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"The lesser evil"
The
Star (www.thestar.com.my)
(15/07/05)
AFTER decades of an all-out campaign against
drug abuse – rooted in zero-tolerance and draconian punishment for drug use
– the Malaysian public is now being challenged to accept harm reduction
methods deemed to be tolerant of drug use.
Harm reduction is essentially about reducing
the harm caused by drug use, to the user and the wider community. It
includes strategies such as rehabilitation, needle/ syringe programmes and
drug substitution programmes.
Abstinence from drugs is the best form of
harm reduction, and rehabilitation remains the mainstay of our drug abuse
prevention strategy.
Rehabilitation, however, takes time and is a
long-term plan. The burgeoning AIDS epidemic in recent years has, however,
forced experts to look at the quickest and most effective ways of preventing
the spread of HIV.
The efficiency of HIV transmission via
injecting is almost six times higher than for heterosexual acts.
“It is not the drugs that are causing HIV
infection, but the contaminated needles. So the best approach is to
eliminate used needles. When drug users are having withdrawal symptoms, it
is hard for them to look for clean needles, or clean them. So making clean
needles available is the fastest method of intervention,” said Palani
Narayanan, who has worked on harm eduction programmes all over Asia.
He has helped the Indonesian government set
up their National Harm Reduction programmes as adviser to AusAid for the
past two years. Palani is now back in Malaysia, and is adviser to the
Malaysian AIDS Council’s Harm Reduction Working Group.
His return is timely as Health Minister Datuk
Chua Soi Lek recently announced that we will embark on a needle exchange
programme. Implementation of harm reduction initiatives such as needle
exchange programmes, said Palani, could be a turning point in our fight
against HIV/AIDS.
Malaysia currently has the fifth fastest
growing HIV infection rate in the Asia-Pacific. Three-quarters of reported
HIV cases are injecting drug users. In 2004, the Health Ministry estimated
that 18.5% of injecting drug users were HIV positive.
THERE are two kinds of needle/syringe
programmes – needle distribution and needle exchange.
“Needle distribution is done when there are
limited resources, and the epidemic among the injecting drug population is
severe.
“Needle/syringe exchange programme is when
clean needles are given out in exchange for used ones. This ensures that
there is no re-using or re-selling of contaminated needles.
“Needle exchange programmes are used when HIV
infection among the injecting drug users is on the rise, such as in
Malaysia,” said Palani.
The needle exchange programme goes beyond
exchanging used needles for clean ones. It is also often the starting point
for drug users to access information and services for treatment and
rehabilitation.
“The needle exchange programme cannot stand
alone, but must be supported by counselling services, primary healthcare
facilities, referrals to rehabilitation and voluntary counselling and
testing services,” Palani added.
One of the biggest challenges in implementing
the needle exchange programme is addressing its legality.
Under Section 37 of the Dangerous Drugs Act
1952, it is illegal to carry injecting equipment without a prescription and
possession of needles may result in up to two years’ imprisonment.
“In Indonesia, the biggest challenge in
implementing the needle exchange programme was the legal aspect. Injecting
paraphernalia can be used as evidence to convict someone for drug use. In
Indonesia, a memorandum of understanding was signed between the AIDS Council
and the Police to allow the needle exchange programme to work,” said Palani.
Malaysia also has a similar legislation. It
takes a long time to change laws, and health authorities will need the
cooperation of the Police and National Anti-Drug Agency to provide an
enabling environment for needle exchange to take place.
The government will also have to build
capacities to ensure that the needle exchange programme succeeds.
“For harm reduction programmes
(rehabilitation, needle exchange, substitution therapy) to have an impact,
we need to ensure wide coverage. We need to reach at least 75% of the
estimated 150,000 injecting drug users in Malaysia. In Kuala Lumpur, drug
injectors share needles with between two and three persons each time, and
inject an average of four to five times a day,” said Palani.
IKHLAS, which Palani co-founded in 1992, is
currently one of a few NGOs working with drug users. With 12 workers and
limited resources, Ikhlas can only cover a small population of drug users in
Kuala Lumpur.
In Indonesia, needle exchange programmes are
also undertaken at selected Puskemas, or government community health
centres.
The long-term plan, said Palani, is to try to
implement needle exchange programmes in government clinics to ensure wide
coverage using existing facilities. However, this will involve changing the
mindset of healthcare workers, from seeing drug users as criminals to
treating them as patients.
“Data from many countries have shown that
needle exchange programmes are effective in reducing HIV infection. There
has been no evidence that such programmes increase injecting drug use,” he
said.
Notes: STF -: Although cheap and
effective, needle exchange programmes to curb HIV infection among injecting
drug users are politically the most difficult to implement as there are
legal obstacles to overcome, reports IVY SOON.
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