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August 2, 2018

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Clean needle exchange helps in fight against HIV

At the International AIDS Conference in Amsterdam, a doctor is on duty to prescribe methadone, a legal heroin substitute, to delegates who might be struggling with withdrawal.

Nelda de Grave, an addiction specialist, was not sure she would have any takers, but considers it her duty to ensure any addicts among the conference goers are 鈥渘ot sick, not in withdrawal鈥 and 鈥渨ell enough to follow鈥 the proceedings. 

Three came for prescriptions on July 24 alone.

One floor down, in a large advocacy space at the conference venue, counsellors staff a 鈥渉arm reduction鈥 booth stacked with boxes upon boxes of sterile needles for intravenous drug users who may need them. 

No questions asked.

Such pragmatism about narcotics use and addiction may be par for the course in the Netherlands, a country known for its open-minded approach to drugs, which remain illegal.

But for many delegates it may seem too good to be true.

鈥淲e were asked (by conference organizers) to be ready especially for people from eastern Europe and (central) Asia,鈥 de Grave said.

This is a region where experts say oppressive drug laws are fuelling an HIV surge through the sharing of tainted needles.

Infections with the immune system-wrecking virus that causes AIDS rose 30 percent in the region since 2010, according to a UNAIDS report.

鈥淭o be on methadone, obviously is not common in these countries, so only to attend the conference, well you have to have some medication,鈥 said de Grave. 鈥淭hat is why we are here.鈥

For epidemiologist and public health expert Chris Beyrer, 鈥減rogressive drug policy can really be a critical part of controlling the HIV epidemic.鈥

鈥淧art of that is making sure that people who are using, are doing so in ways that are safer and are not associated with disease transmission,鈥 he said on a visit to a nearby addiction center in Amsterdam.

The center not only offers counselling, but also offers to test drugs, including heroin, for purity and safety. Walk-in customers pay 2.50 euros (US$3) for a test.

In the Netherlands, experts say, HIV transmission through intravenous drug use is extremely rare. The country has several needle exchange facilities and safe consumption venues.

Ingrid Bakker, one of the 鈥渉arm reduction鈥 advisers stationed at the conference, said about 20 people had made use of the service in the first three days.

鈥淲e have a lot of stuff,鈥 she said, gesturing around the tiny booth. 鈥淢ost of it is for injecting.鈥

There are needles and syringes and sterile cups for dissolving heroin. 鈥淵ou can also do it in a spoon, of course that鈥檚 what most people do, but this is sterile,鈥 she said.

There are filters for removing impurities from the liquid heroin mix, sterilizing wipes, pads to apply pressure to the prick point and portable, yellow, plastic bins for discarding used needles.

鈥淭his is tinfoil for, if you want to smoke heroin,鈥 said Bakker, pointing out another product.

鈥淚n the Netherlands we have very good quality heroin so there鈥檚 a lot of people who don鈥檛 inject heroin but they smoke it from foil, 鈥榗hasing the dragon鈥.鈥

This is a form of harm reduction, she explains, as it presents an alternative to injecting.

There are booklets of sniffing papers too, with tips handily printed on them.

鈥淐rush and chop the powder as finely as possible,鈥 the sheets advise. 鈥淏e kind to your nasal passage and go for small lines.鈥

The papers help stop the spread of Hepatitis C, which can cause liver disease, said Bakker.

鈥淧eople use straws, for instance, which are quite sharp. If you share them and, if you have just a tiny, tiny, tiny bit of blood, it (the virus) could be transferred.鈥

According to Ann Fordham, who leads the International Drug Policy Consortium, an advocacy network, there was a 30-percent increase in HIV among people who inject drugs worldwide between 2011 and 2015. Less than 1 percent of people who inject drugs live in countries where needle exchange is available, she said.

Activists at the AIDS conference launched a campaign entitled 鈥淛ust say no to the war on drugs鈥 鈥 a direct challenge to the Ronald Reagan-era slogan 鈥淛ust say no鈥 at the height of America鈥檚 鈥渨ar on drugs.鈥

鈥淚 said no to drugs but they didn鈥檛 listen,鈥 reads one slogan of the alternative campaign.

鈥淪upport. Don鈥檛 punish,鈥 states another.

A report this month by Harm Reduction International said funding for such services in low- and middle-income countries 鈥 mainly donor money 鈥 had flat-lined in the past decade. In 2016, US$188 million was allocated 鈥 the same as in 2007, it said. 鈥淪imply put, the lives of people who use drugs are being neglected.鈥


 

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