Harm Reduction Responses to Drug Use: Cross-Regional Perspectives

Many people throughout the world continue to use psychoactive drugs despite strong efforts to prevent them from doing so. There is a wide range of adverse medical, public health, and social consequences associated with such use. People Who Inject Drugs (PWID) face, among other things, elevated rates of HIV, viral hepatitis and tuberculosis.

“Harm reduction” refers to policies, programs and practices that aim to minimize the adverse consequences associated with the use of psychoactive drugs by people who are unable or unwilling to stop. Many countries, including in the Middle East and North Africa (MENA) and Asia, permit harm reduction strategies such as needle and syringe exchange programs (NSPs), opioid substitution therapy (OST), and drug consumption rooms (DCR)humane options that are conducted in safe spaces under medical supervision.

Harm reduction networks operate in every region of the world. These networks are making important contributions at the local, national, regional and international levels. At the same time, however, national drug policies that criminalize drug use remain quite prevalent. Furthermore, many harm reduction programs lack funding or other resources and are thus ill-equipped to meet demand. Additionally, age- or gender-based restrictions, various other forms of discrimination, social stigma, and marginalization prevent people from accessing services.

The next United Nations General Assembly Special Session on Drugs (UNGASS) was originally scheduled to be held in 2019. However, in the face of a fractured consensus among UN members states regarding the effectiveness of the existing international drug control regime, the convening of the next UN GASS has been moved up to 2016. With preparations for this summit gathering momentum, the Middle East-Asia Project (MAP) launches a special essay series that examines harm reduction responses in the MENA and Asian regions—the actors and networks engaged in such activities, the contributions they have made, and the roadblocks they have met. 


MAP ESSAYS

Harm Reduction – What It Is and What It Is Not
Alex Wodak
The often-misunderstood term “harm reduction” means simply that the paramount policy or clinical objective is reducing the harms from psychoactive drug use. In the conventional drug policy that has prevailed globally for decades, the reduction or elimination of drug consumption was considered the principal policy aim, while the harms caused by drug use or drug policies were usually an afterthought.

Comparing Harm Reduction Advocacy Approaches in the Middle East, Central Asia, and Southeast Asia
Dave Burrows
For more than three decades, harm reduction initiatives for people who inject drugs (PWID) have focused on preventing the spread of HIV. The objectives of harm reduction activities have gradually expanded to include reducing the number of PWID through education programs, stopping the spread of hepatitis C and other infections, and preventing overdoses. However, the single greatest rationale for introducing or scaling up harm reduction remains HIV prevention and (to a lesser extent) treatment, care, and support for PWID living with HIV.

The Current State of Harm Reduction Policy in the Middle East  
Emran M. RazaghiMohammad Binazadeh  
In the late 1980s, Western governments began to adopt drug policies based on the strategy of “harm reduction” (HR), which concentrates on alleviating the negative effects of drug use rather than on reducing its prevalence. This policy shift, largely motivated by the recognition that injection drug use contributes to the spread of HIV/AIDS, soon paid off. Within a decade the countries that had adopted HR as their primary policy had managed to control the injection-related spread of HIV and other blood-borne infections such as hepatitis. The spread of HIV among substance users came almost to a halt in Australia and the Netherlands, which had implemented the strategy vigorously. HR was a victory for not only health systems, which had successfully controlled a viral infection with no known “infectious disease model” solution (that is, a vaccine or effective antiviral treatment), but also for society in that HR forestalled the adoption of ineffective strategies such as segregation, which instead marginalizes drug users and abandons them to their high-risk behaviors.

Civil Society and Harm Reduction in Thailand – Lessons Not Learned  
Pascal Tanguay  
The Thai government was acclaimed in the 1990s for the bold approaches it supported to reduce HIV transmission among sex workers. Later, the Thai government’s leadership was internationally praised for providing generic antiretroviral treatment (ART) to people living with HIV. Today, global leaders applaud the Thai government’s decision to provide ART to everyone in an effort to prevent transmission, as well as for its decision to take full financial responsibility for HIV programming as of 2017, essentially weaning itself off external donor support. Indeed, there is much to celebrate, and the Thai government’s contributions to leadership and innovation in the area of HIV prevention, treatment, care, and support must be acknowledged—but not blindly.

Drug Use and Harm Reduction in the MENA Region and in Lebanon  
Nadia Badran  
Repressive policies that stigmatize and punish drug users have tended to exacerbate social problems rather than mitigate them. In contrast, harm reduction (HR) approaches to drug use have been shown to prevent the spread of blood-borne viruses (such as HIV, HBV, and HCV), thereby lowering morbidity and mortality rates. Over the past 15 years, many HR initiatives have been launched in the MENA region, including Lebanon. However, continued progress in HIV prevention will require more structured and comprehensive HR interventions, adjusted to the needs of local populations.

Outreach Workers on the Front Lines: Malaysia’s Needle and Syringe Exchange Program
Ismail BabaAzlinda Azman  
Outreach workers have been the backbone of Malaysia’s Needle and Syringe Exchange Program (NSEP) since its inception in 2006. This essay examines the origins of the NSEP, the role that outreach workers play, the everyday challenges they face in providing services to people who inject drugs (PWID), and the critical importance of supporting their efforts.

The Rise of Harm Reduction in Morocco: Successes and Challenges
Hakima Himmich
Morocco has become the second MENA country after Iran to implement a nationwide harm reduction strategy aimed at stopping the spread of HIV/AIDS among people who use drugs. Moroccan civil society organizations (CSOs) have worked to devise a comprehensive strategy that will disseminate a full package of harm reduction services. The longstanding HIV/AIDS community-based organization Association de Lutte Contre le Sida (ALCS) is leading these efforts to make the national drug policy less repressive and more effective. Harm reduction is based on the notion that marginalized populations are entitled to their basic human rights, but in some countries, governments have merely used it as another tool for social control. ALCS has sought to prevent this from occurring in Morocco by remaining focused on harm reduction’s core principles.

Harm Reduction in Indonesia: At a Difficult Juncture
Joyce Djaelani Gordon
Harm reduction started in Asia about two decades ago, as a response to both the increase in injecting drug use and the spread of HIV/AIDS in the region. Most of these programs were spearheaded by community organizations and NGOs, often in conflict with the more moralistic approaches of their respective governments. Indonesia began moving toward the adoption of harm reduction policies in 1999, when various stakeholders gathered to discuss the state of AIDS and injecting drug use in the country.


Useful Links and Resources

Journals 
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Reports
    * European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). (April 2010).
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Networks and Organizations
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    * [Iran]
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