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Southwest Asia: Iranian Harm Reduction Doctors Arrested, Held Without Explanation

Faced with an intractable and growing opiate addiction problem, in recent years Iran has increasingly embraced the principles of harm reduction. But now, according to an international doctors' human rights organization, two leading Iranian harm reductionists, the brothers Dr. Arash Alaei and Dr. Kamiar Alaei, have been detained without explanation by Iranian authorities.

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International Anti-Drugs Day drug burning, Tehran
The doctors are internationally known experts on HIV/AIDS and have been leaders in HIV/AIDS prevention and treatment efforts in Iran and across the region. For the past decade, the pair have focused on harm reduction for injecting drug users in the conflict-ridden province of Kermanshah, on Iran's west coast.

Physicians for Human Rights earlier this month initiated an international campaign and petition urging Iranian authorities to end the incommunicado detention of the pair and "to disclose their whereabouts, provide them access to lawyers and family, and either to charge them with an internationally recognized crime or release them immediately."

Dr. Kamiar Alaei is a doctoral candidate at the SUNY Albany School of Public Health and is expected to resume his studies there this fall. In 2007, he received Master of Science in Population and International Health from the Harvard School of Public Health. His brother Arash is the former Director of the International Education and Research Cooperation of the Iranian National Research Institute of Tuberculosis and Lung Disease.

The Alaei brothers have held training courses for Afghan and Tajik medical workers and have worked to encourage regional cooperation among 12 Middle Eastern and Central Asian countries. They were key organizers of a tri-national meeting in 2004 in Tehran to discuss harm reduction and substitution treatment in Iran, Tajikistan and Afghanistan. At that meeting, Iran's programs proved to be inspiring role models for the region, according to medical experts who participated in the meeting.

Feature: Vancouver's Safe Injection Site Fights for Its Life -- Again

The only officially-sanctioned safe injection site in North America, Vancouver's InSite will have to close its doors June 30 if the Canadian federal government does not extend its exemption from Canada's Controlled Drugs and Substances Act. But while the Conservative government of Prime Minister Stephen Harper has made no secret of its distaste for the program, it has very strong community, local, provincial, and international support, and its supporters are now engaged in a strong campaign to ensure its continued existence.

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InSite (courtesy Vancouver Coastal Health)
Situated on Hastings Street in Vancouver's Downtown Eastside, home to one of the hemisphere's largest concentrations of hard drug users, InSite has operated since 2003, when it was granted a three-year exemption by the then Liberal government. With the advent of Conservative government, with its ideological opposition to programs that "encourage" or "facilitate" drug use, InSite's continued existence has been shaky. Twice, the Conservatives have granted the program temporary 18-month exemptions, saying that more research on its efficacy was needed.

But now, after five years of monitoring and evaluation, the results are in: According to peer-reviewed scientific studies, InSite increased the use of addiction treatment services, increased the use of detox services, reduced needle sharing, led to improvement in neighborhood public order and quality of life, resulted in no increase in drug-related crime, prevented overdose deaths, and helped reduce the spread of HIV/AIDS among drug injectors.

As if the nearly two-dozen studies of InSite were not enough, the Conservative government last year commissioned its own study, "Vancouver's INSITE service and other Supervised injection sites: What has been learned from research?," which was released in early April. According to Simon Fraser University criminologist Neil Boyd, who was hired by the government to advise the committee overseeing the study, the research shows that InSite has no apparent negative impacts, has resulted in "modest decreases" in drug use, and has not disturbed public order.

In fact, said Boyd at a press conference announcing his findings, InSite should not only be continued, but the program should be expanded to other locations. "I think our data suggests... the building of additional facilities of a similar kind in neighborhoods where they are needed would yield benefits much in excess of the costs required for such projects," he said.

That's unlikely under the Harper government, which is ideologically opposed to such harm reduction practices and in fact removed funding for them from its anti-drug budget. As Harper put it last October: "Because if you remain an addict, I don't care how much harm you reduce, you're going to have a short and miserable life."

Harper has also scoffed at empirical evidence when it conflicts with his agenda. In a January speech to party faithful, he mocked opponents who cited falling crime statistics in challenging his emphasis on law and order. "They try to pacify Canadians with statistics," said the prime minister. "Your personal experiences and impressions are wrong, they say; crime is really not a problem."

