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‘Building capacity, redressing neglect’

‘Building capacity, redressing neglect’. Australian Perspectives on Harm Reduction 2011: the 22nd International Conference on the Reduction of Drug Related Harm . Backdrop of Prison Riots. Footage of riot. The MENA assessment Project.

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‘Building capacity, redressing neglect’

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  1. ‘Building capacity, redressing neglect’ Australian Perspectives on Harm Reduction 2011: the 22nd International Conference on the Reduction of Drug Related Harm

  2. Backdrop of Prison Riots Footage of riot

  3. 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

  4. 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.

  5. 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

  6. 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

  7. 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

  8. Injecting risk behavior • Sharing of needles & syringes: ~ 50%

  9. 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

  10. 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

  11. Recommendations: quite obvious • Expand HIV surveillance • Expand access to HIV testing, prevention, and treatment services • Establish national harm reduction programs

  12. ‘Arab Spring’: implications • High Unemployment: drug use risk environment • Implications for civil society overall • Implications for civil society engaging with injecting drug users.

  13. Iran a leader • One of worlds highest rates of opium/heroin usage. • Religious conflicts resolved • Large numbers of civil society organisations • Multi-faceted programs: • Needle exchange • Methadone • Prison-based interventions

  14. Sub-Saharan Africa • Nigeria: trafficking, usage and lack of Government response. • Seychelles: tiny nation, Catholic Church opposition • Tanzania: very early stages of mapping and planning. Methadone beginning soon. • Challenge: advocacy in generalised epidemic populations.

  15. 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.

  16. 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

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