"Harm reduction" needed to cut drug-user AIDS risk

LONDON (Reuters) - Barely a twentieth of the estimated $3.2 billion needed is put into preventing drug users spreading the AIDS virus, experts said on Monday, and the shortfall is fuelling HIV epidemics in parts of Europe and Asia.

A woman shows her clean syringes at the Aids Center of Queens County needle exchange outreach center in New York, November 28, 2006. REUTERS/Shannon Stapleton

In a report on the use of “harm reduction” measures like clean needle exchanges and safer drug substitutes, the experts found that in countries which fail to take prevention steps, drug-related HIV infection accounts for the vast majority of new cases.

The proportion of new HIV cases linked to injecting drug use is 90 percent in Bangladesh, 66 percent in Russia and 50 percent in Indonesia, the report said; yet only around three U.S. cents a day is spent on trying to halt drug-related spread of the virus in low- and middle-income countries.

“We have known now for well over two decades that HIV is preventable -- it is untenable that today in some 100 (poorer) countries nearly all people who inject drugs have absolutely no access to clean needles or methadone,” said Professor Gerry Stimson, a co-author of the report and the director of the International Harm Reduction Association (IHRA).

About 33.4 million people worldwide are infected with the AIDS virus. Since AIDS emerged in the 1980s, almost 60 million people have been infected and 25 million have died.

Drug users can spread the human immunodeficiency virus (HIV) that causes AIDS by sharing needles with an HIV-infected person, or pass it on by having unprotected sex.

Harm reduction measures for drug users -- like providing clean needles, condoms and the drug substitute methadone -- were introduced some 25 years ago in countries such as Australia and in European cities like Rotterdam and Liverpool, where AIDS spreading among addicts was a major problem.


Similar policies have since been adopted by public health authorities in many European and other rich nations and, along with safe sex campaigns, are considered a major factor in the relatively low rates of HIV in those places.

But the report found 20 countries in eastern Europe and Asia where injecting drug use is now the major cause of HIV infection, and said the failure to protect drug users is driving the world’s fast growing HIV/AIDS epidemic in eastern Europe.

“Three cents a day is a terrifying figure and equally terrifying are the HIV infection rates amongst injecting drug users in parts of Eastern Europe and Asia,” said Stimson.

Stimson, who is heading an international conference on harm reduction in the British city of Liverpool this week, said one fifth of the all global funding for HIV prevention should be dedicated to HIV prevention steps for drug users. “Harm reduction is a low-cost, high-impact intervention,” he said.

The report said a full package of HIV-related harm reduction steps in Asia would cost $39 per life-year saved, and treatment with AIDS drugs would be around $2,000 per life-year saved.

Alvaro Bermejo, head of the International HIV/AIDS Alliance, said a less punitive approach to drug users would reduce HIV.

“The ‘war on drugs’ is a war on drug users and it is fuelling the HIV epidemic, making public health responses much more difficult,” he said in a statement on the report.

“It’s time to move away from the detention center system and to provide services for users in their communities and in government health clinics so they can see them as places where they can get help and not be badly treated..”

Editing by Ralph Boulton