Wednesday, February 24, 2010

Through the Eye of a Needle

My mate, a career bureacrat goes apoplectic. He slams his gin and tonic down on the marble tabletop. “WHAT! You mean the Red Cross gives these… these… junkies free needles so they can fill themselves full of heroin? Well that’s it. You’ve just lost my respect”.

It’s true. The Red Cross gives injecting drug users free needles so that they can continue their habit.


I spent much of yesterday in small town called Slutsk in mid-Belarus to see just why.

Let’s be clear. Drugs are – according to the book and film Trainspottting – great fun but they destroy lives. Nikolay and Irina are two cases in point. All their money goes on “Semechki” as the home-made poppy-seed paste is called. Their families have long since kicked them out. They work, they live, just to use. Their sober hours are spent wishing they’d never started, till the rats start scratching in their brains and no other thought but “shot” is entertained. Then the release, the bliss, the love. Till it wears off and the hate-it-need-it-love-it” cycle starts again.

But amazingly, Nikolay and Irina have purpose in their lives now. Every day they come to a shabby apartment on the edge of Slutsk (pop 70,000, levelled in the second world war), under the shadow of two massive chimney stacks, and start their work.

Each has 40 clients who inject several times a day. Nikolay and Irina bring the used needles (each with a residue of narcotics in them, which without a special agreement between the Red Cross and the police could carry a jail term), they leave the needles for destruction and go out, back to the alleys and tower blocks where their peers are waiting.

“No one I work with uses a dirty needle now, but we all used to”, says Nikolay, ansting to get out the door and bang up. “We know what AIDS can do and we don’t want to catch it.”

That’s the beauty of harm reduction. It’s more than just needles, it’s swabs, condoms, vitamins, special chocolate bars that strengthen the blood, but essentially it’s about needles. If someone’s going to use no power of persuasion will work. An infected needle injects the virus straight and deep into another person who can pass it on and on and on through sex, drugs and rock and roll. Well, ok, not rock and roll, but sex and drugs for sure.

One truly impressive feature of the program is the volunteer manager. She’s about 64, short, silver-haired and looks just like any of our mums. And that’s the secret. She is someone’s mum. She sees the harm drug injection does to her community and she will do what it takes to limit its spread.

Nikolay and Irina know the streets, know the users, know the risks. They are trusted in a way no police, partner, parent or pastor could ever be. That’s why they go to schools and tell kids what life as a user is like. They don’t say “just say no”, they say “this is how it is, you choose”. Irina gives a wistful sigh and says “if only this programme had existed 20 years ago I wouldn’t be in the mess I'm in now”.

But I’m not naïve enough to think that this will persuade my bureaucratic buddy. So here’s a list, a cold, impassionate list, as to why harm reduction is the only game in town, why it works, why we do it.

The first seven points are my own, from personal observation, and then follow the humanitarian and legal/human rights arguments.

  1. “Let them die” is not an option for the Red Cross
  2. It works. Everywhere that needle exchange has been tried, it works. Where reducing the supply and locking up users (so-called social evils programmes) are tried, the HIV rate, the crime rate, the usage rate all increase. See chapter 5 in this report.
  3. It puts health workers in contact with a naturally secretive community
  4. Contact between health workers and users makes usage safer and may result in users seeking to come off drugs
  5. It helps users feel useful, wanted, trusted.
  6. It keeps needles off the pavement
  7. The Red Cross emblem is not only for the battlefield or prison. Everyone can avail of its protection, its neutrality, a non-judgemental, safe haven
  8. Currently, it is estimated that there are more than 10 million people globally who inject drugs. Of these, 2-3 million people are estimated to be HIV-positive. HIV can rapidly spread through drug using populations and can stabilize at high prevalence rates. Studies indicate that in the absence of preventive measures the prevalence rate can rise up to 40 per cent or more within 1-2 years of introduction of HIV into a community.
  1. Transmission of HIV also occurs through sexual contact both between IDUs (injecting drug users) and with other sexual partners, including through sex work, facilitating the transmission of HIV to their children and into the general community.
  2. The right of everyone to the enjoyment of the highest attainable standard of physical and mental health, is reflected in Article 25(1) of the 1948 Universal Declaration of Human Rights; Article 12 of the 1966 International Covenant on Economic, Social and Cultural Rights; Article 24 of the 1989 Convention on the Rights of the Child; and Article 12 of the 1981 Convention on the Elimination of All Forms of Discrimination against Women
  3. The right to non-discrimination is enshrined in Article 5(e)(iv) of the 1965 International Convention on the Elimination of All Forms of Racial DiscriminationThis by definition applies to people who inject drugs, including HIV-positive IDUs.
  4. In May 2000, the UN Committee on Economic, Social and Cultural Rights adopted a general comment on the right to health which proscribes, any discrimination in access to healthcare
  5. In the Declaration of Commitment, unanimously accepted at the 26th UN General Assembly Special Session on HIV/AIDS, 2001, states made specific commitments relevant to IDUs: By 2005, ensure that a wide range of prevention programmes is available in all countries, particularly the most affected countries, including expanded access to essential commodities, including male and female condoms and sterile injecting equipment. By 2003, all States will have eliminated any laws, policies and practices that discriminate against people living with HIV/AIDS and other highly vulnerable groups.
  6. The above outlines the legal basis for states to respect, protect and fulfil, all IDUs’ human rights. This includes comprehensive harm reduction programmes
  1. In keeping with the fundamental principles and the role of the Red Cross and Red Crescent in protecting and promoting the health of the most vulnerable populations, IDUs as a vulnerable population merit the strong and privileged voice of social conscience. The Red Cross can lobby governments to fulfil IDUs’ rights to the enjoyment of the highest attainable standard of physical and mental health.

Excuse me, I have to buy my friend a large G and T.


  1. Joe, thanks for this... It is really good to hear a good argument for harm reduction, especially one with a movie quote.
    It got me thinking, most of those who make judgement about such programmes, or in fact about drug users, have probably never seen them outside a movie screen, and they make their judgments accordingly. Maybe a point to add to your arguments is that instead of the hate, mistrust, and alienation, such programmes will introduce people who use to the rest of us in a more realistic and human way and help break that cycle of misjudgment and impersonation. Much of me feels that if the bigger society starts seeing them as people whose unfortunate circumstances put them there rather than 'evil' people, we can, even your businessy friend, start accepting them.

  2. I was with Joe in Slutsk and wrote a short note on Facebok. Got two comments, the second being "they should all be exterminated." Fairly typical of many, I fear. So if the humanitarian argument isn't convincing enough, the simple fact that closing our eyes to the problem will eventually bring it to "us" should be. Rather depressing, though, that the argument of compassion toward fellow human beings isn't enough.