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Lack of Commitment to Harm Reduction Perpetuating Global HIV Crisis

Despite pledging to reduce the spread of HIV among people who inject drugs, governments around the world are failing to provide adequate harm reduction services to do so, a damning report reveals.

The Global State of Harm Reduction 2016 was published today by Harm Reduction International (HRI), an international NGO working to reduce drug-related harms. The report describes how essential harm reduction services are lacking in many countries across different regions and how this dearth is holding back the global fight against HIV.

According to the report, only 90 of the 158 countries in which people are known to inject drugs have established needle and syringe programmes (NSPs). NSPs provide people with sterile equipment to inject drugs with, thus reducing the spread of infectious diseases such as HIV and hepatitis C.

Such programmes are as financially sustainable as they are medically and ethically sound; for every dollar that a government spends on NSPs, $3 are saved in healthcare costs, HRI reported in 2014. Despite this, no new countries have established NSPs since 2014.

HRI reports that even fewer countries, 80 of 158, provide access to opioid substitution therapy (OST), a key medication in tackling dependence on opiates such as heroin. A 2011 report by the World Health Organisation (WHO) described OST as "effective in substantially reducing illicit opiate use, HIV risk behaviours, [and] death from overdose".

The failure of so many nations to implement NSPs or OST programmes is particularly shameful in light of a pledge made earlier this year by UN member states to "end the AIDS epidemic by 2030". The UN estimates that 11.7 million people inject drugs worldwide, among whom 14 per cent have HIV. The WHO estimates that injecting drug use is the cause of around 1 in 10 new HIV infections globally.

Among the countries that do not offer NSPs or OST programmes are Algeria, Ghana, and Saudi Arabia, and their failure to do so is leading to harrowing results. According to HRI’s report, some of Ghana’s estimated 6,000 people who inject drugs are using “discarded injecting equipment found in hospital waste” to do so.

Katie Stone, author of the HRI report, claims that governments’ lack of progress on harm reduction is failing people who inject drugs at a time when trends in drug use are putting even more at risk.

"Although there has been some momentum around decriminalisation in the last years, mass incarceration continues to be the famed approach to drug control. Globally, 1 in 5 prisoners is held on drug-related charges, the vast majority for personal use or possession".

“People who inject drugs are being ever further left behind”, Stone said. “In addition, emerging trends such as rising rates of amphetamine injection and overdose death are likely to see the challenges intensify. Without increased political and financial leadership, we will not end AIDS or meet other global goals relating to people who use drugs.”

At the London launch of HRI’s report, Swiss diplomat Conradin Rasi described the success that NSPs, OST, and other harm reduction services has had in his country.

"In the early Nineties, there were open drug scenes across towns in Switzerland alongside our very repressive drug policies. With the AIDS epidemic that resulted, it became clear that something needed to be done", Rasi told the audience in the Houses of Parliament. "[After implementing harm reduction services,] positive results became quickly evident. Drug deaths decreased, quality of health improved, and new HIV infections reduced dramatically".

In conjunction with the Burnett Institute, HRI found that AIDS could be almost entirely eradicated among people who inject drugs by 2030 if harm reduction services were allocated just 7.5 per cent of the estimated $100 billion spent on global drug law enforcement each year.

The UN’s pledge to end AIDS by 2030, already a bold promise, is entirely infeasible without the provision of harm reduction services to people who inject drugs.

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