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Drug Users Get a Voice
by Zofeen Ebrahim, Karachi
"We've done enough of research, we've asked enough questions and have all the answers and the evidence. We know what doesn't work for the 3.3 million injecting drug users (IDUs) in the Asia-Pacific region. Messages like 'say no to drugs or calling for 'a drug-free world' certainly don't," said 47-year old Tariq Zafar, call the spread of HIV/AIDS an "IDU-ignited epidemic in Asia".
Zafar would know what works and what doesn't. A former heroin user himself, he also runs Nai Zindagi, an NGO providing street-based harm reduction services for drug users in Pakistan's city of Lahore.
Harm reduction is a comprehensive public health approach to drug abuse that aims to reduce drug-related harm experienced by individuals and communities, without necessarily reducing the consumption of drugs. That perhaps is the single most issue why it is looked upon uncomfortably and with a degree of scepticism by states.
It is based on the belief that there will never be a drug-free society. Thus it seeks pragmatic solutions, "ones that really work, based on evidence, human rights, and most of all compassion".
These may include a needle exchange and distribution programme to prevent needle injecting and sharing, drug substitution -- based on the relative harmfulness of the drug to society, or in the fight against HIV/AIDS, from injecting to oral detoxification if that is the need, and returning dignity back to the addict through employment, food, providing space to wash up, and most of all, an atmosphere of compassion and understanding. "Their (IDUs) needs may be different, at different points in time," he explained.
These 3.3 million IDUs are "our biggest resource" toward fighting the AIDS epidemic, said Zafar, who also gave a keynote address at the 7th International Congress on AIDS in the Asia Pacific, held in Kobe, Japan, from Jul. 1-5, 2005. There, he advocated for their "proper utilisation" through education, prevention and treatment.
He, like all the other advocates at the conference, were not happy with the coverage of drug users in AIDS programmes.
"Ask them what they want and ask them for solutions," he said, adding that donor driven or ready-made models are bound to fail if they don't take the client into confidence.
This view was supported by Bijan Nassirimanesh, director of the Persepolis NGO, also a member of the Asian Harm Reduction Network (AHRN), a regional information and support network. "Even if we have models from the region that we want to replicate, these have still to be translated and moulded to local culture." At Kobe, he gave a presentation on the scaling up of their drop-in-centres in Iran, which he called "one-stop-shop", offering all sorts of services to drug users.
What is urgently needed is action from those governments who have already made a commitment to act on the new data pointing to spread of HIV from drug users, said Ton Smits, executive director of AHRN.
"The action must be at the same pace as the speed of HIV explosion, for it to have real impact," added Nassirimanesh, who feels that pilot projects and one-time interventions "till donor money lasts" are really useless. It is necessary that governments, and not donors, take the lead, he explained.
"SARS (Severe Acute Respiratory Syndrome) affected all of us, so we didn't hold ICAAP that year. And if this affected us as much, we'd take it on a war footing," said Zafar, making no bones that all such conferences are mere "tokenism" with the governments paying "lip service" to programmes that benefit the poor.
"Where are the beneficiaries, the drug users?" he asked. When are we going to do something concrete?" he said.
"There is severe denial from policymakers and stigmatisation of IDUs as social evils," said Nassirimanesh. In fact, there were no drug users who made any presentations throughout the ICAAP in Kobe.
Emphasising the continuum of care, Zafar said while some IDUs may want a syringe to be exchanged, others may be looking for substitution therapy or even detoxification. "And there may be some who may just want a place to take a bath, a meal or even a job. "Before you take the crutch of drug use, make sure you have a solution," he warned.
That may be so, but harm reduction has finally found a niche in such HIV/AIDS conferences. "There are more sessions on harm reduction this time than I've ever witnessed before," said a rights activist who has attended many HIV/AIDS conferences.
There were some 13 sessions — including the plenary, one community forum, four satellite sessions, two skills-building workshops and four oral ones — directed to harm reduction. Of these there were presentations, interestingly from the officials of two Islamic republics, Iran and Pakistan who showcased various interventions.
There was yet another victory of sorts for the hidden drug users present. The local organising committee gave their approval for delegates who required medical treatment with Methadone, for drug substitution, to import their medication.
While most at the conference agreed that abstinence from drugs was the ideal solution, not all IDUs, they said, are ready for this or have access to treatment services. So till then, there has to be a way to prevent them from injecting and sharing needles.
Calling for a scaling up of the drug-related interventions programmes was a common theme in the presentations at the Kobe conference.
"Drug-related intervention programmes must be scaled up," said JVR Prasada Rao, Regional Director of the Regional Support Team of the Joint United Nations Programme on HIV/AIDS (UNAIDS). "In terms of coverage, still the population of drug users who are covered is very, very low," he added.
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