasada Rao from (the UNAIDS Regional Director for Asia and the Pacific) told delegates that “focused harm reduction programs which reach people who inject drugs must be built into the national AIDS plans”, and that “access to antiretroviral therapy among this group is unacceptably low due in part to lack of information, exclusion and widespread stigma and discrimination".
|  Click here to view Professor Gerry Stimson’s opening speech [PDF: 36KB]
| Click here to view the conference press release from UNAIDS [PDF: 26KB]
| The topics examined at the conference included alcohol harm reduction, sex work harm reduction, legalisation and regulatory frameworks, drug consumption rooms, harm reduction in prisons, stimulant and party drug use, medication assisted treatment, young people, tobacco harm reduction, needle exchange, advocacy case studies, and universal access. Additionally, the official rapporteur presentation for the conference identified major shifts at the conference towards ‘bottom-up’ (or ‘grass-root’ movements), identifying specific drug use settings and groups, dealing with a wider range of harms (rather than just HIV/AIDS), and focusing on the developing world.
| Click here to view the Rapporteur Presentation from the closing session [PDF: 76KB]
| In the conference’s closing session, Dr. Vladimir Mendelevich received the International Rolleston Award for his continued advocacy and support for harm reduction and medication assisted treatment in Russia in the face of widespread vilification and the threat of imprisonment for his stance. The National Rolleston Award was presented to Marek Zygaldo in recognition of his pioneering efforts in Poland, where he has been at the forefront of harm reduction for over 20 years. The Travis Jenkins Award (presented to a current or former injecting drug user who has made an outstanding contribution to harm reduction) was presented to Alexandra (Sasha) Volgina, a Russian drug user activist who works in a hostile environment to ensure that drug users are seen not as problems, but as partners and experts. Finally, the Film Festival Award was won by Eugene Zaharov and Sergey Bogatyrev for their film entitled “FrontAids”.
Also in the closing session, Lady Jocelyn Keith (from the International Federation of Red Cross and Red Crescent Societies) delivered a wonderful summary in the form of a fable in which she (as the fairy godmother) bestowed four birthday gifts to a teenager named IHRA – the gifts of Imagination, Humanity, Reliability and Agility for future years.
| Click here to view Lady Jocelyn Keith’s closing speech [PDF: 36KB]
| Overall, the conference was a great success and we now look forward to next year’s event, scheduled for May 11th – 15th 2008 in Barcelona, Spain. This next conference is entitled “Harm Reduction 2008” and carries the strap-line “Towards a Global Approach” to explore how harm reduction can further expand from its current position in terms of geographical coverage and scale, but also in terms of integration with other movements (such as human rights, social development and poverty alleviation). The 2008 event promises to be even bigger and better than this year, and will aim to showcase the latest policy, research and practice developments from the field. Conference updates will be available on the IHRA website shortly.
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| Free Journal Access to IJDP for the IHRA Conference
| To coincide with the 18th International Conference on the Reduction of Drug Related Harm (May 2007, Warsaw), the latest issue of the International Journal of Drug Policy is dedicated to the conference theme - "Harm Reduction - Coming of Age". As a special offer for IHRA supporters, this issue will be free to access until the 13 June 2007. The articles can be accessed at www.ijdp.org, and no user name or password is required.
The issue (volume 18, issue 2) aims to complement the IHRA conference by providing reviews and commentaries on the last 18 years of global harm reduction. There are reports by the Asian Harm Reduction Network (AHRN), the Central and Eastern Harm Reduction Network (CEEHRN), and the Latin American harm reduction network (RELARD) which review the implementation of harm reduction in these regions and the challenges that they have faced. There are also specific reports from South America, China and Malaysia, as well as commentaries from Pat O'Hare (the IHRA Honorary President) on harm reduction in the Mersey region of the UK – where the conferences began back in 1990.
In addition to these historical pieces, there are also reports on some of the issues which remain crucial to harm reduction – such as the coverage of interventions, and where the movement fits in terms of global tobacco use, the ethics debate, the prohibition debate, and drug user activism and involvement.
