Drug-Related AIDS/HIV or Hepatitis C

In a meeting in Bangkok last weekend, more than two dozen drug users from nine different countries came together to put the finishing touches on the creation of a new drug user advocacy organization, the Asian Network of People who Use Drugs (ANPUD). The Bangkok meeting was the culmination of a two-year process began at a meeting of the International Congress on AIDS in Asia and the Pacific in Colombo, Sri Lanka, in 2007, and resulted in creating a constitution and selecting a steering committee for the new group. ANPUD adopts the principles of MIPUD (Meaningful Involvement of People who Use Drugs), and in doing so, aligns itself with other drug user advocacy groups, including the International Network of People who Use Drugs (INPUD), of which ANPUD is an independent affiliate, the Australian Injection and Illicit Drug Users League (AIVL),the Vancouver Area Network of Drug Users, and the Nothing About Us Without Us movement. ANPUD currently has more than 150 members and sees its mission to advocate for the rights of drug users and communities before national governments and the international community. There is plenty to do. Asia has the largest number of drug users in the world, but is, for the most part, woefully retrograde on drug policy issues. Not only do drug users face harsh criminal sanctions—up to and including the death penalty—but Asian has the lowest coverage of harm reduction services in the world. Access to harm reduction programs, such as needle exchanges and opioid maintenance therapy, is extremely limited. "People who use drugs are stigmatized, criminalized and abused in every country in Asia," said Jimmy Dorabjee, a key figure in the formation of ANPUD. "Our human rights are violated and we have little in the way of health services to stay alive. If governments do not see people who use drugs, hear us and talk to us, they will continue to ignore us." The Director of the UNAIDS Regional Support Team, Dr. Prasada Rao, spoke of the urgent need to engage with drug user networks and offered his support to ANPUD, saying that "For UNAIDS, HIV prevention among drug users is a key priority at the global level," said Dr. Prasada Rao, director of the UNAIDS Regional Support Team. "I am very pleased today to be here to see ANPUD being shaped into an organization that will play a key role in Asia's HIV response. It is critical that we are able to more effectively involve the voices of Asian people who use drugs in the scaling up of HIV prevention services across Asia." "When I go back home, I am now responsible for sharing the experiences with the 250 or so drug users who are actively advocating for better services at the national level," said Nepalese drug user and newly elected steering committee member Ekta Thapa Mahat. "It will be a great way for us to work together and help build the capacity of people who use drugs in Asia." "The results of the meeting exceeded my expectations," said Ele Morrison, program manager for AVIL's Regional Partnership Project. "The participants set ambitious goals for themselves and they have achieved a lot in just two days to set up this new organization. The building blocks for genuine ownership by people who use drugs is definitely there." While the meetings leading to the formation were organized and managed by drug users, the process received financial support from the World Health Organization, the UNAIDS Regional Task Force, and AIVL.

Southwest Asia: Afghan Opium Trade Wreaking Global Havoc, UNODC Warns The UN Office on Drugs and Crime (UNODC) warned Wednesday that the traffic in Afghan opiates is spreading drug use and addiction along smuggling routes, spreading diseases, and funding insurgencies. The warning came in a new report, Addiction, Crime, and Insurgency: The Threat of Afghan Opium. "The Afghan opiate trade fuels consumption and addiction in countries along drug trafficking routes before reaching the main consumer markets in Europe (estimated at 3.1 million heroin users), contributing to the spread of HIV/AIDS and other blood-borne diseases," the report said. Neighboring countries, especially Iran, Pakistan, and the Central Asian republics, are among the hardest hit, said UNODC. According to the report, Iran now has the highest opiate addiction rates in the world. "Iran faces the world's most serious opiate addiction problem, while injecting drug use in Central Asia is causing an HIV epidemic," UNODC said. But the impact of the multi-billion flow of Afghan opiates could have an especially deleterious impact on Central Asia, UNODC chief Antonio Maria Costa warned in remarks accompanying the report. "The Silk Route, turned into a heroin route, is carving out a path of death and violence through one of the world's most strategic yet volatile regions," Costa said. "The perfect storm of drugs, crime and insurgency that has swirled around the Afghanistan/Pakistan border for years is heading for Central Asia." In Pakistan and Afghanistan, the opium trade is funding violent radicals. "The funds generated from the drugs trade can pay for soldiers, weapons and protection, and are an important source of patronage," the report said. In Afghanistan, the Taliban generated between $90 million and $160 million annually in recent years, the UNODC estimated. In Pakistan, the UNODC estimated the trade at $1 billion annually, with "undetermined amounts going to insurgents." Although Afghan opium production declined slightly last year, the country is producing—and has produced—more opium needed than to meet global supply. As a result, the UNODC estimates that there is an unaccounted for stockpile of 12,000 tons of opium—enough to satisfy every junkie on the planet for the next three to four years. "Thus, even if opiate production in Afghanistan were to cease immediately, there would still be ample supply," the report said. Unsurprisingly, the UNODC report did not address the role that global drug prohibition plays in exacerbating problems related to opiate use and the opiate trade. Prohibitionist attitudes restrict the availability of harm reduction programs, such as needle exchanges, that could reduce the spread of blood-borne diseases. And it is global drug prohibition itself that creates the lucrative black market the UNODC says is financing insurgencies and spreading political instability.

