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.



  1. hi paul. i agree with you wholeheartedly bro. especially the last two paragraphs about not criminalizing but also not condoning it. i think polarizing it destroys the humanity couched in between the polarizations.

    i myself am a human rights advocate. love what youre upto. i am also working on a project that hybrids art, philosophy and human rights and uses art as a tool for resistance. would love to connect with you on this. looking forward to hearing back!

  2. Hi George - many thx for the feedback. We have had a lot of pick up today on the harm reduction angle which is a good sign. You're work sounds interesting indeed. Let me know how/if I can learn more . Work email is Paul.conneally@ifrc.org