The issue opens with an editorial piece from Professor Gerry Stimson (IHRA Executive Director), which overviews the last two decades of “a local movement with global impact”. This article documents the development of harm reduction from its humble beginnings as a local initiative in Holland (where the first needle exchange was opened by drug users in 1984), ground-breaking work in Merseyside in the UK, and innovative projects in North America, Australia and elsewhere in Europe. From this point, the evidence-base and global acceptance and support for harm reduction has grown and grown (despite on-going opposition from certain governments and organisations). This approach is now explicitly approved by governments across the world (regardless of economic, religious or cultural differences) as well as major international bodies (such as the United Nations and the World Health Organization). The harm reduction approach, based on evidence, pragmatism and human rights, has grown beyond its initial roots as a HIV prevention tool, and can now be applied to tackle a range of harms for all psychoactive substances.
Throughout the history of harm reduction, the International Journal of Drug Policy (and its predecessor, the Mersey Drugs Journal) has continued to provide coverage of the latest research, debates and advances in this field. It is fitting, therefore, that this journal now looks back at what has been achieved – as well as looking forward to what challenges lie ahead.
The idea of the harm reduction movement “coming of age” was a major theme at the 18th International Conference on the Reduction of Drug Related Harm in May. As Professor Stimson notes in his editorial, “The 18th conference provides an opportunity to reflect on harm reduction achievements, to examine problems and failures, and to look forward to the future of harm reduction”.
To view all of these articles for free, please visit the International Journal of Drugs Policy homepage If you would like to see more of the journal, subscription is included in the Premium and Institutional membership packages for IHRA. To become an IHRA Member, or for more information, please visit our membership page.
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| Insite: Hanging in the Balance
| 'Insite', in Vancouver’s downtown eastside, is North America’s only official safe injecting facility - a health-focused project where people can go to inject illicit drugs under medical supervision and connect with health care professionals and addiction services. Despite a large evidence-base in its favour, however, this innovative service is facing closure by the Conservative Canadian Government.
Since opening in September 2003, Insite has consistently proven its effectiveness in reducing drug related harm. Over 20 peer-reviewed scientific studies have shown that the facility has helped to reduce public injections, reduce overdose fatalities, reduce the transmission of blood-borne infections, reduce injection-related infections, and improve public order (through less public injecting, unsafely discarded injection equipment etc). There has also been widespread support for the service – from politicians, the police and local residents. However, Insite has remained a highly contentious project in Canada, caught in the middle of ongoing media and political debates between moralistic ideologies and a large body of public health-orientated scientific evidence.
In order to operate, Insite was granted a three and a half year legal exemption in 2003 to protect the staff and clients from arrest, and protect the facility from closure or harassment. On 1st September 2006, when this exemption was due for renewal, the new Conservative Health Minister, Tony Clement, claimed that further evidence was needed to investigate whether safe injecting facilities “contribute to lowering drug use and fighting addiction”. As a result, the decision on whether to extend the exemption for a further three and a half years was simply deferred until December 31st 2007.
The future of Insite is now hanging in the balance. As such, it is important that the harm reduction community supports Insite through the coming months. To show your support for this facility, please visit www.communityinsite.ca, from which you can send a template letter to the Canadian Prime Minister, which states that “Insite is helping make a very troubled neighbourhood safer while providing medical attention to some of its most vulnerable people”. There are currently around 65 safer injection facilities (or ‘drug consumption rooms’) around the world and, crucially, there has yet to be a single death from drug overdose in any of them. Quite simply, these facilities save lives, and Insite must be allowed to continue into 2008 and beyond.
| Click here to download a recent report on drug consumption rooms by the Joseph Rowntree Foundation, including contributions from Professor Gerry Stimson (the IHRA Executive Director).
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| Harm reduction to be scaled-up in Ukraine
| In March 2007, over 400 stakeholders in Ukraine’s response to HIV/AIDS gathered for the ‘2nd National Conference on Harm Reduction’ in Kiev. The attendees included government officials, health and social care practitioners, drug users, law enforcement and public security personnel, and media figures. Together, participants shared experiences and listened to expert speakers on areas such as best practice and advocacy, financial and political support for harm reduction, and the implementation of programmes in Ukraine.
