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09 February 2009

Asia fights AIDS

Our health consultants in HLSP are helping curb the spread of HIV/AIDS in southeast Asia by challenging drug user behaviour.

In cities across the world poverty is accompanied by problems of drug use, crime and prostitution. “Hand in hand with drug injection go HIV infection and AIDS and a lot of people on drugs go into sex work to feed their habit,” comments HLSP programme manager Gordon Mortimore. “In places where there are lots of visits to sex workers you get two very high risk groups crossing over. It raises a real danger of HIV jumping from a sub-group into the general population.”

Gordon is leading a major eight-year project to curb drug use and the spread of HIV in southwest Asia. Now in its second year, the HIV/AIDS Asia Regional Programme (HAARP) is setting out to firstly encourage drug users to stop injecting and then to stop taking drugs at all. HAARP is funded by Australian Agency for International Development, AusAID.

“Rather than saying to people ‘don’t use drugs’, we accept the situation that people do use them. Instead we try to educate people not to share needles and not to inject. Injecting, and especially needle sharing, carries the highest risk of infection.” The programme encourages users to substitute methadone for heroin. Because methadone is prescribed, substitution brings users onto the right side of the law and helps with social reintegration.

“The ultimate step is stabilisation of the individual and reintegration into society. There’s evidence from across the world that rehabilitating drug users has beneficial knock-on effects. They become employable and are able to hold down jobs, which reduces crime.” The approach, described as ‘harm reduction’, contrasts with the typical police position of zero tolerance. It was first pioneered in Australia and the UK, and has been officially recognised in India.

But the project faces obstacles: “In most countries there’s a very strong contradiction between the treatment of HIV and drug law enforcement, which takes a zero tolerance approach, making it difficult for infected drug users to get medical help. One of our aims is to bring health and law enforcement agencies together so they take a more pragmatic approach to substance abuse,” Gordon says.

HAARP works in partnership with governments at local and national level, and liaises closely with women’s organisations and drug user support groups where they exist. The project encourages neighbouring countries to share information about what works.
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