1 Current status of harm reduction in Asia International AIDS Conference, Toronto, August 2006 Mr Jimmy Dorabjee Macfarlane Burnet Institute, Melbourne, Australia Dr Alex Wodak St. Vincent’s Hospital, Sydney, Australia

2 In the beginning: Asia - home to half the population of the world and > 50% of the world's IDUs First sign of HIV/IDUs in Asia: –Thailand 1988 –HIV prevalence increased 1%  40%, 10 months –Prisons probably critical

3 The gathering storm: In 5-6 years, HIV prevalence NW Thailand reached –16% male military recruits –12% pregnant women HIV from IDUs  CSWs  general population Early 1990s: many Asian countries threatened by HIV /IDUs

4 Epidemic spread: Timeline HIV/IDUs: –1984 Thailand, Hong Kong –1985 South Korea, Singapore –1986 India, Malaysia, Sri Lanka –1987 Indonesia –1988 Nepal, Taiwan, Myanmar –1989 China, Japan, Philippines, Bangladesh –1990 Vietnam –1991 Cambodia –1992 Laos, Mongolia

5 Epidemic spread: 2 In the early 1990s all countries: –committed  war on drugs (WoDs) –rejected harm reduction completely

6 Harm reduction accepted harm reduction adopted most populous Asian countries: –China –Vietnam –Malaysia –Indonesia –Burma –Taiwan –India –Bangladesh

7 But still very low coverage Most countries still only starting to implement programs Coverage still very low Most countries still working out how to reconcile harm reduction and a WoDs approach

8 China Plans to have 300,000 on methadone maintenance treatment by 2008 Favours methadone maintenance treatment for cities Needle syringe programs rural areas Currently 128 methadone clinics operational

9 Vietnam Just passed new harm reduction law in national parliament July 2006 Long internal debate drawing to a close Small scale NSP last 2 years

10 Malaysia Started when PM realised Malaysia did not meet Millennium Development Goal #6 [HIV control] Started methadone Buprenorphine only through private practitioners Started needle syringe programs

11 Indonesia Indonesia – started methadone Buprenorphine through private practitioners Needle syringe programs started Started first methadone maintenance treatment in prison in Asia (Bali) First HR course Asian University: Atma Jaya Catholic University - May 2006

12 Burma Long debate nearing an end Programs about to start NSP begun under GF and Funds for HIVAIDS in Myanmar Methadone through WHO-M o Health

13 Taiwan Started methadone Needle syringe programs

14 India Manipur (NE state) first in Asia to declare harm reduction as State AIDS Policy (1996) Now high prevalence HIV/IDUs 4 major cities populations > 10 million Buprenorphine now rapidly being expanded Also needle syringe programs.

15 Bangladesh CARE SHAKTI program covers 75% of known IDUs with NSPs

16 Thailand Only major Asian country with major HIV/IDUs problem and antipathy to harm reduction Extra judicial killing of 2,000-3,000 IDUs recent years No NSPs Methadone dose  zero every 180 days

17 Conclusions: 1.Most Asian countries threatened by serious HIV/IDUs 2.Major threat: health, well being, economy, national security 3.Half world’s population 4.Most Asian countries now recognise seriousness of threat

18 Conclusions: 5.Harm reduction now well accepted at high level, most countries 6.Harm reduction programmes start soon or already started 7.Coverage still very low 8.Major barrier excessive reliance on drug law enforcement