Tuesday, November 30, 2010

Do No Harm - why clean needles are magic bullets

December 1st is World Aids Day. If government policies fighting the spread of HIV are to succeed, they must treat people who inject drugs through healthcare and not through law enforcement.

Someone, somewhere, right now is in a basement room with a needle and a spoon, trying to take away the pain. In fact, if the 16 million people who are injecting drugs were gathered in one place it would be equivalent to the entire population of Shanghai.

In the shooting galleries of the world, from Mumbai to Managua, the frequent sharing of dirty syringes and needles is providing easy passage for the transfer of tainted blood from one body to another. It is simply the most effective way to spread the transmission of HIV and reverse years of hard-won progress.

There are many reasons why people choose to inject drugs rather than snort, smoke or swallow. Chief among these reasons is the fact that injectable drugs are cheaper, easier to find, quicker to take (handy if the police are about) and reputedly produces a faster and more intense high.

Taking drugs by needle injection has escalated in recent years and it is a trend that is observed on every continent. When injecting drugs is combined with selling sex to pay for drug habits, it creates a cocktail that massively increases the likelihood of spreading HIV to an unsuspecting public.

In Sichuan province in China, for instance, we know that almost 60 per cent of the women who sell sex are also injecting drugs with shared, contaminated needles. In parts of the UK it is as high as 78 per cent, and in Syria more than 50 per cent.

Why people choose to take drugs is a long discussion, but most often it is to escape the hardship of their daily lives, to create an artificial high where they may feel safe and elated. It is a flight from reality, that regrettably often leads to a crueler existence that brings even more suffering and stigma.

But many governments around the world – indeed more than 80 per cent of them – are also inclined to live with an artificial reality, blind to the evidence that criminalizing people who inject drugs is a failed policy that even contributes to the spread of HIV.

Public health officials are deliberately ignoring the fact that to be successful in containing HIV, health services must start to provide what are known as harm reduction programmes to support and care for people who inject drugs. These programmes typically offer heroin-replacement syrups, sterile needles and a safe environment for those who are among the most vulnerable in our society.

Instead, people who inject their drugs are constantly demonized and detained with little or no regard for their rights or the healthcare that they so desperately need. Often, the best you can hope for, if you are hooked to taking drugs through a needle, is to be driven underground to live with your addiction in the dark back streets and abandoned buildings of our towns and cities. You are shunted out of sight, rendered invisible to society, and left alone with your HIV death sentence.

Misguided government policies are without doubt contributing to the growing rate of HIV transmission that is on the rise among drug-injecting communities. We know that more than 10 per cent of new HIV infections result from sharing needles and syringes. If we are to take sub-Saharan Africa out of the equation – where sharing drug paraphernalia is less common but nevertheless firmly on the rise – the new rates of infection from unregulated syringe sharing rises to more than 30 per cent.

If we drill down to country level, in Russia for instance, HIV transmission amongst injecting drug users is a staggering 83 per cent. In Ukraine, it is 64 per cent. In Malaysia, 72 per cent. In Vietnam, 52 per cent – you get the picture. These levels of HIV-positive people who inject drugs is so high that some countries are edging dangerously close to a generalized epidemic. Yet laws and policies continue with failed enforcement tactics singling out users for blame, incarceration and exclusion.

Left unchecked and untreated, injecting drug use constitutes a serious public health hazard that can only be addressed through rational public health services that act according to medical science rather than misinformed morality. Harm reduction programmes that combine free exchange of sterile needles, drug replacement therapy, addiction counselling and other forms of health and social support, work in the prevention and containment of HIV. This is worth repeating. Harm reduction works.

Treating drug addicts as criminals, subjecting them to stigma, punishment and censure may play out well on the evening news for tough-talking politicians, but it is a recipe for failure. Worse still, it is destined to fuel the rise of HIV infection not only among those unfortunate enough to have a serious drug addiction, but also for children born into addiction and ordinary members of the public who are not normally exposed to HIV risks. Injecting drug use is a public health issue. It is an issue of human rights. It cannot be condoned – but neither should it be criminalized.

One more thing before we go - we would like to show you a trailer of a documentary called "People Like Us" that shows the importance of treating people who inject drugs with dignity, and allowing them access to health care (access to their rights if you like). If you would like to watch the full movie you can click through from Youtube. You can also find a report and many more communication products on the topic on the IFRC's special webpage.


Tuesday, November 23, 2010

Seeing into the future - Kathmandu's nightmare

Last week I had the opportunity and privilege to spend time in beautiful, crazy Kathmandu. We were there as part of a gathering of Red Cross and Red Crescent Societies from all over Asia Pacific. Colleagues from as far afield as North Korea, Mongolia, Maldives, Philippines, China, Laos, Cambodia, Japan, Australia, Thailand and East Timor, to name a few, were working together to try and improve our emergency response and preparedness.

Fail to prepare - prepare to fail, is what Roy Keane used to mantra all the time. And of course he's right. But in Kathmandu's case the future will inform us on the usefulness of foresight. We know for instance that Kathmandu tops the list of the world's most at risk cities in danger of being stricken by an earthquake.

