|
|
 |
| |
| A recent posting on SEA-AIDS (HCV treatment
for drug users: What works in the real world, Peter Wiessner,
Germany; online at: |
| http://www.thecorrespondent.org/featuredarticle.view.aspx?a=b5476555-df58-45f6-829e-4a0da2cfd38b
alerted readers to the dire situation regarding hepatitis C
(HCV) infection among injecting drug users (IDUs) by providing
a glimpse of the discussions at the International Conference
on the Reduction of Drug Related Harm. |
| |
| This posting stimulated staff at the Asian
Harm Reduction Network (AHRN) to reinforce the call for 'what
works in the real world' with insight from the Asian region. |
| |
| As reported by Mr Weissner, HCV treatment,
much like HIV treatment, is unnecessarily inaccessible for many
people who are using drugs, or who are recovering from drug
dependence. Compounding this unfortunate reality, the very means
through which this highly vulnerable community could protect
itself and reduce its vulnerabilities to HCV and HIV (i.e. comprehensive
harm reduction programmes) face continued contempt and widespread
general resistance, being tainted by association with 'illegal
activities' and thus being addressed by many governments as
a 'social evil' instead of a public health issue. However, the
nexus of drug use, HIV and HCV cannot be ignored and, as the
noose tightens around the neck of the most populous continent
in the world, such closed-minded approaches cannot be possibly
continue. |
| |
| The sharing of injecting equipment among
IDUs is a major vector for HIV and HCV transmission. It has
been estimated that there are up to 9 million IDUs in the Asia-Pacific
region. Out of the 7.4 million recorded people living with HIV
in Thailand, Nepal, Indonesia, Myanmar and parts of India, Pakistan
and China, more than half inject drugs[1]. |
| |
| In many Asian countries, IDUs account for
up to 89% of new HIV transmission cases. Further, between 170
and 200 million people are currently living with HCV around
the world, with HCV prevalence recorded at up to 93% among various
IDU communities of Asia. Within the same population groups,
HIV-HCV co-infection is becoming increasingly common. |
| |
| In the global response to HIV, resources
and programmes address HIV and related opportunistic infections
like tuberculosis and malaria, but few platforms and agencies
(including donors) consider HCV in the implementation of a comprehensive
response. Were we to broach the topic of effective HIV and HCV
prevention, we would quickly realise that such measures - much
like the lives of drug users themselves - are viewed as being
a low priority for most governments, and are overlooked or ignored
in short-sighted acts of political self-preservation. This political
and moral reluctance to address issues among IDUs is one of
the key factors that has constrained the incorporation of HCV
in a comprehensive response. It seems that 'universal access'
to essential treatment might not be all that universal after
all. |
| |
| Like it or not, the international community
remains ethically bound to act and must rapidly mobilise, for
there is still an opportunity to bring about positive change.
By investing, developing and implementing evidence-based measures
responding to risk behaviour within drug user communities -
including harm reduction measures like pharmacotherapy and needle
and syringe exchange programmes - we can step closer to simultaneously
neutralising two of the world's most devastating and rapidly
expanding epidemics. |
| |
| A little upwards of USD$200 million is
required for adequate harm reduction service coverage for the
world's injecting drug users. If the strings on the purse that
hold the USD$8.3 billion (in 2006) are so tight and resources
so constrained that the world can afford to ignore the situation
among injecting drug users in Manipur India, in Jakarta Indonesia,
and in Bangkok Thailand, and across Asia and Eastern Europe,
then it is imperative that we re-examine our investment plans
and ensure that those resources are invested where the impact
will be greatest - where every dollar can prevent and treat
both HIV and HCV, for example. |
| |
| What works in the real world is often unpopular,
unpleasant and may unfortunately require more effort and resources
than we are willing to invest. In order to make an impact on
the raging HCV epidemic, massive implementation of harm reduction
services and generic production of HCV medicines must become
a shared priority, in much the same way as people around the
globe synergised to address HIV and improve access to ART. Without
immediate sensitisation of stakeholders and the urgent mobilisation
of resources, there will be no will, and there will be no way. |
| |
| We hope that this article can stimulate
drug users and their representatives, and people genuinely committed
to improving the quantity and quality of health and social care
services for people using drugs, to share with this forum more
local experiences to complement this regional overview and lend
their weight in supporting more reports on 'what works in the
real world.' |
| |
| [1] WHO. 2005. Biregional Strategy for
Harm Reduction 2005-2009. |
|
|
