ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

How Drug Policy Should Respond to the HIV Epidemic

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Walking around Vancouver you can't help noticing the shops selling medicinal cannabis - the big cartoon weed pictures are so obvious!  So it was interesting to hear about the response to the IVDU problem here, and in yesterday's plenary Dr Evan Wood gave a summary of the main issues and how local authorities have worked to address them.

Dr Wood is a Professor of Medicine with an interest in HIV and drug addiction. He has been researching the impact of medically supervised safer injecting sites in reducing drug-related harm while increasing access to detox services for drug users. His research was the first to clearly demonstrate the positive impacts of safer injecting facilities for injecting drug users in Canada. This research has been instrumental in the development and continuation of Insite, a supervised injecting site in Vancouver that has saved many lives.  Dr. Wood pointed out that stigmatization of drug addiction is a major barrier, and he has been a voice for evidence based policies rather than ones based on negative perceptions of drug use.

He described the 4 Pillar approach to tackling drug use:

  1. Prevention
  2. Treatment
  3. Enforcement
  4. Harm Reduction

Vancouver had an explosion in HIV cases amongst its IVDU population in the 1990's, which at its height saw a fatal overdose occurring every day.  This prompted the city authorities to use a new approach.

The strategies employed included:

  • sterile needle provision
  • supervised safer injecting facilities (which prevents needle sharing)
  • methadone programs and other OSTs
  • treatment as prevention

Unfortunately, the 4 Pillars philosophy is not shared by the Canadian federal government, and a quick google search reveals that there is still much debate over the issue.  This is despite Dr Wood's claims that new HIV diagnoses in the IVDU community in Vancouver have dropped by 90% since the actions were implemented.

In stark contrast, at today's plenary I caught the last 10 minutes of the overview of the HIV situation in the Russian Federation, Eastern Europe and Central Asia, and was dismayed to hear that the situation there with respect to HIV in the IVDU population is very serious, largely driven by unsafe injecting although heterosexual transmission is also increasing. 

There are very few structured and recognized civil society and community-based organizations in most countries in the region.

The Russian Federation has some of the world's highest incarceration rates, with prisoners often waiting in overcrowded jails for months before trial.  Unsafe injection use, corrupt prison staff and high rates of unsafe sex and TB prevail.

Drug policies rely heavily on prohibition law enforcement, and methadone is illegal.

It is hard to see how a focused approach to the problem can be achieved under such circumstances.






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