‘BUILDING CAPACITY, REDRESSING NEGLECT’

Australian Perspectives on Harm Reduction 2011: the 22nd International Conference on the

Reduction of Drug Related Harm

Footage of riot

Backdrop of Prison Riots

The MENA assessment Project

Limited knowledge of the HIV epidemic in Middle East and North Africa (MENA) region

High levels of heroin production in MENA

Major drug trafficking routes pass through the region

About the MENA Project

To gather, review, analyze, and synthesize for the first time all evidence on the epidemiology of HIV among IDUs in MENA.

Methodology

Study design: – Systematic review, synthesis and analysis– Triangulation approach

Sources of data:– Scientific literature search of Medline– Country-level reports & databases– International organizations reports & databases

Results: more data than expected

Status of the evidence:– Hundreds of data sources identified

– Variable quality

– Recent integrated bio-behavioral surveillance surveys

– Some state of the art sampling methodologies

Fraction of the population who inject drugs

– There are nearly one million IDUs in MENA

– Population fraction: 0.2% (0.05-0.4%)

– Intermediate range compared to other regions

Note Iran, Iraq and Pakistan

Injecting risk behavior

– Sharing of needles & syringes: ~ 50%

IDU mode of HIV transmission:

• Fraction of the total HIV cases due to IDU

• Important mode of transmission in: Afghanistan, Bahrain, Iran, Libya, Pakistan, and Tunisia

• Note Iraq: Situation Unknown

Discussion

• Concentrated HIV epidemics at a national level: Iran and Pakistan

• Emerging HIV epidemics: Afghanistan and Egypt

• At least “outbreak-type” HIV epidemics: Algeria, Bahrain, Libya, Morocco, Oman, and possibly Tunisia

• Apparently low/zero HIV prevalence: Lebanon, Jordan, Kuwait, Saudi Arabia, and Syria

Expand HIV surveillance

Expand access to HIV testing, prevention, and treatment services

Establish national harm reduction programs

Recommendations: quite obvious

‘Arab Spring’: implications

High Unemployment: drug use risk environment

Implications for civil society overall

Implications for civil society engaging with injecting drug users.

High Unemployment: drug use risk environment

Implications for civil society overall

Implications for civil society engaging with injecting drug users.

Iran a leader

One of worlds highest rates of opium/heroin usage.Religious conflicts resolvedLarge numbers of civil society organisationsMulti-faceted programs:

–Needle exchange–Methadone–Prison-based interventions

Sub-Saharan Africa

Nigeria: trafficking, usage and lack of Government response.Seychelles: tiny nation, Catholic Church oppositionTanzania: very early stages of mapping and planning. Methadone beginning soon.Challenge: advocacy in generalised epidemic populations.

Other Snippets

Indonesia to begin prison-NSP

Moroccon King endorses harm reduction

– including prison-NSP.

Excellent session on smoking harm reduction.

– More than plain packaging

Afghanistan has begun methadone.

DRUG LORDS CELEBRATE PROHIBITION

To raise awareness of 50 years of prohibition, Hungarian Civil Liberties Union filmed the real beneficiaries:

Including Igor the Russian Heroin Trader

http://drogriporter.hu/en/dli_short