More recently, Health Minister Tony Clement and his underlings have sounded similar themes. Science would not be the only factor in determining whether to continue InSite's exemption, Clement's undersecretary, Winnipeg MP Steven Fletcher told The Canadian Press earlier this month. While the government would make a "rational and thoughtful decision based on science," it must also take into account "the realities of the situation," Fletcher explained. "There's multiple sides to this and they all have to be taken into consideration," said Fletcher.

When pressed in parliament by Vancouver East MP Libby Davies, a staunch InSite supporter, Clement vowed to make a decision before June 30 and responded to her criticism about rejecting the science supporting the program: "We are the government that actually wants more research, that actually commissioned more research because we want to make sure this decision is the right decision for Canada, for addicts and for the community in Vancouver," he said. "That is the decision we have made, more research and more consideration. That is because we are open-minded and we want to make the best decision for Canada and Canadians."

Now, as the June 30 deadline looms, InSite's supporters have mobilized. Already this month, the International Journal of Drug Policy published articles by scientists from around the world condemning the federal government for interfering politically with the site's research, Boyd held his Ottawa press conference, advocates held a rally in a Downtown Eastside park featuring 1,000 white crosses to symbolize the people who didn't die from drug overdoses while injecting at InSite, Vancouver street nurses picketed the office of the Vancouver Police Union, whose president is a leading critic of the site, BC Nurses Association president Debra MacPherson held a press conference to tout the health benefits of InSite, and all three BC civic parties have signaled their joint support of the program.

"We're fully behind the effort to keep InSite open," said David Hurford, director of communications for Vancouver Mayor Sam Sullivan. "It is part of the solution, not part of the problem, and it is a bottom-up solution from the grassroots. The federal government has said it supports grassroots decision-making, so why should bureaucrats from 3,000 miles away be making decisions for us here?" he asked.

The mayor's office is "working with local stakeholders to help communicate the benefits of InSite," said Hurford. "We wrote to the health minister last week asking him to keep the site open, and at a minimum, to extend the permits until all pending legal issues are heard."

Hurford is referring to a lawsuit pending in the BC courts that challenges Health Canada's jurisdiction over InSite. That suit argues that since under Canadian law, health care is the domain of the provinces, the federal government should not have control over InSite. But that lawsuit will not be settled by the end of next month.

Opposition politicians have also joined the fight. "This government chooses to view harm reduction as nothing more than dirty words, at the expense of protecting the safety and health of Canadians," said Liberal Party public health spokesperson Dr. Carolyn Bennett.

"The results from the InSite project show measurable evidence that it saves lives," said Liberal MP Dr. Hedy Fry, who played a key role in bringing the agreement that allowed InSite to open. "This has won it widespread support not only from experts in Canada but from the international scientific community, from the Vancouver police and from residents of the Downtown Eastside," said Dr. Fry. "It is simply irresponsible to ignore scientifically-based proof of the efficacy of harm reduction programs like this, and base public policy on ideology alone because real people suffer the consequences."

"The Conservative government must stop its unconscionable interference in scientific research on Vancouver's safe injection site," added New Democratic Party MP Libby Davies, who represents the Downtown Eastside. "Medical researchers from the University of British Columbia have revealed that Harper and his team have been suppressing evidence and denying funding to scientists who are looking objectively at the merits of Insite," she said.

"More than 20 medical and academic studies have been published showing the health and social benefits of InSite. We now have both scientific fact and evidence from users in our community that this facility is helping, not hurting the people of our city. The research record shows that Insite saves lives and increases public safety," Davies continued. "Harper doesn't understand that you can't just hide the facts whenever they don't suit your political agenda. We need a change in direction. It's time for this government to make decisions based on evidence instead of ideology -- InSite needs to be kept open."

"What we want is a 3 ½ year renewal of the exemption from the Controlled Substances Act," said Nathan Allen of InSite for Community Safety. "The fact that the Harper government has not granted this renewal shows they are very reluctant to support the community."

While the Harper government has previously said it needed more research to evaluate InSite's efficacy, that dog won't hunt anymore, said Allen. "They've already spent more than $1.5 million studying InSite, they've produced two dozen academic papers, and they've concluded that it has all kinds of positive impacts. We're wondering what questions the government has left to ask," he scoffed. "InSite has undergone the most thorough and well-funded scrutiny of any health clinic in the country."

In the event the government refuses to grant another exemption, Allen said he hoped it would respect provincial authority and local autonomy. "This has been a regional response to a local crisis here in Vancouver. We need to let the people here on the ground do what they need to do. If not, people will die," he predicted bluntly.

