‘HIV/AIDS in our Region: Human Rights and Interventions’ 3 May, 2007

1. Australia's critical role supporting harm reduction in Asia: helping control HIV spread among and from injecting drug users ‘HIV/AIDS in our Region: Human Rights and Interventions’ 3 May, 2007 School of Public Health & Community Medicine Support for Health for All in our Region Dr. Alex Wodak, St. Vincent's Hospital, Darlinghurst

2. Outline: • HIV: current global overview • HIV: Asia developments • Why harm reduction matters • Political support for harm reduction • What stops harm reduction? • Harm reduction Asia today • Australia’s role in Asia

3. HIV: current global overview • First identified: 5 June 1981 • 1987 global infections 50,000 • 2007 global infections 60 million • Major threat health, social, economy, national security of nations • Most serious threat global public health since Black Plague 1340s

4. A spectre is haunting Asia – the spectre of HIV

5. HIV Asia developments: • Epicentre shifting from Africa to Asia • From 800 million to > 2.5 billion • From IDU minimal to IDU driving HIV • 30% HIV global outside Africa • 30% HIV outside Africa are IDUs • IDUs 10% global HIV • IDUs central to control HIV in Asia

6. Why harm reduction matters: • Effective: reducing HIV among IDUs • Safe: does not increase IDU • Cost effective: affordable • Scientific debate re HR now over • Meaning ‘harm reduction’: • Reducing harmful consequences without necessarily reducing consumption • Achieving what is feasible; rather then setting & failing to reach utopian goals

7. Harm reduction HIV package: • Needle syringe programs • Substitution treatment • Education • Community development • Other interventions • Both community and prison settings

8. Political support harm reduction: • WHO, UNAIDS, World Bank, Red Cross • UNODC +/- but increasing over time • Afghanistan, Australia, Brazil, Canada, China, Europe, Iran, Pakistan • UN Position Paper. Annex Report 8th Session ACC Subcommittee 2000 • UNGASS Declaration of Commitment HIV/AIDS 2001 – P 52 explicit targets • UN Dublin Declaration 2004

9. What stops harm reduction? • USA, Russia, Japan, Sweden • INCB • Report of Legal Affairs Section UNDCP 2002: • Q: is harm reduction compatible with UN drug conventions? • A: ‘consistent with treaties’ • Result of entrenched opposition drug law enforcement: too little, too late

10. ‘Proponents (of harm reduction) contend harm should be reduced by needle exchange, ‘safe’ injection facilities, decriminalisation or legalisation of drugs, heroin maintenance, and other measures. Such measures are acquiescence: attempts to manage consequences of drug abuse rather than addressing the problem directly’ US Office of National Drug Control Policy 28 July 2006

11. Australia: against ‘The path to success does not lie in giving in to the drug barons; it does not lie in giving in to the harm minimisation philosophy’ John HowardHansard, December 12, 2002 ‘You’re soft on drugs, Tony, you give free needles to heroin addicts’ Kim Beazley (Opposition Leader) to Tony Abbott, June 14, 2006

12. Australia: for • Commonwealth $10 million to states/territories /year from 1999 enhance needle syringe programs • Generous support AusAID for harm reduction Asia • Vigorous support harm reduction at UN • Diversion drug offenders from criminal justice to drug treatment • ‘Walking both sides of the street’

13. MCDS: ‘Ministerial Council on Drug Strategy (MCDS), the peak national policy … body for licit and illicit drugs …’ Communiqué May 20 2004: ‘Ministers endorsed the new National Drug Strategy 2004-2009 … ‘… Ministers endorsed harm minimisation as the Australian approach… defining … harm minimisation encompasses supply reduction …, demand reduction … and harm reduction strategies.”

14. The great enemy of language is insincerity. When there is a gap between one's real and one's declared aims, one turns as it were instinctively to long words and exhausted idioms, like a cuttlefish squirting out ink. In our age there is no such thing as ‘keeping out of politics’. All issues are political issues, and politics itself is a mass of lies, evasions, folly, hatred, and schizophrenia... Political language...is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind.George Orwell ‘Politics and the English Language’

15. Harm reduction Asia today: • Major change last 5 years • Now embraced in principle by all major governments Asia from Iran to China • Many starting, expanding programs • India 7 HR NGOs 1999, > 300 2007 • China aiming 300,000 MMT 2008 • Thailand since September 2006 • Indonesia methadone in prison

16. Australia’s role in Asia: • Critical issue for Australia • Strong support AusAID • Altruism • Also self-interest • Rhetoric, reality irreconcilable • Risk that rhetoric becomes reality • Army of Australian consultants working for harm reduction in Asia

17. Harm reduction, human rights: • Cannot contain HIV without respect human rights those most at risk, those infected • UNAIDS June 2005 PCB prevention document • ‘Criminal law should not be an impediment to measures taken by States to reduce the risk of HIV among injecting drug users…’ OHCHR/UNAIDS ‘HIV/AIDS and Human Rights. International Guidelines. Geneva 1998.

18. Conclusions: • HIV major threat global public health • Asia, IDU growing importance • Harm reduction one of most effective interventions in HIV repertoire • Australian support HR Asia critical • Need to end confusion Australian official attitudes to harm reduction • Critical respect human rights at risk or infected