Transcript Australia`s critical role supporting harm reduction

Australia's critical role supporting
harm reduction in Asia: helping
control HIV spread among and
from injecting drug users
‘HIV/AIDS in our Region: Human Rights and Interventions’
3 May, 2007
School of Public Health & Community Medicine
Support for Health for All in our Region
Dr. Alex Wodak, St. Vincent's Hospital, Darlinghurst
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Outline:
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HIV: current global overview
HIV: Asia developments
Why harm reduction matters
Political support for harm reduction
What stops harm reduction?
Harm reduction Asia today
Australia’s role in Asia
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HIV: current global overview
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First identified: 5 June 1981
1987 global infections 50,000
2007 global infections 60 million
Major threat health, social, economy,
national security of nations
• Most serious threat global public health
since Black Plague 1340s
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A spectre is haunting Asia –
the spectre of HIV
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HIV Asia developments:
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Epicentre shifting from Africa to Asia
From 800 million to > 2.5 billion
From IDU minimal to IDU driving HIV
30% HIV global outside Africa
30% HIV outside Africa are IDUs
IDUs 10% global HIV
IDUs central to control HIV in Asia
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Why harm reduction matters:
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Effective: reducing HIV among IDUs
Safe: does not increase IDU
Cost effective: affordable
Scientific debate re HR now over
Meaning ‘harm reduction’:
– Reducing harmful consequences without
necessarily reducing consumption
– Achieving what is feasible; rather then
setting & failing to reach utopian goals
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Harm reduction HIV package:
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Needle syringe programs
Substitution treatment
Education
Community development
Other interventions
Both community and prison settings
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Political support harm reduction:
• WHO, UNAIDS, World Bank, Red Cross
• UNODC +/- but increasing over time
• Afghanistan, Australia, Brazil, Canada,
China, Europe, Iran, Pakistan
• UN Position Paper. Annex Report 8th
Session ACC Subcommittee 2000
• UNGASS Declaration of Commitment
HIV/AIDS 2001 – P 52 explicit targets
• UN Dublin Declaration 2004
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What stops harm reduction?
• USA, Russia, Japan, Sweden
• INCB
• Report of Legal Affairs Section UNDCP
2002:
– Q: is harm reduction compatible with UN
drug conventions?
– A: ‘consistent with treaties’
• Result of entrenched opposition drug
law enforcement: too little, too late
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‘Proponents (of harm reduction) contend
harm should be reduced by needle
exchange, ‘safe’ injection facilities,
decriminalisation or legalisation of drugs,
heroin maintenance, and other measures.
Such measures are acquiescence: attempts
to manage consequences of drug abuse
rather than addressing the problem directly’
US Office of National Drug Control Policy
28 July 2006
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Australia: against
‘The path to success does not lie in giving in
to the drug barons; it does not lie in giving in
to the harm minimisation philosophy’
John Howard Hansard, December 12, 2002
‘You’re soft on drugs, Tony, you give free
needles to heroin addicts’
Kim Beazley (Opposition Leader) to Tony Abbott, June 14, 2006
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Australia: for
• Commonwealth $10 million to
states/territories /year from 1999
enhance needle syringe programs
• Generous support AusAID for harm
reduction Asia
• Vigorous support harm reduction at UN
• Diversion drug offenders from criminal
justice to drug treatment
• ‘Walking both sides of the street’
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MCDS:
‘Ministerial Council on Drug Strategy (MCDS),
the peak national policy … body for licit and
illicit drugs …’
Communiqué May 20 2004:
‘Ministers endorsed the new National Drug
Strategy 2004-2009 …
‘… Ministers endorsed harm minimisation as
the Australian approach… defining … harm
minimisation encompasses supply reduction
…, demand reduction … and harm reduction
strategies.”
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The great enemy of language is insincerity.
When there is a gap between one's real and
one's declared aims, one turns as it were
instinctively to long words and exhausted
idioms, like a cuttlefish squirting out ink. In
our age there is no such thing as ‘keeping
out of politics’. All issues are political issues,
and politics itself is a mass of lies, evasions,
folly, hatred, and schizophrenia... Political
language...is designed to make lies sound
truthful and murder respectable, and to give
an appearance of solidity to pure wind.
George Orwell ‘Politics and the English Language’
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Harm reduction Asia today:
• Major change last 5 years
• Now embraced in principle by all major
governments Asia from Iran to China
• Many starting, expanding programs
• India 7 HR NGOs 1999, > 300 2007
• China aiming 300,000 MMT 2008
• Thailand since September 2006
• Indonesia methadone in prison
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Australia’s role in Asia:
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Critical issue for Australia
Strong support AusAID
Altruism
Also self-interest
Rhetoric, reality irreconcilable
Risk that rhetoric becomes reality
Army of Australian consultants working
for harm reduction in Asia
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Harm reduction, human rights:
• Cannot contain HIV without respect human
rights those most at risk, those infected
• UNAIDS June 2005 PCB prevention
document
• ‘Criminal law should not be an impediment to
measures taken by States to reduce the risk
of HIV among injecting drug users…’
OHCHR/UNAIDS ‘HIV/AIDS and Human Rights. International
Guidelines. Geneva 1998.
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Conclusions:
1. HIV major threat global public health
2. Asia, IDU growing importance
3. Harm reduction one of most effective
interventions in HIV repertoire
4. Australian support HR Asia critical
5. Need to end confusion Australian
official attitudes to harm reduction
6. Critical respect human rights at risk
or infected
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