Socialcast IDU Group

Dear IDU Bloggers,

The IDU Blog, now about 2 years old, is rapidly being superceded by the IDU group on Socialcast.

Currently, messages sent to the Blog are automatically streamed onto Socialcast. Those of you who are signed up for the Blog and Socialcast IDU group will have noticed that duplication.

To avoid that issue, increasingly, we will disseminate information directly through Socialcast, rather than from the Blog. So, if you have not done so already, please take a few seconds and sign up for the IDU group on Socialcast, by going to:

https://psi-org.socialcast.com/groups/injectingdrugusers

In the near future, we will decide whether or not to keep this blog running, or just switch everything over to Socialcast.

Cheers for now
Rob

Harm Reduction Conference - Lebanon - Film Submissions

In April 2011 the Int'l Harm Reduction conference will be held in Beirut, Lebanon.

Call for Submissions
The Film Festival of the IHRA conference screens documentaries, advocacy films, training videos, and fictional work relevant to reducing drug and alcohol related harms. Films shown at the event have subsequently been used for advocacy purposes in many countries.

Film Submission Deadlines
Film abstracts close on Friday 17th December 2010

For further information please email the Drugs & Harm Reduction Film Fest Committee:

filmfest@burnet.edu.au.
or go to:

http://www.burnet.edu.au/freestyler/gui/media/Call%20for%20Film%20Submissions%202011.pdf

New HCV Test Predicts Treatment Success

The following fact sheet on Hepatitis C testing discusses new genetic tests which can be used as a tool in treatment decisions. The tests look at the genetic characteristics of an individual and predict their chance of treatment success.
http://www.hep.org.au/documents/factsheets/TestingOverview2010-200MB.pdf

Additional fact sheets are available here on a wide range of topics related to HCV.

Beth

Rapid Hepatitis C Testing Now Available

The FDA recently approved Orasure Technologies rapid HCV (hepatitis C virus) test. http://www.orasure.com/products-infectious/products-infectious-oraquick-hcv.asp
Orasure is selling the test for less than $2 U.S. per unit ($1,950 for 1,000 tests).

PSI/Washington can procure the tests if a platform is interested in adding HCV testing to its IDU program. The FDA approval is sufficient for USAID-funded programs but the procurement department can also assist in determining if additional registration or approval is needed in country.

NOTE: If a platform adds HCV testing to its programs, strong linkages to treatment are a must.

For more information on HCV testing procurement, contact Ken Bonneville at kbonneville@psi.org. For information on program design contact Rob (robgray@laopdr.com) or me (eskorochod@psi.org).

Beth

IHRA Call for Abstracts Now Open!

KEY CONFERENCE FACTS
- April 3-7 in Beirut, Lebanon
- Website: http://www.ihra.net/contents/634
- Theme: Building capacity, redressing neglect

ABSTRACT REQUIREMENTS
- Must be in English
- Maximum words 300
- Three format options
Click here for the IHRA Guide for Submitting An Abstract. Please read this carefully


ABSTRACT REVIEW AND SUPPORT
The HIV Department is coordinating, in partnership with Research & Metrics, abstract review to improve quality and increase the likelihood of acceptance.

Review Process

October 11, 2010 First drafts submitted by lead author to abstracts@psi.org
October 18, 2010 Abstracts returned to lead author with review comments
October 25,2010 Revised abstracts re-submitted to abstract reviewer
October 29, 2010 Final review returned to lead author
Oct 29-Nov 5 Lead authors submit final abstracts online
November 5, 2010 Final abstracts to be submitted by lead author. Go to www.ihraconferences.com/2011 and follow links to "register"


FUNDING AND CONFERENCE SCHOLARSHIPS
PSI/W does not have funding allocated to assist PSI platform staff to attend the conference.

There are a limited number of scholarships offered by the conference itself. More details at: http://www.ihra.net/registration-scholarships

New Needle and Syringe Program manual

The Harm Reduction Coalition in the US has created a new Guide to Developing and Managing Syringe Access Programs (SAPs) available for downloading here:

http://www.harmreduction.org/article.php?list=type&type=145

There are many such manuals out there, but the Harm Reduction Coalition is a highly reliable source and the manual may be helpful to your program.

