HIV and HCV in Injecting Drug Users - Essay Example

HIV and HCV in Injecting Drug Users Human Immunodeficiency Virus(HIV), an incurable disease that has eaten away millions of lives globally since its first incident recorded in 1984, has become more of an insurmountable challenge for health care policy makers in particular and the world community in general. A UN report of 2003 places the number of people living with HIV/AIDS at a whopping 38 million. (Abbot. 2005, 3). It is relevant that over the years, the use of syringes for both medicine administration as well as drug abuse has rose drastically, especially in underdeveloped countries where there is an absence of awareness because of lack of education. The appalling rise in figures over the years is mainly attributed to unsafe sex, widespread use of non-sterilized syringes, and spread of virus through unsafe methods of blood transfusion. Sending a chilling reverberation throughout the world, the UN Report of 2003 on infections recorded a staggering 4.8 million cases. It is brought out that over 13,000 people were infected a day. The spread of disease worldwide is most rampant among young people between the age group of 15-25, and that alone accounts for nearly half of all infections. Cases among children under 15 years touched a shocking proportion of 630,000 during 2003.http://www.unaids.org. This is the sordid side of reality. Propelling the infection rate to higher levels, the epidemic is spreading in a rapid pace in Asia, specifically in the developing countries. If the steep increases in HIV infections in China, Indonesia, and Vietnam are an indication, the Asian phenomena has far reaching implications when we consider the fact that this region is home for 60% of world population. It is needless to say what will happen if the world community does not take cognizance of the issue and act immediately to facilitate proper remedial measures. The grim situation arising from the widespread of disease in Asia/Pacific region has put it as a landmark in the global map of AIDS/HIV infection. In 2003 alone, about 1.1 million people in this region were infected with HIV, adding up the total to 6.5 million. Another half a million died of AIDS. (Abbot. 2005, 3). As the infection rate in this region continues to soar to alarming proportions, especially in nations like Indonesia and Papua New Guinea, Australia has every reason to worry. The main cause of concern is that it will adversely affect Australia’s efforts to put an effective check on the spread of HIV. Australia has remained responsive to the threat, and the reports from this country are invigorating to the hopes of the world community. The effective manner in which the Australian community and healthcare givers handled the situation definitely deserves praise, and they have been able to contain the menace to a remarkable extent through their concerted efforts. Their rational approach and timely reaction to the challenge resulted in a sharp fall in HIV infections from a peak of 1700 in 1984 to the current rate of around 700 -800 per year. The estimated prevalence among adult population in Australia is now about one sixth of that of United States and one third of that of Canada and France. Australia has also registered a 80% downward trend in new HIV diagnosis during the period between 1994 and 1999. (Abbot. 2005, 4). The significant improvement in the Australian scenario here has given a glimmer of hope to the rest of the world. The success of the Australian model could be attributed to certain concerted programmes involving education and prevention. Support from the public, coupled with the mobilization of affected communities, particularly gay community, had also been the determining factors in the effectiveness of their drive against the infection. They confronted the problem in a most humane manner, honouring the victims and understanding their need for sympathy. It was evident that the Australians had been able to promptly recognize the role of non-sterile syringes in spreading the disease and to take suitable counter measures. The Needle and Syringe Program (NSP) had been very effective in containing the infection among injecting drug users. A case study in this regard revealed that 25% of newly acquired HIV infections both in US and Canada were linked to injecting drug use, whereas it was less than 5% in Australia.(Abbot. 2005, 4) The Needle and Syringe Programs (NSPs) took the shape of a public health measure to restrain the spread of blood borne viral infections like HIV and Hepatitis C which were transmitted among injecting drug users mostly through syringes. (Coutinho. 1998, 433). NSPs in Australia were put in public domain by the support of National Drug Strategy’s harm reduction framework. Their services comprised the provision of injecting equipment, information, education, and communication activities on drug-related harms, referral to drug treatment, medical care and socio-legal services. Among the measures to prevent HIV spreading through injecting drug was promoting the use of sterile equipments and thereby reducing the infection through blood contact. Steps in the direction of exhorting drug users for the safer injecting practices had its qualitative dimensions. Thus, to say that NSPs became a key strategy for bringing down the new HIV cases to such a remarkable level since its inception in 1991 would not at all be an exaggeration.