Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries An Assessment of the Evidence (2007) / Chapter Skim
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Appendix C Country Case Studies
Appendix C Country Case Studies
Pages 211-224
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The case studies of Iran, Malaysia, and China illustrate how countries with burgeoning HIV epidemics among IDUs have forged a compromise between a criminal justice approach and a public health approach to the dual epidemics of drug dependence and HIV among drug users. These experiences particularly informed the Committee's recommendation regarding the value of creating broad cross-sector consensus processes which permit those with conflicting perspectives to find the "common ground." The fourth and fifth case studies, on Russia and Ukraine, show the impact of the legal and cultural context on policy, and the ability of a country to review and modify its policies on the basis of evolving lessons learned.
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From page 212... ...
The Iranian government encouraged its medical and public health experts to talk with drug treatment experts from other countries. This dialogue and several other factors led to a more comprehensive approach to reducing HIV transmission among drug users, including psychosocial services, opioid agonist maintenance therapy, drug-free treatment, and access to sterile needles and syringes (Nissaramanesh et al., 2005)
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. Overall, although Iran still sees drug dependence as a crime, the broad range of HIV prevention services targeting drug users reflects a shift from a strictly punitive approach to one that includes drug treatment and HIV prevention.
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. However, a major policy shift has occurred over the past 2 years, as Malaysia's response to its IDU-driven HIV epidemic has evolved from a primarily criminal justice model to one that includes public health interventions.
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Government funding is available for methadone maintenance treatment programs in urban areas, and for needle and syringe exchange in rural areas. Despite these encouraging signs, there are tensions and inconsistencies between criminal justice and public health policies that have operational
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Yet police have also intensified crackdowns on drug users, committing growing numbers to detoxification centers and labor camps and driving many others underground. These activities have had a chilling effect on the willingness of IDUs to meet with peer educators and receive sterile injecting equipment: the average number of needles/syringes the cross-border project provides each month dropped from 12,000 in 2003 to 8,000 in 2005 (Personal communication, T
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In the face of the tensions between the law enforcement approach and the public health approach, progress has been made. A peer-outreach counseling program (without needle exchange)
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. Thus Russia continues to balance the tradeoffs between ensuring quality of individual programs and dissemination for public health impact.
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. The country's "100% condom use campaign" is lauded as a model effort to control HIV through collaboration among government agencies, law enforcement officials, public health authorities, and private groups (Perngmark et al., 2003)
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. The recently unveiled national HIV/AIDS plan for Thailand noted that HIV prevention interventions for IDUs including needle and syringe exchange, opioid agonist maintenance, and outreach, will be expanded and made accessible throughout the country (Thailand Ministry of Public Health, 2006)
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Presentation at the Institute of Medicine Workshop on the Prevention of HIV Among Injecting Drug Users in High-Risk Countries, Geneva, Switzerland. Institute of Medicine Committee on the Prevention of HIV Infection Among Injecting Drug Users in High-Risk Countries.
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. Thailand Ministry of Public Health.
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2004. Sexual risk reduction in a cohort of injecting drug users in Bangkok, Thailand.
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