Rob

Compulsory Drug Detention Centers

The link below will take you to a short video on the topic of compulsory drug detention centers in Asia.

http://drogriporter.hu/en/ddt

This has been a controversial topic for PSI, as we conduct HIV prevention activities in some of these centers in Asia. Some groups (Human Rights Watch, Soros, and others) argue that the centers should simply be shut down and that working in these centers risks giving them legitimacy, and that the work conducted in the centers has questionable value. We have argued that the centers are the location for many risk behaviors and that our work in the centers results in improved health behaviors, so the work has real value. And we continue to engage with human rights groups about if/when/how to do such work.

I won't get into the details of this debate further, but would recommend that those of you who are involvd in this topic take 10 minutes to view the video. It will give you a good idea about how human rights organizations are framing their arguments around this issue.

Rob

Naloxone Video

The link below will take you to a 9 minute video giving an overview of Naloxone.

http://drogriporter.hu/en/naloxone

PSI Russia is implementing a Naloxone program, and we hope many other PSI IDU programs can add Naloxone to their interventions.

A recent change in USAID regulations now allows you to use USAID funding to purchase Naloxone for distribution to your IDU clients.

For more information, contact me (robgray@laopdr.com) or Beth (eskorochod@psi.org)

Cheers
Rob

Why Overdose Matters for HIV

For most drug users and people who work with them, overdose is an urgent issue. Many AIDS, harm reduction, and other drug service organizations have created programs to educate people who use drugs about overdose prevention and response techniques; to distribute naloxone—a safe and highly effective opioid overdose antidote that is included in the World Health Organization’s Model List of Essential Medicines; and to document the extent of overdose and the success of responses. But funding has been limited.

Recently, the Global Fund to Fight AIDS, Tuberculosis and Malaria and PEPFAR both issued guidance that they will support these kinds of overdose prevention activities. Service providers should ensure that overdose services are available to their drug-using clients directly or through local referral networks.

This document, prepared by overdose experts Matt Curtis and Nab Dasgupta for OSI and EHRN, presents evidence and arguments that organizations can make to AIDS funders to show that overdose prevention and response matter for HIV programming.

The document is available in English and Russian at this link: http://www.soros.org/initiatives/health/focus/ihrd/articles_publications/publications/why-overdose-matters-20100715

For your reference:
The Global Fund’s harm reduction information note for Round 10: http://www.theglobalfund.org/documents/rounds/10/R10_InfoNote_HarmReduction_en.pdf
PEPFAR’s IDU Guidance: http://www.pepfar.gov/documents/organization/144970.pdf

Lowering the Threshold: Models of Accessible Methadone and Buprenorphine Treatment

Deemed “essential medicines” by the World Health Organization, methadone and buprenorphine treatment help reduce drug injection and drug-related crime and improve public order, family satisfaction, return to employment, and adherence to HIV treatment.

Unfortunately, even when methadone or buprenorphine are available, treatment fails to reach many of those who could benefit. One reason for this is the many requirements—including admission restrictions, limited hours of operation, waiting lists, and cumbersome prescription and storage requirements—that make it difficult for patients to enter treatment programs.

Lowering the Threshold: Models of Accessible Methadone and Buprenorphine Treatment documents low-threshold methadone and buprenorphine programs—that is, programs that seek, in the spirit of harm reduction, to meet patients “where they’re at” and minimize bureaucratic requirements.

