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

Footage of riot Backdrop of Prison Riots

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 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

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.

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 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

Results: more data than expected

Fraction of the population who inject drugs

Injecting risk behavior

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

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

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

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

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 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

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. 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.

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. 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.

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