Transcript PHARMACOTHERAPY IN VICTORIA (AUSTRALIA)

‘Building capacity, redressing neglect’
Australian Perspectives on Harm Reduction 2011:
the 22nd International Conference on the
Reduction of Drug Related Harm
Backdrop of Prison Riots
Footage of riot
The MENA assessment Project
Limited knowledge of the HIV epidemic in
Middle East and North Africa (MENA) region
High levels of heroin production in MENA
Major drug trafficking routes pass through the
region
About the MENA Project
To gather, review, analyze, and synthesize for the
first time all evidence on the epidemiology of HIV
among IDUs in MENA.
Methodology
Study design:
– Systematic review, synthesis and analysis
– Triangulation approach
Sources of data:
– Scientific literature search of Medline
– Country-level reports & databases
– International organizations reports & databases
Results: more data than expected
Status of the evidence:
– Hundreds of data sources identified
– Variable quality
– Recent integrated bio-behavioral surveillance
surveys
– Some state of the art sampling methodologies
Fraction of the population who inject
drugs
– There are nearly one million
IDUs in MENA
– Population fraction: 0.2%
(0.05-0.4%)
– Intermediate range
compared to other regions
Note Iran, Iraq and
Pakistan
Injecting risk behavior
– Sharing of needles & syringes: ~ 50%
IDU mode of HIV transmission:
• Fraction of the total HIV
cases due to IDU
• Important mode of
transmission in:
Afghanistan, Bahrain,
Iran, Libya, Pakistan,
and Tunisia
• Note Iraq: Situation
Unknown
Discussion
• Concentrated HIV epidemics at a
national level: Iran and Pakistan
• Emerging HIV epidemics:
Afghanistan and Egypt
• At least “outbreak-type” HIV
epidemics: Algeria, Bahrain, Libya,
Morocco, Oman, and possibly
Tunisia
• Apparently low/zero HIV
prevalence: Lebanon, Jordan,
Kuwait, Saudi Arabia, and Syria
Recommendations: quite obvious
Expand HIV surveillance
Expand access to HIV testing, prevention, and
treatment services
Establish national harm reduction programs
‘Arab Spring’: implications
High Unemployment: drug use risk
environment
Implications for civil society overall
Implications for civil society engaging with
injecting drug users.
Iran a leader
One of worlds highest rates of opium/heroin
usage.
Religious conflicts resolved
Large numbers of civil society organisations
Multi-faceted programs:
–Needle exchange
–Methadone
–Prison-based interventions
Sub-Saharan Africa
Nigeria: trafficking, usage and lack of
Government response.
Seychelles: tiny nation, Catholic Church
opposition
Tanzania: very early stages of mapping and
planning. Methadone beginning soon.
Challenge: advocacy in generalised epidemic
populations.
Other Snippets
Indonesia to begin prison-NSP
Moroccon King endorses harm reduction
– including prison-NSP.
Excellent session on smoking harm reduction.
– More than plain packaging
Afghanistan has begun methadone.
Drug Lords celebrate prohibition
To raise awareness of 50 years of
prohibition, Hungarian Civil Liberties Union
filmed the real beneficiaries:
Including Igor the Russian Heroin Trader
http://drogriporter.hu/en/dli_short