The clock is ticking for InSite, but the pressure is mounting on the Harper government. The next few weeks will determine if that pressure is sufficient to overcome the government's ideological opposition to the safe injection site.

Harm Reduction: More Than 300,000 HIV/AIDS Cases Linked to Injection Drug Use

According to the Centers for Disease Control and Prevention, more than 300,000 people have been infected with the HIV/AIDS virus through injection drug use. That is roughly 30% of all the slightly more than one million cases reported in the US since the disease first appeared on the radar in the early 1980s. The figures are contained in Table 3 of the CDC's latest HIV/AIDS Surveillance Report, covering cases through 2006.

According to the report, more than 170,000 men and nearly 75,000 women contracted the virus through sharing dirty needles. Another 68,000 men contracted the virus through a combination of injection drug use and male-to-male sexual contact.

If there is any good news on the HIV/AIDS drug injection front, it is that the percentage of new cases linked to injection drug use appears to be dropping. While over the history of the epidemic, roughly 30% of all cases are linked to needle-sharing, in 2006 that number was only 17%.

Still, that means that more than 3,000 men and more than 1,700 women contracted the virus in 2006 through injection drug use. Nearly 1,200 more men contracted the virus through a combination of needle-sharing and male-to-male sex.

Needle exchange and other programs designed to reduce the spread of HIV/AIDS currently operate in around 200 US localities, but despite their proven record in reducing the spread of HIV/AIDS, they continue to face hostility in some communities and from some state and local officials. Under an amendment offered by then Sen. Phil Gramm (R-TX), the federal government is prohibited from spending federal funds on needle exchange programs. Both remaining Democratic Party presidential candidates, Sens. Hillary Clinton (NY) and Barack Obama (IL), have called for an end to that ban.

Southeast Asia: Drug Crackdowns Spread HIV/AIDS, Experts Say

Repressive law enforcement responses to injection drug users in Southeast Asia are undermining the effort to slow the spread of HIV/AIDS in the region, analysts meeting in Bangkok said last week. Needle sharing among injection drug users could account for up to 50% of all new infections, they said.

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Thai embassy protest in Washington (DRCNet's David Guard in foreground)
Harassment and arrests of clients at needle exchange programs means many avoid them, while heavy-handed police crackdowns in places like Thailand have driven users deep underground, away from needle exchange programs and treatment services.

In Thailand, where a government "war on drugs" killed a reported 2,500 people over three months in 2003, police often blur the line between dealers and users, hindering efforts to treat addicts, said Precha Knokwan of the Thai Drug Users' Network. "The drug users themselves are afraid that they might be a victim of the police," he said.

It's a similar situation in Indonesia, where prisons are full of HIV-positive drug users who have no access to services, said Aditya Anugrah of the Indonesian Drug Users' Association. "Drug policies in Indonesia do not separate users from dealers," he said. That leads to needle-sharing and the spread of HIV, he said. "Our policies are focusing on sending people to jail and treating them as criminals rather than as health problems."

What is needed is harm reduction, but that requires the cooperation of governments and law enforcement, said Daniel Wolfe of the Open Society Institute. "Harm reduction measures can only work if law enforcement understands them and helps to enforce them," he said.

Feature: San Francisco Ponders a Safe Injection Site, Would Be the Nation's First

San Francisco city officials last Thursday took a tentative first step toward opening the nation's first safe injection site for drug users. In an effort to reduce the city's high number of fatal drug overdoses, as well as slow the spread of blood-borne infectious diseases, such as HIV and Hepatitis C, the city's public health department teamed up with a coalition of health and social service nonprofit groups to present a daylong forum on safe injection sites, how they work, and how they can be established.

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O'Farrell St., Tenderloin district, SF (courtesy Wikimedia)
San Francisco's needle-using population is estimated at between 11,000 and 15,000, with many of them being homeless men. While injection-related HIV rates are relatively low, Hepatitis C is spreading quickly among drug users. About 40 San Franciscans die from drug overdoses each year.

Injection drug use is also a quality of life issue for businesses and residents in areas of the city like the Tenderloin, where public injecting is not rare and dirty needles can be found on the streets. The neighborhood, a center of services for down and out residents, is often mentioned as a potential location for a safe injection site.

Safe injection sites are up and running in some 27 cities in eight European countries, as well as Australia and Canada. They have been shown to reduce overdoses, needle-sharing, and the spread of disease, as well as entice some users into drug treatment -- all without causing increased drug use, crime or other social disorder.