( Drummond. 2002, 6). For the fruition of this mission five service models namely, primary outlets, secondary outlets, mobile services, outreach services, and vending machines have been introduced. Each of them needs to be understood in more details: - Primary outlets are specifically established to provide injecting equipments along with primary medical care, and to cater to the needy without prejudice. This, in turn, has helped to develop a rapport with the users and expanded the scope of reaching individuals who generally tend to shy away. Secondary outlets offer needle distribution or exchange as one of a range of other health or community services. Mobile services are distribution and exchange services provided by vehicle or on foot to promote its popularity among a wider segment. Outreach services have workers who move around from place to place to extend the reach of the service, often out of hours. Vending machines, which are monitored and restocked by Needle and Syringe Program staff, dispense needle and syringe packs containing several 1ml syringes for a small fee. For better accessibility, NPSs are located generally in public places. In addition, pharmacies are also associated in government-sponsored schemes. 1 ml syringes are exchanged free on return of used syringes and these are also available for purchase through counters. Syringes and other equipments for injecting are can also be procured commercially through such pharmacies which are not participating in the government sponsored schemes. Drug users have a tendency to avoid testing or treatment for fear of stigmatization and also because of the impending threat of law. Hence, it is difficult to project a realistically exact HIV statistics. Studies on the spread of HIV, conducted by UNAIDS, reveal that about 10% of all global HIV infections prevail among Injecting Drug Users (IDUs). (Wolfe and Malinowska. 2004, 11). It is also alarming to note that the number of countries reporting HIV among IDUs has increased from 52 in 1992 to 114 by the year 2002, and more than one third of new infections come from contaminated needles. It may not be an exaggeration that HIV/AIDS has emerged as the major pandemic of global economy, and has been fuelled by the same process as globalization. Trans-location of people, rapid movement of goods and labour, and economic transitions and dislocations have paved the way for drug abuse, sex work and related increase in the spread of HIV infection. The poorest and marginalized people in the society, particularly those hailing from ethnic minorities, migrants, unemployed youth, and those exchanging sex for sustenance, injecting drug user etc are most vulnerable to HIV infection. Free trade zones of the newly globalized economies are the breeding ground for drug abuse and HIV infection. The sustained endeavours to strengthen economic relations, sharing of resources, and trade agreements between countries in the ‘Golden Quadrangle’ have in fact boosted the speed of drug trafficking which also helped the spread infections. “HIV epidemics closely follow drug trafficking routes out from Burma, Laos, and Afghanistan, three of the world’s largest producers of opium. Increasingly, heroin trading, and the drug use and needle sharing that follow them, have come to represent a map of the hotspots of new HIV infections. ”(Wolfe and Malinowska. 2004, 13) It is relevant that the developing countries like China, Russia, Uzbekistan, Kazakhstan, Burma, Thailand, Laos, Vietnam, etc are yet to recognize the real implications of the issue. “Areas receiving a sudden influx of goods and labour similarly experience sharp increases in HIV and STDs. The Northern Shan State in Burma, where as many as 500,000 migrant workers arrive each year to work in jade and ruby mines, is the site of widespread heroin use, sex work, and infection with STDs and HIV.” (Wolfe and Malinowska. 2004, 13) Some social and environmental factors do play a role in isolating drug users and compelling them to share needles. This has aided the rapid spread of injection driven epidemic of HIV/AIDS. Because of the punitive provisions in law for the possession of psychotropic substances and the restrictions on opium sale, some drug users are forced to change their habit from heroine use or smoking to visiting shooting galleries where the indiscriminate use of contaminated equipment is a common feature. Use of pre-loaded syringes, which may be infected, drawing solution from communal pot or a single large syringe, and even the social practices in some nations contribute to speeding up of the infection among IDUs. Most of the global and national and regional regulations on illicit drugs are based on the existing protocols in UN Drug Conventions. ”The impact of the UN drug conventions—and the widespread incarceration and resistance to innovation justified in their name—requires special review in light of the HIV epidemic. Increasingly, advocates have questioned the adequacy of conventions regulating international response to drugs that reflect no awareness whatsoever of HIV.” (Wolfe and Malinowska. 