HARM REDUCTION IN ASIA. Adeeba Kamarulzaman University of Malaya, Kuala Lumpur

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1 HARM REDUCTION IN ASIA Adeeba Kamarulzaman University of Malaya, Kuala Lumpur

2 Prevalence of HIV among IDUs: 2007 DU identified in 148 countries 15.9 million PWID No estimate of HIV prevalence 0% <7.5% 7.5% <15% 15% and greater Accounts for 30% of all new infections outside Sub-Saharan Africa Up to 3.3 million PWID living with HIV IDU *Mathers et al., The global Reference epidemiology Group of injecting to the drug United use and Nations HIV among on HIV people and who Injecting inject drugs: Drug a systematic Use Lancet review The Lancet: IN PRESS

3 Estimated number of people who inject drugs in selected Asian Countries China 541,184 Indonesia 219,130 Malaysia 205,000 India 164,820 Thailand 160,528 Vietnam 135,305 Pakistan 130,460 Myanmar 75,000 Bangladesh 30,000 Nepal 22,050 Cambodia 1,750 Lao PDR Not known Total 1,685,227

4 HIV prevalence among people who inject drugs UNRTF 2008

5 HIV prevalence in incarcerated settings Vietnam % of the estimated 88,000 prisoners Indonesia % of 100,000 prisoners China and Malaysia % Vietnam % among residents in drug rehabilitation centres

6 Progress of Harm Reduction in Asia

7 Harm Reduction in Philippines Has three identified sites with people who inject drugs Harm reduction programme supported by the Global Fund and ADB implemented mainly by NGOs Needles and syringes continue to be distributed discreetly in identified sites, with support from GF Rounds 3 and 5 AIDS Project NGOs refer IDUs to treatment hubs for treatment, care and support Outreach work and outreach post supported by ADB in one site Government drafting the national guidelines on HR

8 Cambodia National Strategic Plan for drug use and HIV/AIDS, NSP operational since 2004 Outreach programmes Govt authorisation to commence MMT through Ministry of Health

9

10 China First NSP in Yunnan province and Guangxi Zhuang AR in 1999; Since 2001, the State Council has officially advocated needle social marketing; National policy guidelines on NSP in 2002; Almost 800 NSP in 17 Provinces by September ,000 accessing NSP 515 MMT clinics by end of 2007 in 22 Provinces 100,000 on MMT Wu, Sullivan et al. (2007) Evolution of China's response to HIV/AIDS, The Lancet. 369: Mesquita, F et al. (2008, submitted) Accelerating Harm Reduction interventions to confront the HIV epidemic in the Western Pacific and Asia: the role of WHO (WPRO), Harm Reduction Journal. WHO Report, Towards Universal Access, Geneva, 2 of June

11 Methadone Maintenance Clinic in Kunming - China 11

12 Malaysia National response since 2005 after evaluation of the non achievement of the Millennium Goals. Mainly a Public Health Based approach, combined with NGOs for NSP Comprehensive approach - NSP, MMT and CST Currently 74 MMT clinics, started in prisons in NSP covering 3600 IDUs by the end of National Government supports the response Mesquita, F et al. (2008, submitted) Accelerating Harm Reduction interventions to confront the HIV epidemic in the Western Pacific and Asia: the role of WHO (WPRO), Harm Reduction Journal. 12

13 on opiate substitution treatment 11 NSP sites > 1.3 M needles and syringes distributed as of June 2008 Pre release prison methadone project

14

15 Indonesia Strong political commitment Costed National Action Plans ST: 7 methadone clinics (4 in Hospital, 2 in Puskesmas, 1 in prison) Around 1700 on MMT and Buprenorphine NSP: 130 NSP sites ARV: Required for IDU limited access/availability

16 Vietnam Public Health Based approach 42 Provinces in Vietnam conducting HR activities 60,000 IDU accessing NSP with a total of 11 million syringes distributed In April 2008 Vietnam announced its first MMT clinic Currently ~ 500 on MMT ARV for IDUs has good coverage, thanks to PEPFAR

17 Deputy First Minister of Vietnam Addressing the National HR Conf.

18 India Political commitment: No established policy on Harm Reduction. Enabling environment: Drug use remains a criminal offence. Methadone classified as narcotic and not used. The legality of NSP under the NDPS Act is unclear.

19 India OST: Buprenorphine. NGO interventions in Delhi, Chennai, Kolkata and Mumbai 4,000 on Buorenorphine NSP: 122 government supported NGO targeted intervention sites which include NSP. ARV: Affordability generally limited.

20 Political commitment: Thailand No concrete political commitment to HR strategies - law enforcement approach dominates. Enabling environment: A National Strategy for collaboration between public health and law enforcement required. Policy environment: Incarceration for drug possession. No effort to address legal/policy issues.

21 Thailand ST: Methadone only free in Bangkok very hard to access in other provinces. No methadone in prison settings. NSP: Small scale (needle distribution almost totally underground) 2 official NSP - less than 500 clinets

22 Factors that Hamper Progress of Harm Reduction in Asia Legislative and policy barriers to harm reduction High level of stigma and discrimination Overlap between SW and injecting drug use Limited government capacity and infrastructure to develop, scale up and monitor harm, reduction programmes

23 Factors that Hamper Progress of Harm Reduction in Asia Disproportionately low allocation of national AIDS budget for HIV prevention and harm reduction among IDU Absence, or limited availability of research, surveillance and M&E data for planning, implementation and scaling up

24 What Role for TREAT Asia Advocacy Policy Access to OST, ARV, HCV therapy Capacity Building Healthcare workers Community Operational Research Integration of prevention and treatment Integrating ARV/OST/TB/HCV

25 What Role for TREAT Asia Clinical Research Coinfections HIV/HCV/Tuberculosis Hepatotoxicity Drug drug interaction HAART TB treatment HAART OST HAART HCV treatment

26 Acknowledgements Anna Bergenstrom UN Regional Task Force on HIV & IDU Fabio Mesquita WPRO David Jacka WHO, Vietnam

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