The symposium was cosponsored by the Harm Reduction Coalition, the Drug Policy Alliance, and the San Francisco AIDS Foundation, and was organized by a local consortium of community-based groups known as the Alliance for Saving Lives. That broad-based umbrella group includes public health officials, service providers, legal experts, injection drug users, and researchers.

"Having the conversation today will help us figure out whether this is a way to reduce the harms and improve the health of our community," said Grant Colfax, director of HIV prevention for the San Francisco Department of Public Health.

Vancouver's Insite safe injection site, the only one in North America, was held up as a model for a potential similar program in San Francisco. Both Dr. Thomas Kerr of the British Columbia Center on Excellence in AIDS, who has evaluated InSite, and the facility's program manager, Sarah Evans, addressed the forum about their experiences.

Evans described the Downtown Eastside Vancouver facility as a bland place where drug users can come in and inject in a safe, sterile environment under medical supervision, then relax in a "chill out" room where they are observed. "It looks kind of like a hair salon," Evans said of the bustling space. "If we were a restaurant, we would be making a profit."

While InSite has seen some 800 drug overdoses, said Kerr, none of them had been fatal because of the medical supervision available at the site. His research has found increases in addicts seeking treatment and decreases in abandoned syringes, needle-sharing, drug-related crime and other problems since the clinic opened three years ago, he said. Those findings suggest it is worth doing elsewhere, despite the criticism it will attract, Kerr said.

But while the science appears to be on the side of such facilities, political reality is a different matter. San Francisco Mayor Gavin Newsome's office has said that he does not support safe injection sites, and by this week, even public health department spokesmen were keeping mum. "We're not talking to the media at all any more," Colfax said on Tuesday in response to inquiries about what comes next.

While there has been community concern, the only vocal reaction has been coming from Washington, DC, where one senator, Republican James DeMint (SC), has introduced an amendment that would cut off federal health funds for any locality that starts a safe injection site, and where the Office of National Drug Control Policy (ONDCP) has attacked the idea via the press and its Pushing Back blog.

Bertha Madras, ONDCP deputy director of demand reduction, told the Associated Press the fact that the idea was even being discussed was "disconcerting" and "poor public policy." According to Madras, "The underlying philosophy is 'We accept drug addiction, we accept the state of affairs as acceptable.' This is a form of giving up."

But Hilary McQuie, Western Director for the Harm Reduction Coalition, and one of the guiding forces behind the push for a safe injection site in San Francisco, pronounced herself unworried about either DC opponent. "DeMint's measure is a rash overreaction that won't go anywhere," she predicted, "and as for ONDCP, well, I won't even debate them. It's none of their business; this is a local issue, not a national one."

It's a local issue that McQuie and others have been working patiently on for some time now. "We initiated the Alliance for Saving Lives about a year ago," she explained. "It's mostly agencies that work with drug users, and we've been meeting monthly. We've had some quiet conversations with the health department, and we decided it was time to take the next step."

Now it's time for advocates to build more community support for a safe injection site, including bringing the mayor and the Board of Supervisors on board. Even with science on their side, they have some work ahead of them.

"We know the issues and the science," said Randy Shaw, a long-time community activist working on homeless issues in the Tenderloin, "but no one here wants more of these kinds of facilities." "Why should the poor people of the Tenderloin have to live with all these problems? There are junkies in Golden Gate Park, there are junkies in SOMA, there's more drug traffic at the 16th Street BART station than anywhere in the Tenderloin," he said. "If some neighborhood wants to accept it, that's fine, we just don't want it in the Tenderloin."

City officials have made the neighborhood "a containment zone," Shaw complained. "We already have methadone clinics, needle exchanges, food programs, shelters, drug treatment programs. Now they don't even think about putting things in other neighborhoods." Some activists want to turn the Tenderloin into Hamsterdam, the industrial neighborhood turned into a drug trafficking free zone in the HBO show The Wire, Shaw said. "But we're a residential neighborhood."

"It's controversial," conceded Tenderloin Economic Development Project executive director Julian Davis, a supporter of the idea. "Some folks think the Tenderloin already has too high a concentration of these kinds of services, while others think like this sort of facility would enable drug users as opposed to ending drug addiction in the Tenderloin."