Lowering the Threshold includes the following topics:
• Methadone on Demand: The Hong Kong Model
• Treatment by Prescription in France
• Slovenia: High Coverage, Low HIV Prevalence
• Widespread and Uncontroversial: Methadone and Buprenorphine in Croatia
• Methadone by Bus in Amsterdam
• Vancouver: Integrated Low-threshold Models of Care

Lowering the Threshold is available in Russian and English at this link: http://www.soros.org/initiatives/health/focus/ihrd/articles_publications/publications/lowering-the-threshold-20100311

Lancet series on people who use drugs

HIV in people who use drugs
Launched in Vienna, Austria, July 20, 2010

Executive summary
Almost three decades after the discovery of HIV, this Series highlights the threat of a largely unpublicised and growing HIV epidemic: in people who use drugs. While large gains have been made in fighting the epidemic in the general population, socially marginalised populations such as people who use drugs, who often enter prison systems, continue to suffer great stigma and lack of access to treatments that can save both their own lives and prevent HIV transmission to others. “Complacency about the HIV /AIDS epidemic now would be a terrible mistake,” says Lancet Editor Dr Richard Horton.

The Series tackles the myths surrounding HIV and people who use drugs, and subjects as diverse as women and drugs to the effect of amphetamines, alcohol, and human rights on the epidemic. The issues surrounding antiretroviral HIV treatment, opioid substitution therapy, and needle and syringe programmes are covered in depth, as are the social issues around decriminalisation of drug users and reducing intimidation, stigmatisation, and imprisonment of drug users.

Follow this link to view articles.

Rob

Those important 2 Weeks After Release...

An interesting article is out showing a much higher risk of death among drug users in the the first 2 weeks after release from prison.

This is precisely the kind of evidence that enables us to zero in on the right times and places (the "Place" P) to deliver components of our Marketing Mix.

Abstract pasted below.

Cheers
Rob


Meta-analysis of drug-related deaths soon after release from prison

Elizabeth L. C. Merrall et.al.

ABSTRACT
Aims The transition from prison back into the community is particularly hazardous for drug-using offenders whose tolerance for heroin has been reduced by imprisonment. Studies have indicated an increased risk of drug-related death soon after release from prison, particularly in the first 2 weeks. For precise, up-to-date understanding of these risks, a meta-analysis was conducted on the risk of drug-related death in weeks 1 + 2 and 3 + 4 compared with later 2-week periods in the first 12 weeks after release from prison.

Methods English-language studies were identified that followed up adult prisoners for mortality from time of index release for at least 12 weeks. Six studies from six prison systems met the inclusion criteria and relevant data were extracted independently.
Results These studies contributed a total of 69 093 person-years and 1033 deaths in the first 12 weeks after release, of which 612 were drug-related. A three- to eightfold increased risk of drug-related death was found when comparing weeks 1 + 2 with weeks 3–12, with notable heterogeneity between countries: United Kingdom, 7.5 (95% CI: 5.7–9.9); Australia, 4.0 (95% CI: 3.4–4.8); Washington State, USA, 8.4 (95% CI: 5.0–14.2) and New Mexico State, USA, 3.1 (95% CI: 1.3–7.1). Comparing weeks 3 + 4 with weeks 5–12, the pooled relative risk was: 1.7 (95% CI: 1.3–2.2).

Conclusions These findings confirm that there is an increased risk of drug-related death during the first 2 weeks after release from prison and that the risk remains elevated up to at least the fourth week.

Harm Reduction at the 2010 AIDS Conference

For those of you going to the Int'l AIDS Conference in Vienna, please take a look at this useful summary of some of the main conference presentations and events related to Harm Reduction, available at the link here.

Rob

Vienna Declaration

As many of you know, the 18th International AIDS Conference will begin in Vienna, Austria in less than two weeks. The Vienna Declaration is "a statement seeking to improve community health and safety by calling for the incorporation of scientific evidence into illicit drug policies." This is the official declaration of the conference and we encourage you to read and sign-on. Learn more at: www.viennadeclaration.com.

Take Home Naloxone

An interesting study came out in the journal "Drugs: Education, Prevention and Policy". Entitled, "Responsible management and use of a personal take-home naloxone supply: A pilot project", Scottish researchers reported on the success of a program designed to train people who use drugs to administer naloxone and to provide a take home supply of the drug. The study found that after six months, 89% of study participants reported that they still had their naloxone at home, ready for use. Two individuals reported using the naloxone during an overdose.

The study results shows that people who use drugs can be trained to administer naloxone and to keep a stock of naloxone in their home. This contributes to a growing evidence-base that proves naloxone can and should be provided for home administration. This is where the majority of overdoses occur, and by putting naloxone in the hands of the people that need it most, we save lives.

