Inter Press Service - April 25, 2009
Marwaan Macan-Markar

The Asian island came in for praise at an international conference here for a successful public health initiative that saw an over 50 percent plunge in the number of new HIV cases among IDUs over a three year period.

In 2005, Taiwan recorded its highest number of new reported cases of people infected with the killer virus - over 3,300 - nearly twice the number recorded the previous year. But, by the end of 2008, the new HIV cases had dropped to 1,752 cases.

The secret to the country's success was a humane approach to help IDUs through a nation-wide harm reduction campaign, Sheng Mou Hu, the health minister at the time, told participants at the international Harm Reduction conference, held in the Thai capital this week.

"Time proved we were right," he said. "Our approach was that harm reduction should be based on human rights."

Consequently, the Taiwanese IDUs were not viewed as criminals for their drug habit - they were presented to the public as "patients" in need of help. The public health initiative launched in 2006 ranged from greater screening and monitoring of drug users living with HIV, a needle exchange programme, and a drug replacement therapy with methadone.

Yet, the initiative sparked a strong public outcry, according the former health minister. "We had a lot of resistance from the media and parliament," he said.

"No other country in Asia can match Taiwan's achievement in launching and sustaining this harm reduction programme," said Ton Smits, executive director of the Asian Harm Reduction Network (AHRN). "In most countries across the region, drug control policies are in direct conflict with HIV-related policy, undermining harm reduction programmes in the region."

"In southeast Asia, only three percent of people who inject drugs have access to harm reduction services," added the head of AHRN, which is based in the northern Thai city of Chiang Mai. Furthermore, "harm reduction funding in Asia is facing a financial crisis. There is a 90 percent resource gap to be met for 2009."

Encouraging signs have emerged in four Asian countries - China, Malaysia, Thailand and Vietnam - which are heading in the same direction that Taiwan has since 2006. They have taken tentative steps to help IDUs through a public health approach, marking a break from the long tradition of dealing with IDUs through strict law enforcement measures.

But, the region has a long way to go, given that IDUs are ranked as one of the major vulnerable communities through which HIV is transmitted. "It is estimated that in China in 2006, slightly fewer than half the people living with HIV are to have been infected through use of contaminated injecting equipment," states a 2008 report by the Joint United Nations Programme on HIV/AIDS (UNAIDS). "Similar scenarios are estimated to be occurring in parts of India, Pakistan and Vietnam."

Asia currently is home to over five million people living with HIV, out of the global total of 33 million HIV cases.

IDUs number close to 16 million people across 158 countries, according to information released by the International Harm Reduction Association (IHRA), the hosts of the Bangkok conference. "The overwhelming majority [80 percent] live in low- and middle-income countries."

"The prevalence of HIV among injecting drug users varies considerably around the world," added a conference background note. "It is estimated that there may be three million injecting drug users who are HIV positive." Some estimates put the number of IDUs at over 6.6 million.

Yet, resources to help this vulnerable community are limited, adding to the burden IDUs face. "Only 2-3 percent [200-300 million U.S. dollars] of all the available resources for AIDS is spent on harm reduction," says Gerry Stimson, executive director of IHRA. "If we are serious about reducing HIV infection amongst injecting drug users then we are going to need between two billion U.S. dollars and three billion U.S. dollars this year and the next."

"Many of us who are drug users and activists are demanding treatment," says Paisan Suwannawong, co-founder of Thai AIDS Treatment Action Group. "Drug users are punished. Treatment should start by looking at us as human beings."

Failure to help IDUs living with HIV condemns them to an earlier death than those people living with HIV who are not drug users.

"For someone who is in their 20s with HIV in the developed world, access to antiretroviral drugs ensures they can have 40 more years," says Michael Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. "But IDUs live 12 years less," said the head of the fund that finances health programmes through governments and non- government organisations to combat the three killer diseases in the developing world.

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+ Q&A: Meltdown a Challenge for HIV/AIDS Programmes (http://www.aegis.org/news/ips/2009/IP090312.html)

+ HIV/AIDS - IPS Focus (http://ipsnews.net/hivaids.asp)

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