Seismologists are certain. Indeed they agree that it is overdue and that the longer time passes without it happening the worse it is going to be. Right now there is general agreement that the would-be quake will register 8 or more on the Richter scale i.e. about ten times harder than Haiti's horrible quake. And this will happen in a city of 2.5 million people living in cramped, poorly constructed homes, with little or no awareness of the imminent dangers.

Aid agencies believe that the one-strip runway will be destroyed and rendered useless, possibly for weeks. Even if it isn't its capacity to cope with the aid that will be required is worse than Haiti's (which could take four planes an hour - and only if it had the resources at hand to unload the cargo fast enough - you may remember that particular controversy) - but Haiti had ports and Kathmandu is landlocked, mountainous, inhospitable terrain - especially for a massively urgent aid operation. Logistics experts who know the region say Kathmandu could be cut-off for more than one month.

Casualties in Kathmandu are expected to be huge, some say that they will 'incapacitate' 70% of potential workforce (working to rescue, evacuate, support the injured etc.). There are plans to evacuate survivors to flat areas which are safer from aftershocks and more accessible for air-drops and so forth. The only problem here of course is that most of these areas are high in the mountains far from any services such as water and sanitation.

These are the type of reality-based conundrums that local government, civil society organizations and other actors such as ourselves are trying to get our heads around in Kathmandu (and in Delhi, Istanbul, Tehran, Ecuador, Manila and other hot spots). Preparing now to mitigate loss of life and injury is important but massively complex. Preparing for the response likewise. It doesn't bear thinking about but think about it we must.


Wednesday, November 3, 2010

No Doubting Thomas - Hurricane Preparedness at full speed in Haiti

HDEO gives an update on preparation efforts in Haiti ahead of the arrival of Hurricane Thomas and the damage it is expected to wreak. The next 48hrs will be all about trying to save lives before disaster strikes.

Investing in preparedness against natural disasters and severe weather events is a hallmark of the Red Cross community-level approach which stresses prevention and preparation over the knee-jerk, parachute response. This investment before disaster strikes is about to be tested to the core as Hurricane Tomas threatens Haiti. Authorities are predicting that the storm will make landfall on Haiti’s south-west on Friday, and may come close to making a direct hit on Port-au-Prince and other earthquake affected areas on Saturday.

The country is on high alert. The government is already advising people to seek
shelter with families and friends over the weekend, or to take whatever steps they
can to protect their families and their assets.

Even if there is not a direct hit, the storm is big enough and strong enough to see heavy rains and strong winds affect communities across the whole of the country, particularly the South. We know from experiences in 2004 and 2008 that even tropical storms or heavy rain can be catastrophic for the country.

How is the Red Cross preparing

We have been preparing for this kind of event since the first weeks of the earthquake response. Historically we know that Haiti is disproportionately vulnerable to hurricanes, and that even tropical storms or just heavy rain can trigger serious disasters.

We have reached tens of thousands of people through disaster preparedness activities in dozens of camps. We have worked with communities to help them dig drainage ditches, sandbag hillsides and create evacuation routes. In addition, Red Cross volunteers have provided emergency first aid training, and handed out waterproof bags that contain safety messages and can be used to store and protect important documents.

We have sent 1.5 million of SMS to communities since Monday right across the country, providing people with simple and accessible information on the steps they can take to minimize hurricane danger. These important messages have also been relayed through our weekly, national radio programme (Radio Croix Rouge Haitienne), through messages carried through camps on ‘sound’ trucks, and through dialogue between communities and trained Red Cross volunteers.

What’s in stock…

We have enough emergency stocks in country for 17,000 families. These include emergency shelter kits (tarpaulins, rope, nails and tools), jerrycans, hygiene kits, and kitchen sets (for example).

Additional supplies for 8,000 families are coming this week from the Red Cross’ regional hub in Panama. Supplies for 500 families have been sent from Port-au-Prince to Les Cayes to bolster readiness there. Supplies for a further 500 families also sent tomorrow to Jeremie.

Red Cross volunteers will continue to visit camps across the earthquake affected area, working to make sure that as many people as possible are aware of the storm and have information on what they can do to protect themselves.

Eight emergency response teams (ERTs) are on standby in Jacmel, Leogane and Port-au-Prince. These multi-disciplinary teams, comprising representatives from all Red Cross societies in Haiti can quickly respond to the disaster, providing us with rapid assessments and guiding the crucial initial delivery of assistance.

We also have the capacity to quickly bring in additional resources from the region or globally. A team of highly-skilled disaster assessment experts (known as a Field Assessment Coordination Team – FACT) has been placed on standby.

As Thomas approaches, direct hit or not, we will be relying on the fact that intense preparedness for inevitable storms and hurricanes will pay off.


Note to Journalists - Broadcast quality b-roll, showing the disaster preparedness efforts of the Red Cross in Haiti can be accessed at www.ifrc.org/newsroom.