Opening the conference, Vladimir Zhovtyak (a Chair of the Coordination Council of the All-Ukrainian Network of People Living with HIV) emphasised the urgency of scaling-up access to harm reduction in Ukraine. For example, although 110,000 people accessed harm reduction services in Ukraine in 2006, only about 500 people currently have access to substitution therapy in a country with an estimated 397,000 injecting drug users. Mr Zhovtyak reminded delegates that funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Ukraine’s primary donor towards the AIDS response) is largely dependent on Ukraine meeting its target of 3000 injecting drug users accessing substitution therapy by the end of 2007. If this target is not met, Mr Zhovtyak warned that future Global fund money might be discontinued. This would have severe implications for a country with one of the fastest growing HIV epidemics in the world.
The overwhelming message from the conference - from the grassroots level to policy makers - was that substitution therapy is an essential part of the HIV prevention effort in Ukraine, and an urgent scale-up is needed in order to have an impact on the HIV epidemic there. The Head of the Ukrainian AIDS Centre announced that scaling-up towards universal access for HIV prevention, treatment and care (including substitution therapy and harm reduction interventions) was now their national goal. In Ukraine, the small numbers on substitution therapy are receiving buprenorphine. The World Health Organization, amongst others, have urged the Ukraine Government to begin distributing methadone (a cheaper and effective alternative to buprenorphine). Methadone prescribing remains a contentious and unresolved issue in Ukraine.
As well as the commitments from stakeholders to scale-up harm reduction, the conference also led to the establishment of a working group to devise an action plan on harm reduction measures in prisons. The Central and Eastern European Harm Reduction Network (CEEHRN) reported that two needle and syringe pilot projects will start in penal institutions in Ukraine by September 2007. The World Health Organization will be helping to monitor these projects, with the Canadian HIV/AIDS Legal Networkproviding additional technical assistance.
| Click here to view the CEEHRN article about the conference
| Click here to view the CEEHRN article about the Ukraine pilot projects
| Click here to view a UNAIDS feature story on the scale-up plans in Ukraine
| Click here to view a press release on the conference by the International HIV/AIDS Alliance in Ukraine
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| Drugs & Health Alliance Launches in the UK
|  On May 3rd 2007, a new alliance of drug charities launched in London, calling on the UK Government to put public health, harm reduction and tackling poverty and exclusion at the heart of UK drug policy. The Drugs & Health Alliance (DHA) claims that the criminal justice approach to drugs in the UK has failed, and that the priority must be public health instead.
The DHA is a group of organisations and individuals - including IHRA - who support an evidence-based, public health-led approach to dealing with illegal drugs. There is an overwhelming body of evidence which shows that the criminal justice-led approach to illicit drugs around the world can actually increase drug-related harms - as is highlighted in IHRA’s “50 Best Collection on Policing and Harm Reduction (Illicit Drugs).” In contrast, public health-led approaches (such as needle exchanges, substitution treatment, outreach and brief interventions) consistently reduce harm.
In 2007, the UK’s ten-year drug strategy comes to an end and a window of opportunity opens for review and change. However, there has been no evidence-based review or consultation with informed public opinion by the Government, and many UK drug charities have been reluctant to criticise policy because of their reliance on Government funding Danny Kushlick (spokesperson for DHA, Director of Transform Drug Policy Foundation), and a member of the IHRA Executive Committee) said: “Ten years ago, the Government brought in an ex-police officer (Keith Hellawell) as ‘drug czar’, to head up the UK drug strategy. A decade down the line, the evidence of the failure of our enforcement-led approach is all too apparent. DHA is calling for the upcoming drug strategy to reallocate resources away from enforcement and towards a public health approach to drugs. It is truly criminal that the Government has not seen fit to publicly audit the enforcement approach to drugs and compare it with health interventions.”
The launch event included a presentation from Professor Gerry Stimson (Executive Director of IHRA), who said: "This Government's first war was the war on drugs – one that rumbles on with a growing roll-call of casualties. The mistake was to move responsibility for drugs policy to the Home Office rather than the appropriate health agency, and to downgrade health targets whilst focussing almost exclusively on crime reduction. It's time to refocus drugs policy, and get back to dealing with the evidence of what works at reducing harm for users and the wider community."