PSI is working to build access to naloxone in Russia. If you're interested in introducing naloxone programs in your platform, contact Rob or Petra for more information.

Harm Reduction Certificate from York University

As your harm reduction program expands, it may be wise to consider building the capacity of your team members in a more formal way. York University offers a Certificate in Harm Reduction, described below.

Rob

-----

The Certificate in Harm Reduction consists of 117-hours of instruction designed to introduce service providers, administrators and policy makers to the principles, concepts and practices of harm reduction, to provide an opportunity to critically examine examples of harm reduction work; and to become familiar with strategies for mobilizing support for and developing harm reduction programs in communities, families and institutions.

Participants who complete all evaluative components will receive a Certificate in Harm Reduction from York University.

http://dce.yorku.ca/SubCgyPgmCrs.aspx?CgyID=3&SubCgyID=8

"Methadone Man" and "Buprenorphine Babe"

A new multimedia campaign has been launched to support the roll out of Methadone and buprenorphine to help drug users stop injection, reduce HIV risk, and stay on AIDS treatment.

These essential medicines are available to less than 10% of the people worldwide who need them most.

The campaign features "Methadone Man" and "Buprenorphine Babe" in an innovative cartoon-style action story.

The materials are interesting and highly creative. Be careful about using them in your country, as I suspect that the campaign style might not appeal to people who are still not fully supportative of Methadone and buprenorphine. Two campaign websites linked up, below.

Rob

http://www.methadoneman.org/
http://www.facebook.com/group.php?gid=62587415607

UNODC releases World Drug Report 2010

The UNODC launched the World Drug Report 2010 today. Taking part in the launch were UNODC Executive Director Antonio Maria Costa, Viktor Ivanov, Director of the Federal Drugs Control Service of the Russian Federation, and Gil Kerlikowske, Director of the White House Office of National Drug Control Policy.

The Report shows that drug use is shifting towards new drugs and new markets. Drug crop cultivation is declining in Afghanistan (for opium) and the Andean countries (coca), and drug use has stabilized in the developed world. However, there are signs of an increase in drug use in developing countries and growing abuse of amphetamine-type stimulants and prescription drugs around the world.

Click here to read a summary and to link to the report.

Cheers
Rob

Harm Reduction Posters Online

Link to the below site for a set of quite good harm reduction posters, posted on line:

http://www.hep.org.au/index.php?article=content/info-resources/harm-reduction-posters

Cheers
Rob

Safe Injecting Rooms

Australians are debating whether or not to expand the use of safe injecting rooms, which have been shown to reduce risk behaviors, deaths from overdose, and even street-based crime in many of the 76 sites around the world where they now exist.

Below is an opinion piece by renowned drug expert Robert Power, laying out the case for injecting rooms.

Most safe injecting rooms are in the developed world, leaving IDUs we serve in the developing world (once again) under-served and out in the cold, quite literally. In the future, PSI countries working with IDUs should consider whether or not to add injecting rooms to their marketing mix. Obviously, this would require a good enabling environment from the government. But the evidence base around this kind of intervention is getting quite strong. Something to think about, for the future.

Rob



Injecting rooms benefit all, not just drug users
ROBERT POWER
June 22, 2010

http://www.theage.com.au/opinion/society-and-culture/injecting-rooms-benefit-all-not-just-drug-users-20100621-ys4w.html
The evidence is in, and Victorians must decide how best to use it.

LOTTE believes Sydney's supervised injecting room saved her life. "I've overdosed before, when I was living rough … was lucky, my mate called the ambos and they brought me round." She'd injected in a hurry, in a car, concerned that police were close by. The heroin was too strong and she passed out.

Now she attends the Sydney facility, where she can take her drugs in a secure environment, with medically trained staff close by. "They give us clean needles and teach us safe ways to inject. They talk to us like people, not junkies, tell us where we can get help for other stuff. If I hadn't gone there, I'd be dead on the streets, I know I would." She talks about trying to get off heroin, but hasn't made it yet. "I know when I'm ready they'll help me out."

