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Scaling-up harm reduction services towards universal access in Asia: Models of good practice

A Symposium organised by the United Nations Regional Task Force on Injecting Drug Use and HIV/AIDS for Asia and the Pacific

Most countries in Asia have HIV epidemics which are concentrated amongst the most vulnerable groups in society, including people who inject drugs. Currently in many countries people who inject drugs have very poor access to harm reduction services.

Harm reduction interventions have been implemented in many countries and barriers to implementation are being overcome, step by step. There are still many challenges that must be addressed, including improvement in the quality of services, expansion of services to reach individuals at a larger scale, including services for hepatitis C, tuberculosis and other health consequences of unsafe injecting drug use. If countries are to achieve universal access scaling up harm reduction services should ensure services are equitable, accessible, affordable, comprehensive and sustainable.

Despite the challenges, harm reduction is no longer a marginal approach in the region. More and more countries have initiated or are expanding availability of harm reduction services. The development of a comprehensive response in the region has included scaling up of needle and syringe programmes (NSPs), methadone maintenance treatment (MMT), and care, support and treatment for people who inject drugs. This development is being supported by ongoing changes in policies and legislation.

Increasingly there is a 'diminishing need to look far away for good models', there is a clear potential for South to South Cooperation and exchange of best practices from Asia. With that in mind, UNAIDS Regional Support Team for Asia and the Pacific, WHO Regional office for South East Asia, WHO Regional Office for Western Pacific Region, UNODC Regional Centre for East Asia and the Pacific and UNODC Regional Office for South Asia were pleased to showcase a Symposium on Scaling-up harm reduction services towards universal access in Asia: Models of good practice at the ICAAP, 2009, in Bali, Indonesia.

This symposium session presented some of the innovative work that is being implemented in Asia to scale up harm reduction services with and for people who inject drugs. Five countries in Asia (Bangladesh, China, Indonesia, Malaysia and Pakistan) highlighted differing models for delivering harm reduction services, including services implemented by governments, governments and civil society in partnership and civil society led responses. Each speaker provided a brief overview of their countries universal access targets for people who inject drugs, comment on the progress being made nationally towards those targets and discuss the lessons learned and challenges of a model of service delivery operational in their country. Speakers discussed service delivery outcomes, challenges for scaling up sustainable services and how these have been overcome and plans for scaling up services towards universal access.

The objectives of the Symposium were to showcase different models for scaling up harm reduction service delivery in Asia, including:
1. Effective partnerships in service delivery between government and civil society
2. Government led service delivery
3. NGO led service delivery

The symposium was co-chaired by

  • Mr Christian Kroll, Global Coordinator for HIV/AIDS, UNODC
  • Mr Murray Proctor, Australia's Ambassador for HIV/AIDS

Each presentation is summarised below and speakers PowerPoint slides provided where possible:

Dr Nafsiah Mboi (National AIDS Commission, Indonesia). The Indonesian Experience: Government and civil society partnership model for expanding coverage of harm reduction

Dr Mboi presented on the civil society and government partnership model for scaling-up the national harm reduction programme in Indonesia. In her presentation she provided an overview of: the evolution of the policy context, national harm reduction programme, the movement towards the active involvement of the drug users in policy making processes at both the national and the local levels.

Dr Wenyuan Yin and Dr Zunyou Wu (National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China). China: Government model for taking harm reduction to scale

In her presentation, Dr Yin, began by providing an overview of the latest epidemiology of injecting drug use and HIV, including the changing patterns of mode of transmission of HIV in China. She then described the national policy context, expansion of the national methadone maintenance and needle and syringe programmes, including positive impact of the programmes in having averted a significant number of HIV infections in China.

Professor Adeeba Kamarulzaman (University of Malaya, Malaysia): Malaysia: Rolling out the national harm reduction programme

Professor Adeeba Kamarulzaman highlighted the progress made in Malaysia in scaling up the national methadone maintenance and needle and syringe exchange programme. She stressed the negative impact the "abstinence-only" approach has had on access to and utilisation of services by drug users, along with other challenges which impact on reaching out to drug users with harm reduction and public health interventions.

Mr Tariq Zafar (Nai Zindaqi), Pakistan: Harm reduction for people who inject drugs, services delivered by drug users

Having provided an overview of the context and coverage of the harm reduction services in Pakistan, Mr Tariq Zafar, discussed the benefits of the public-private partnership in scaling up HIV prevention, treatment and care, with a vision of universal access, for people who inject drugs. He also shared lessons learned discussing the "client-driver" approach and the proposed scale-up plan for 2010-2014.

Mr Shamim Rabbani (Padakhep), Bangladesh: Harm Reduction Program in Bangladesh: Progress, Opportunity and Challenges

Mr Rabbani shared an overview of the evolution of drug use in Bangladesh, epidemiology of injecting drug use and HIV, the development of components of the harm reduction programme, key achievements and challenges and the impact the harm reduction programme which is being implemented by the civil society and supported by the National AIDS/STD Programme, has had in Bangladesh. He stressed the three "secrets" behind an effective harm reduction programme: early intervention, wide coverage and quality of the programme.

Finally, the discussant, Dr Alex Wodak (Director, Alcohol and Drug Service, St Vincent's Hospital, Australia) reflected on the five presentations and made the following five observations:

Dr Wodak drew attention of the delegates to the Report of the Secretary-General on Progress made in the implementation of the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS (7 May 2009) which notes that laws which impose criminal sanctions for drug injection constitute major barriers to reaching key populations with HIV services and that the behaviour should be decriminalized, and people addicted to drugs should receive health services for the treatment of their addiction.

While intervention coverage is increasing in the region, the current baseline coverage in many countries remains very low. With a rapid scale-up plan to accelerate coverage countries can avert new infections among men and women who use drugs, as demonstrated by the country case studies.

Finally, he noted that more countries in the region need to make available harm reduction interventions in prisons, as was discussed by the Indonesia and Malaysia presenters.He observed that scaling-up of harm reduction interventions is greatly enhanced by strong political leadership and political and social stability.

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