The DHA includes The Alliance, the Beckley Foundation, the International Harm Reduction Association, the Kaleidoscope Project, Release, Transform Drug Policy Foundation, the Socialist Health Alliance, Plymouth Public Health Development Unit and the UK Harm Reduction Alliance. More details, including the group’s ‘Consensus Statement’, can be found at www.drugshealthalliance.net.
| Click here to view Professor Stimson’s presentation at the launch [PDF: 19KB]
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| June 2007 Article of the Month
| Brand DA, Saisana M, Rynn LA, Pennoni F & Lowenfels AB (2007) Comparative Analysis of Alcohol Control Policies in 30 Countries. PLoS Med 4(4): e151.
| This paper attempts to assess and compare national alcohol policies around the world, and explore any relations between these policy options and national alcohol consumption. The authors used routinely collected and available data from the 30 countries that compose the ‘Organization for Economic Cooperation and Development’. Each nation’s alcohol policy was scored using an “Alcohol Policy Index” – based on a number of criteria such as legal purchase age, restrictions on business hours for selling alcohol, the relative price of beer, wine and spirits, and whether or not there is a mandatory penalty for exceeding legal blood alcohol limits when driving. There were 16 criteria in total, each given a different weighting in the final policy score based on their evidence-base and effectiveness. The resulting score was out of 100 – the higher the score, the more stringent the national alcohol policy.
The Alcohol Policy Index “revealed wide variation in the strength of alcohol control policies among the 30 countries”, which were then listed in a table – with Norway, Poland, Iceland, Sweden and Australia receiving the top five scores, and Luxembourg receiving the lowest. The authors then compared these policy scores to national statistics for “per capita” alcohol consumption (the amount of alcohol consumed, on average, by each person in that country). They concluded that there was a relationship between the two – with a higher Alcohol Policy Index score generally leading to a lower per capita consumption.
This attempted policy comparison is to be commended for what it has set out to achieve. It is important to analyse national alcohol policies in an international context in order to gain understanding of what works and what does not. However, it is important to note that this paper only concentrates on the developed countries that form ‘Organization for Economic Cooperation and Development’, and do not examine data from developing countries in, say, Latin America, Africa and South Asia. This is understandable in that developed countries form a much more homogenous group for research and comparisons, and developing countries typically have less developed alcohol policies and data collection. However, it does mean that the conclusions made here can not be reliably applied to the developing world (as the authors note in the paper).
In general, developing countries have a lower incidence of alcohol related problems but, in many parts of the world, these problems are rising rapidly. Therefore, the mechanisms for dealing with alcohol related problems in developing countries will differ from those in the developed world. As a perfect example of this, developing countries tend to have more non-commercial or illicit alcohol (produced outside of commercial industry settings and with no regulation). The Alcohol Policy Index developed by Brand et al attributes high scores to policy strategies which are ineffectual on the illegal alcohol market (such as legal purchase age and beer price index), as these are not major problems for the countries which this study examined. However, this would need to be addressed for this methodology to be applied to the developing world. To demonstrate this point, the study found little relationship between Alcohol Policy Index score and per capita alcohol consumption in Mexico, with the conceding that this “may be explained by a high estimated amount of unrecorded consumption” (Mexico is a recent addition to the ‘Organization for Economic Cooperation and Development’).
Finally, population-level measures, although a useful guideline and perhaps the best available indicator for a comparative study like this, cannot account for the intricate role that alcohol may play within a country – in different groups, contexts and behaviours. The authors themselves comment that “consumption per so is not the ultimate concern… [rather] harm associated with excessive or inappropriate alcohol use”, so it is perhaps disappointing that relatively low values were attributed to “drinking context” policy measures (such as server training) in the Alcohol Policy Index calculations.
There are methodological issues associated with any international policy comparison (as Alison Ritter concluded in her response to the Brand et al paper, “The multiplicity of problems - conceptual, methodological, and political - lead some researchers and policy makers to conclude that the effort is not worth pursuing”), but, overall, the intentions of this paper are to be applauded. Alcohol policy is such an important area of public health that researchers should be encouraged to develop methods such as the Alcohol Policy Index so that we can learn more about which policies are effective in reducing harm and which ones are not.
| Click here to view the article by Brand et al
| Click here to view the response from Alison Ritter
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