A decade has passed since supervised injecting places were last seriously considered (and then rejected) as an option for Victoria. But the debate - and, more significantly, the evidence - has moved on from the days of the Bracks government. It is now timely for a considered and dispassionate review of this harm reduction option. Supervised injecting rooms have been around for 20 years, providing clean and safe places for drug users to inject. Of the 76 around the world, mainly in Europe, Scandinavia and North America, there's just one in Australia, in Sydney's Kings Cross.

The evidence points to three main conclusions: the facilities reap benefits for individual and public health; they render improvements in public amenity and community well-being; and they need to be part of a broader harm reduction response.

The facilities attract the most marginalised and stigmatised drug users: the homeless, sex workers, former prisoners, frequent injectors, and poly-drug users. Of Sydney's clients, three-quarters had never previously been in contact with a drug agency, and these are the ones most likely to be engaged in high-risk activities, such as needle sharing. For them, life on the street is unhygienic and often dangerous, leaving them vulnerable and liable to injecting drugs in dirty, rushed conditions, where overdoses, needle sharing and injuries linked to poor injecting techniques are everyday realities.

Evidence from across the globe shows that supervised injecting rooms can ameliorate these problems. Sydney's has attracted more than 12,000 vulnerable clients in nine years and supervised more than half a million injections: injections that took place off the streets, away from the public, with safe disposal of injecting material.

A Burnet Institute study found that two-thirds of injectors in Melbourne last injected in a public place, mainly in cars, streets, parks and in the stairwells of public buildings. This is not only inappropriate for the injector, but also bad for the local population, raising concerns about discarded needles and general security and safety.

Overdose is a huge risk to drug users on the street, as Lotte's experience shows. The Sydney facility has dealt with 3500 cases of overdose, with no fatalities. Indeed, no overdose fatalities have been recorded at any supervised injecting room anywhere in the world. Aside from the personal and familial tragedies averted, there are cost savings from thousands less overdose cases for ambulances and emergency rooms.

If we factor in the primary healthcare these facilities offer, alongside problems deflected through teaching injecting techniques, then the cost benefits and returns on investment increase.

Some European facilities have "contact cafes" where drug users can relax with staff and peers, receiving health promotion, counselling and much-needed trust building. A fifth of Sydney's clients were referred to health and social services, including drug treatment.

What of concerns over a "honey-pot" effect? The Sydney and Vancouver evaluations showed that drug dealing, drug acquisition crime and rates of new drug injectors have not increased in their environs. Indeed, many reported reduced crime and the closure of illegal "shooting galleries" in the surrounding areas. This improves local communities, with less visible signs of drug use, notably public injecting and discarded needles.

So where to for Melbourne and Victoria? First and foremost we need to be guided by the evidence. We must accept that some Victorians will continue to use illicit drugs and a smaller proportion will inject. Some may wish to stop using drugs, and these facilities, through their own staff efforts and referral networks, can help.

Harm reduction is based on a hierarchy of needs that equally well supports efforts towards abstinence alongside other public health goals. But for those who stumble and fall, we need to offer comprehensive harm reduction services to keep them healthy and protect society from drug-related harm.

For supervised injecting rooms to function effectively, there needs to be community and political support, engagement and collaboration with healthcare services and other agencies. The rooms need to be in places where drug users congregate and may be integrated into existing services, such as needle-exchange programs, or even as mobile units.

And supervised injecting rooms must be adequately funded, but not at the expense of other vital harm reduction services. In short, the evidence is there. It's now over to Victorians to decide how to use it.

Professor Robert Power is principal for disease prevention at the Burnet Institute.

Global Fund calls for Round 10 applications to include harm reduction

For the first time, the Global Fund has released an Information Note explicitly calling for countries to look for opportunities to launch and scale up harm reduction programs for IDUs through the GF rounds-based applications. (R10 applications are due on August 20th, 2010.)

Click here to read the document.