2004, 25). Though millions are spent in counter-narcotics efforts, no concrete measures are taken to reduce the spread of drug related HIV infections. The basic approach of preventing drug use and reducing its adverse consequences through opioid substitution therapy and syringe exchange program were not adequately addressed in the UN Drug convention. Some key areas of inconsistency in drug policy and HIV prevention activities are (i) Substitution therapy, (ii) Harm reduction, iii) Syringe exchange, and iv) International mandate. Public health approaches and criminal enforcement regulations on illicit drugs often seem to be at loggerheads as the institutions responsible for coordinating the activities are different and there is a lack of rapport and effective interaction between these agencies. Inconsistencies in national policies and programs in turn lead to tension between prioritization of criminal enforcement or public health requirements. Police officers have only limited awareness of HIV and health interventions, and hence the decisions taken by them for drug use treatment, cannot be as effective as those taken by healthcare professionals. This, naturally, hampers the successful implementation of relevant programs. Some countries where IDU-driven epidemic is prevalent impose harsh penalties on drug use under the label of ‘war on drugs’. The society also indulges in stigmatizing affected people. Fear of negative mass media coverage, public beating and executions, and conviction also prevent them from seeking help in detecting or treating the infection. The most positive approach to exercise effective control will be through reform of drug demand reduction and less punitive interventions. Steps like condom distribution, staff training and substitution therapy at institutional level will perhaps pay better dividends. Though some countries have mobilized institutional resources to isolate and contain drug use and users, efforts to contain risks of HIV infection have received less funding. Except Vietnam, no government across Asia and former Soviet Union provides funds for distribution of sterile injection equipment among IDUs. Lack of substitution therapy remains a major challenge, which affects the successful implementation of effective policies. However, if the needed focus is given in creating awareness in the public, infections induced by injections can be contained to a great extent. The following public health principles will go a long way in preventing HIV/AIDS among IDUs: 1. Focus on risks associated with drug use, rather than on its illegality. 2. Recognize that risk is often relational, rather than merely individual. 3. Move beyond the binary of drug abusing/drug-free in gauging success 4. Prioritize evidence-based approaches over ideological ones 5. Seek to have the largest impact on the largest number of people at risk. 6. Create integrated services addressing both drug use and HIV. Wolfe and Malinowska. 2004, 54-56). The hepatitis C virus transmits through blood easier than HIV virus and its clinical consequences are serious in the long run. Indirect sharing of injecting accessories such as spoon cotton swabs etc may also cause the transmission. Thus it appears that so far Australia is concerned, the main reason for the spread of this disease is not due to sharing of injecting equipment but accessories. However Wodak maintains that the main reason for the spread of Hepatitis C in Australia is injecting drug use. (Wodak. 1997, 166: 284). Since HCV is more easily transmitted than HIV, prevention of the former is much difficult. To contain the HCV infection a more exhaustive program on needle exchange prevention and methadone treatment measures should be in place. A most useful strategy will be to promote non-injecting routes of administration and encourage other ways for the same. WORKS CITED Abbot, Tony. (2005). National HIV/AIDS Strategy: Revitalizing Australia’s Response 2005-2008. Drummond, Michael. (2002). Commonwealth Department of Health and Ageing. Return on investment in needle and syringe programs in Australia. Canberra: AGPS. Wolfe, Daniel and Malinowska-Sempruch, Kasia. (2004). Illicit drug policies and the global HIV epidemic: Effects of UN and national government approaches. New York: Open Society Institute http://www.soros.org/initiatives/health/focus/ihrd/articles_publications/publications/ cnd_20040316 Coutinho, R.A (Ed.). (1998). HIV and hepatitis C among injecting drug users: Success in Preventing HIV has not been mirrored for hepatitis C. BMJ, Wodak, Alex (1997). Hepatitis C: waiting for the Grim Reaper. MJA. UNAID. (July 2004). Report on the Global AIDS Epidemic, Geneva. Read More