Responding to years of agitation by harm reductionists and public health advocates, the Pennsylvania Board of Pharmacy Saturday published new regulations that will allow pharmacies to sell syringes without a prescription. The change goes into effect immediately. The move was lauded by activists as a significant public health victory in the battle against the spread of HIV/AIDS and Hepatitis C via injection drug use. Under previous regulations, pharmacies could sell syringes only to people who obtained a doctor’s prescription. The new regulations carry no limit on the number of syringes that can be purchased at a time, nor do they have age limits. “This change is particularly important in Pennsylvania because we have only two locations--Pittsburgh and Philadelphia--in which legally authorized syringe exchange programs operate,” said David Webber, an attorney for the AIDS Law Project of Pennsylvania. “These two programs alone are simply not adequate to address this problem across the entire state, but syringe exchange programs continue to be crucial in providing sterile syringes as well as access to drug treatment and health care for injection drug users.” “This is a chance for every pharmacy to become part of HIV prevention in Pennsylvania,” said Scott Burris, professor at Temple University’s School of Law and a national authority on syringe regulation and HIV prevention. “The pharmacy board has taken an important step forward for evidence-based policy.” It didn’t come swiftly or easily. Activist organizations including the Pennsylvania Aids Law Project, Prevention Point Pittsburgh, Prevention Point Philadelphia, as well as legislators, HIV workers, and others had lobbied for the change for a decade. In August 2007, the pharmacy board proposed new regulations allowing for over-the-counter syringe sales and opened them up for public comment. Thanks to concerns expressed by harm reduction and public health groups during the comment period, the board removed age and quantity restrictions. The board rejected record-keeping requirements requested by the House Professional Licensure Committee, saying it “does not believe that maintaining a record and requiring individuals to provide a name or other identifying information would advance the public health and safety.” Similarly, it rejected a number of concerns from the Pennsylvania Medical Society that the rule change would increase drug use. The board’s action reflected well-established scientific evidence that access to clean syringes is a critical component of stemming the spread of blood-borne diseases such as HIV and Hep C among injection drug users. Now the number of states that do not allow syringe sales without a prescription is down to two: Delaware and New Jersey.

Despite having nearly a million heroin addicts, with HIV spreading rapidly through that population, Russia's government has very tragically said no to methadone maintenance. According to a short video posted by the Hungarian Civil Liberties Union (HCLU), 80% of all new HIV cases in Russia are due to needle sharing by injection drug users. Check out the video here: Check out HCLU here.

EDITOR'S NOTE: I tried to post this Friday morning from the Hilton in Salt Lake City, but due to some mysterious problem with the internets, it didn't get through. The 2nd National Conference on Methamphetamine, HIV, and Hepatitis is now in its second day. The Hilton Hotel in downtown Salt Lake City is doing an admirable job of dealing with the influx of treatment providers, social service workers, needle exchangers, speed freaks, drug company representatives, academics, researchers, and politicos who have flooded into the hotel for three days of plenaries, panels, workshops, and breakout sessions on various aspects of the methamphetamine phenomenon. For me, a lot of the sessions and presentations are of limited interest, which is not to say they have no value, only that they are directed at people who are doing the hands-on work in the field. As someone interested in drug policy reform and, frankly, legalizing meth and everything else, the differences in behavior or susceptibility to treatment between gay urban speed freaks and rural hetero speed freaks is not really that important to me. Ditto for comparisons of different treatment modalities. Again, I'm not saying this stuff is unimportant, only that it's not what I'm about. I'm much more interested in the politics of meth, the methods of blunting repressive, reactionary responses from the state, and the ways of means of crafting more enlightened policies. For all the progress we have made in the drug reform arena in the past decade or so, it seems like all someone has to do is shout "Meth!" and we are once again in the realm of harsh sentencing, repressive new legislation, and drug war mania reminiscent of the crack days of the 1980s. That's why it's so heartening to see political figures like Salt Lake Mayor Rocky Anderson stand front and center for enlightened responses to meth use and abuse. Of course, it isn't just Rocky. Here in the Salt Lake Valley, state and local officials from the governor on down are attempting a progressive response, whether it's the governor lobbying for more money for treatment or local prosecutors practicing restorative justice. And it's not just Utah. Cut across the Four Corners into New Mexico, and you find another state where officials are rejecting harsh, repressive measures and instead seeking to educate youth and adults alike with evidence-based curricula. As one measure of the changing status quo, the Drug Policy Alliance is getting involved in the Land of Enchantment. It has been selected by the state government to administer a $500,000 grant to develop prevention and education curricula. I find it just a little bit ironic that I'm sitting in Salt Lake at this major meth conference just as SAMSHA puts out an analysis of national survey data showing that meth use is declining after about a decade a stable usage patterns. There was a significant drop in the number of new meth users between 2004 and 2005 and a steady decline in past year meth users since 2002. Despite all the hoopla, meth users now account for only 8% of all drug treatment admissions. Meth crisis? While there is no denying the social and personal problems that can and do result from excessive resort to the stimulant, it seems like there is less to it than meets the eye. Still, it has the politicians and funding agencies riled up enough to cough up money for programs and conferences and the like. I guess we'll take what we can get.