Tuesday, December 2, 2014

Leadership key to fighting Aids

In conjunction with World Aids Day on
Dec 1, Dr Rick Lines and Datuk Dr Raj Karim write on the importance of leadership to manage the disease
WHILE the recent Ebola outbreak has certainly reminded us just how fragile the global fight against infectious diseases can be, we’d do well too to acknowledge that progress on HIV and Aids, while replete with remarkable successes, has not in many countries reached those most in need — people who inject drugs, sex workers, men who have sex with men and transgenders.
The Millennium Development Goals come to fruition in 2015 and it is clear that we will fall well short of meeting the targets on a number of levels.
Take injecting drug use. By next year, 50 per cent of all people who inject drugs are meant to be receiving anti-retreviral treatment. That figure looked conservative a decade or so ago.
It now looks positively over optimistic and utterly unattainable unless there is a profound shift in political leadership, such as that shown by the Malaysian Government since 2005.
In the intervening years, the introduction of harm reduction programmes (needle and syringe exchange and methadone provision) has made huge inroads into turning the tide of an HIV epidemic that was largely being driven by injecting drug use — specifically, a 50 per cent decline in new HIV infections among people who inject drugs.
In a region like Asia, with such an uneven epidemic, injecting drug use continues to be a major driver of HIV.
In Indonesia, 35 per cent of all people who inject drugs are living with HIV.
In Vietnam, around 70 per cent of HIV infections are among people who inject drugs, with an overall HIV infection rate that doubled over the past decade.
In China, 28.4 per cent of all people infected with HIV are believed to have become infected through unsafe injecting drug use.
At a global level, the statistics are horrifying. It is estimated that of the estimated 13 million people who inject drugs worldwide, 13 per cent are living with HIV and more than 60 per cent live with Hepatitis C.
Around the world, only four per cent of HIV-positive injecting drug users receive anti-retreviral therapy — a long, long way off the 50 per cent target by 2015.
The statistics are sobering and on the surface they tell a common story: An epidemic among those who inject drugs. But dig deeper and there is another story. This is a preventable epidemic, one that can totally be defeated with the implementation and scale up of harm reduction programmes. The provision of sterile syringes, methadone or buprenorphine and support services, along with embracing drug users themselves as part of the solution — rather than stigmatising them as part of the problem — prevented HIV and Aids epidemics in all major western cities in the 1980s and continue to do so today.
Harm reduction is a key component of the health systems in many countries and a recognised public health medical package by the UN family.
So, on the one hand we know what works. And the other we know that what works has the backing of some of the globe’s finest scientific and political leaders working within the UN family.
But it’s not enough. If we are serious about ending the Aids epidemic among injecting drug users, we will need bold political leadership similar to that shown in this country. That leadership needs to embrace harm reduction on the basis that such interventions are in the public health interest of everyone, that stigma and discrimination are wrong.
There is currently a strong body of evidence emerging that the injection of amphetamines and metamorphines and associated risky behaviours is becoming synonymous with the urban party scene amongst youth in Southeast Asian cities.
This week, the global community observes World Aids Day. Three decades on we are still grappling with avoiding HIV-related deaths amongst those who inject opiates.
The situation is critical. Leadership on that is crucial now if we are to avoid the terrifying scenario of a re-run amongst a new generation of people who use drugs.
Dr Rick Lines is the Executive Director of Harm Reduction International and International Chair of the 24th International Harm Reduction Conference (IHRC2015) to be held in Kuala Lumpur Oct 18-21, 2015.
Datuk Dr Raj Karim is the President of the Malaysian Aids Council and local Co-Chair of IHRC2015.

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