Vilnius , 11 June 2013 - With 2015 around the corner, the bold targets set at the 2011 UN General Assembly Special Session on HIV/AIDS, including reduction of HIV transmission among people who inject drugs by 50% by 2015, are ambitious. They stimulate us to do more, better and to do it together.
Yesterday, in the margins of the 2013 Harm Reduction Conference, UNODC convened delegates to take a look at where we stand in Asia before this 50% reduction target. With HIV epidemics in this region remaining largely concentrated among people who inject drugs, men who have sex with men, sex workers and transgender people, the session provided insightful information and set the tone for the task ahead.
The well-attended session, chaired by Dr. Monica Beg, UNODC HIV Section Chief a.i., entitled " HIV among people who inject drugs in Asia: Is the region on track with meeting global commitments on reducing HIV transmission?". Various stakeholders expressed their views on the status of the HIV response in Asia, including a look into the progress made in the phasing out drug detention centres in the region.
Ms. Anne Bergenstrom, Regional HIV Adviser in UNODC Regional Office for Southeast Asia and the Pacific, painted the picture of a region at a critical junction. While significant progress in reducing new HIV infections and AIDS-related deaths in the general population in Asia were noted, the epidemics still outpaces the national responses in the case of people who inject drugs.
Wide variations in HIV prevalence in this population were also noted, as well as significant variations in coverage of services depending on approaches adopted by individual countries. What remains clear for everyone is that of an estimated 3 to 4 million people who inject drugs in Asia, and with some 238,000 people detained in over a thousand compulsory centres across the region, the window of opportunity to turn the tide around is narrowing month by month. More concerted efforts and resources are needed in this region if we are to reach a 50% reduction in HIV transmission.
Ms. Ruth Birgin, Vice Chair, Asian Network of People who Use Drugs, presented the perspective of the community. She highlighted the importance of meaningfully involving people who use drugs at all stages of the response. From planning phases to the implementation and monitoring of the HIV services, the perspective of the community of a necessity to ensure services are really tailored and implemented effectively. In addition, we heard how the voices of people who inject drugs need to be heard in the policy dialogue and how are important it is to the success of a harm reduction responses. "Nothing About Us, Without Us!"
The widely endorsed and promoted UN comprehensive package for the prevention, treatment and care among people who inject drugs proposes nine key evidence-informed interventions that are deemed the most efficient in preventing the spread of HIV. Among proposed interventions is the provision of opioid substitution therapy opioid substitution therapy (OST). Mr. Gary Reid, an Independent Consultant with years of hands-on experience in the region, shared the findings of an overview of OST in South-East Asia. With less than one in ten people who inject opiates currently being reached with OST, and that despite the WHO/UNODC/UNADS recommendation stressing that at least 40% of opioid dependent persons should have access to OST, much needs to be done.
Finally, Ms. Bergenstrom gave a snapshot of the current situation as it relates to drug detention centres in the region; Widespread in East and South East Asia, they constitute a complex phenomenon. With a sharp increase in the number of centres between 2005 to 2010, in 2012 the UN estimated that almost a quarter of a million people were detained in over a thousand drug detention centers in the region. Albeit the high figures, it was encouraging to note that there was a modest reduction of the number of such centres as well as the number of people in them since the peak in 2010.
Ms. Bergenstrom presented some of the concerns that compulsory drug detention and rehabilitation centres raise while referring participants to the Joint Statement on Drug Detention Centres issued in 2012 by twelve United Nations organisations, calling for the closure of these centres-which raise rule or law and human rights issues and threaten the health of detainees, including through increased vulnerability to HIV and tuberculosis infection. In addressing the need for the closure of the centres, she reported encouraging developments across the region; for example, the introduction of a number of evidence and community-based treatment services for people who inject drugs in Malaysia; to the rapid expansion of methadone maintenance treatment in Vietnam and China.
Mr. Luke Samson of the Asian Harm Reduction Network also joined the panel as a discussant - While pointing out the enormous gaps in service delivery in Asia, he also commented on the fact that the reliability of HIV data and lack of information on Hepatitis B and C remained a great concern for people who inject drugs.
After the insightful presentations, Dr. Beg facilitated a lively discussion - the urgency to do more in Asia was palpable. Members of the community, service providers and other delegates could not have agreed more on the fact that small isolated initiatives would no longer do it for Asia and that large scale programmes were needed to curb the HIV epidemic among people who inject drugs in the region. Moments after the session, Dr. Beg reinforced her message by saying " We h ave had enough of boutique-type pilots of needle syringe programme and opioid substitution therapies in Asia - its time to scale up!"