“I stayed in prison for 45 days waiting for a decision [from the Sub–Committee]. Some [others] were released. There was no medical treatment. It was very difficult to stay there… [it was] very crowded, not enough water. This place could accommodate 150 people but when I was there, there were 300. They did not know where to put the people. People had to sleep on their sides. If I moved [during the night] I would lose my space.” B.L., woman from Bangkok Thailand.

This is story of a typical state of prisoners in Indonesia, and it also happens in Jakarta. Instead of getting human rights based rehabilitation treatment, injecting drug users (IDUs) are treated like criminals and punished by being locked up in prisons. Many of them experience a worse fate than B.L. Most, when released, return to injecting drugs and find themselves back in prison.

Harassment causes Injecting drugs users to refrain from using required health and support services. The example of what happened in Bangladesh presented at the 9th International Congress on AIDS in Asia and the Pacific (ICAAP) held on 9–13 August 2009, showed that knowledge of police about harm reduction (HR) issues can reduce harassment. A comprehensive harm reduction program conducted an assessment of the information needs of police personnel in relation to harm reduction programming. Consultative and advocacy workshops were conducted with the police, with a curricula developed and training provided in 5 police training institutes. In total, 12, 500 police personnel were trained, including high ranking police offers.

Another example presented from India was that of a pro– harm reduction strategy in the management of service delivery directly impacting the outcome of oral substitution therapy roll–out done between 2007 and 2009. The programme which was funded by the Department for International Development (DFID) and the National AIDS Control Organization, ran at 9 centres in 9 states where oral substitution therapy was provided. There were around 25, 000 Injecting Drug Users in India on different drug treatment services at the beginning of 2007 and services available for them included needle syringe exchange programme (NSEP), detoxification, rehabilitation, income generation, referral for Directly Observed Short Course Treatment (DOTs), antiretrovirals and other essential drugs.

More than 1,725 IDUs were on oral substitution treatment therapy. Sites with pro–harm reduction strategies employed in their day to day functioning witnessed better results. Following a client suited time schedule of services, adherence protocols applicable to clients, dosage compliance adapted to the client’s needs all made a positive impact to the outcome of the programme.

The engagement of users in the program along with the support groups helped the programs at these sites in a big way. Clients came for their dosage, stayed and helped others to be part of the program. Peer Counseling played an important role. Inclusion of peers who had recently started oral substitution therapy helped the program acknowledge the latest trends and movement of drug users around the supply of the drugs. Clients in the program were also given an opportunity to be part of the program management team.

Additional services were provided by these sites as per their needs, such as nutrition and self help groups. The families of clients were also involved, this way increasing the awareness of drug use, its consequences, OST/ Buprenorphine–adherence as a prime focus. The efficacy of the oral substitution treatment lies in how best these three key criteria are combined: accessibility, availability and most importantly acceptability – all need to be translated in harm reduction services. Finally, it is highly important to condnuct training to increase understanding of OST at all levels, with health services, policy makers, clients and their families.


Source: HealthDev