But Davis has a different perspective. "I look at the Tenderloin and I see that our city, our society is already enabling open drug use and drug dealing," he argued. "The idea behind the site is to get some of these users off the street and inside, where they can get access to services, and also to stop the needle-sharing and the spreading of HIV and Hep C. I see quite a few potential benefits from this."

And so the public discussion begins in San Francisco. It will be a long and twisting path between here and an actually existing safe injection site, with much work to be done at the neighborhood, municipal, state, and federal levels. It could take years, but advocates are confident its day will come.

"I think we will have a safe injection site eventually," McQuie predicted, "but how long that will take depends on how well we organize, who's in power, and how much pressure those in power locally feel from the feds."

Harm Reduction: Jersey City Signs Up for Needle Exchange

The Jersey City, New Jersey, City Council Wednesday unanimously passed an ordinance allowing for the creation of a needle exchange program in the city. The move came after the city hesitated earlier this year because Mayor Jeremiah Healey, a needle exchange supporter, balked at a part of the state's pilot program that would have included a needle exchange van.

Jersey City becomes the fifth Garden State city to pass a needle exchange ordinance since Gov. Jon Corzine (D) signed a bill allowing them into law in December. The other cities are Atlantic City, Camden, Newark, and Paterson. None have functioning needle exchange programs yet. All have either just passed ordinances or have applications to join the pilot program under review by the state.

New Jersey has the highest rate of cumulative HIV/AIDS cases among women, the third highest rate of pediatric HIV/AIDS cases, the fifth highest rate of adult HIV/AIDS cases and a rate of injection-related HIV infection that is nearly twice the national average.

Still, it took years of activism and lobbying by local public health officials and the Drug Policy Alliance, whose Roseanne Scotti paced the halls of the state capitol, to win approval of needle exchange programs in New Jersey. And the battle isn't over yet. Seven other New Jersey cities that could be eligible to participate have so far failed to do so.

Strategy to Reduce Drug Injection-Related AIDS in California Gains Support

Location: 
CA
United States
Publication/Source: 
California Progress Report (CA)
URL: 
http://www.californiaprogressreport.com/2007/06/strategy_to_red.html

HIV infection rates will rise under new anti-drug plan, critics say

Location: 
Canada
Publication/Source: 
Xtra.ca (Canada)
URL: 
http://www.xtra.ca/public/viewstory.aspx?AFF_TYPE=1&STORY_ID=3175&PUB_TEMPLATE_ID=2

Alone in a City’s AIDS Battle, Hoping for Backup

Location: 
Washington, DC
United States
Publication/Source: 
The New York Times
URL: 
http://www.nytimes.com/2007/05/29/washington/29district.html

NAMA Press Release: Leaders of NAMA’s Swedish Affiliate Svenska Brukarforeningen (SBF) Report to Police for Handing Out Clean Needles

National Alliance of Methadone Advocates For Immediate Release: May 17, 2007 Contact Person: Joycelyn Woods, President, Tel: 212-595-NAMA, E: nama.president@Verizon.net Leaders of NAMA’s Swedish Affiliate Svenska Brukarforeningen (SBF) Report to Police for Handing Out Clean Needles On May 4 SBF’s President, Berne Stålenkrantz and the Stockhom Director, Johan Stenbäck presented themselves to the Norrmalm Police Station in Stockholm for handing out clean needles to drug users. The purpose of the action was to get an official assessment of the their crime and to bring to the public the fact that Sweden does not allow syringes to be sold in pharmacies as is done is all other countries in the European Union (EU). SBF is also considering reporting Sweden to the European Union for its failure to comply with EU rules surrounding the common market. In southern Sweden needle exchange programs have been keeping the spread of HCV nd HIV under control for the past 20 years. County and Town Councils have been allowed to establish needle exchange programmes if they so wish. However in Stockholm no such programs have been established. According to Stålenkrantz if the penalty is mild they will continue with what they are doing. However after SBF publicized that they were providing drug users with clean needles the organization suddenly found its financing from Stockholm City Council under threat. Stålenkrantz also reported that a colleague suffering from a Hepatitis C was planning to report the city's social services department to the police because he has contracted a deadly illness after being refused clean syringes. He will also state that he was a victim of SBF’s having received clean syringes from the organization.. Needle exchange programs have been used worldwide for the past twenty years and provides a way for drug users to avoid the risks of drug use as well as a way to access support services including treatment. "We are handing out syringes for purely humanitarian reasons. And we are forced to do so since society is not providing this type of healthcare," said Stålenkrantz.
Location: 
Sweden

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