PSI countries thinking about applying for R10 funding for HIV and/or TB work with IDUs, can get support from the HIV Department to write the proposal. Contact Rob (robgray@laopdr.com) or Petra (pstankard@psi.org)

Rob

Interesting new article on the effectiveness of harm reduction, below.

Cheers
Rob

The effectiveness of harm reduction in preventing HIV among injecting drug users

Alex Wodak and Lisa Maher

New South Wales Public Health Bulletin , Volume 21 Number 4 2010 pp. 69-73

http://www.publish.csiro.au/?act=view_file&file_id=NB10007.pdf

Abstract:

There is now compelling evidence that harm reduction approaches to HIV prevention among injecting drug users are effective, safe and cost-effective. The evidence of effectiveness is strongest for needle and syringe programs and opioid substitution treatment. There is no convincing evidence that needle and syringe programs increase injecting drug use. The low prevalence (,1%) of HIV among injecting drug users reflects the early adoption and rapid expansion of harm reduction in Australia. Countries that have provided extensive needle and syringe programs and opioid substitution treatment appear to have averted an epidemic, stabilised or substantially reduced the prevalence of HIV among injecting drug users. However, despite decades of vigorous advocacy and scientific evidence, the global coverage of needle and syringe programs and opioid substitution treatment falls well short of the levels required to achieve international HIV control.

More research needed on effectiveness of harm reduction interventions

A new study is out that seeks to "review the evidence on the effectiveness of harm reduction interventions involving the provision of sterile injecting equipment in the prevention of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission among injecting drug users (IDUs)."

The study concludes: "The evidence is weaker than given credit for in the literature. The lack of evidence for effectiveness of NSP vis-à-vis biological outcomes (HCV and HIV incidence/prevalence) reflects the limitations of studies that have been undertaken to investigate these associations. Particularly for HCV, low levels of IRB may be insufficient to reduce high levels of transmission. New studies are required to identify the intervention coverage necessary to achieve sustained changes in blood-borne virus transmission."

PSI should be trying to fill the gap that exists in research and data to show the link between exposure to harm reduction interventions and behavioral and biological outcomes, esp. reduction in HIV incidence.

For the full report, go to:
http://www3.interscience.wiley.com/journal/123307018/abstract?SRETRY=0

Rob

Detention of drug users in Cambodia, Laos, and Thailand

The Nossal Institute for Global Health and the Open Society Institute are pleased to announce the release of a new report, Detention as Treatment: Detention of Methamphetamine Users in Cambodia, Laos, and Thailand.

It is available online at www.soros.org/initiatives/health/focus/ihrd/articles_publications/publications/detention-as-treatment-20100301

If you would like to receive a hard copy, please contact Johna Hoey at jhoey@sorosny.org

Harm reduction in Asia - report

In January 2010, the 2nd Consultation on HIV related to drug use was held in Bangkok. PSI Thailand staff were active participants.

The meeting report is below. Each section presents a useful summary of emerging best practices/recommendations for quality harm reduction programs. Useful to read/skim.

The report can be downloaded at the link below (but only for the next 7 days)

https://www.yousendit.com/download/bFFPU2VxeFhrUmswTVE9PQ

Rob

Lancet paper on IDU

The Lancet published a paper that researched shortfalls in HIV prevention, treatment, and care services for injecting drug users (IDUs) worldwide. The findings revealed that international “coverage of HIV prevention, treatment, and care services in IDU populations is very low” and are nowhere near the levels required to meet the needs of the population.

Read a summary of the report at:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960232-2/fulltext

See a map summary of the Eurasia region at:
http://www.ihra.net/Assets/581/1/GSHREurasia.pdf

Harm Reduction Overview

Neil Hunt (the creator of the Break the Cycle intervention in the UK) has put together a superb overview document outlining the main components of harm reduction.

The authors describe the document as follows:

This overview addresses both understandings of harm reduction and summarises its key principles before going on to consider the strength and nature of the evidence of the effectiveness of various forms of ‘harm reduction’ intervention. In doing so, some consideration is also given to criticisms of harm reduction that are occasionally encountered.

The document is called:

A review of the evidence-base for harm reduction approaches to drug use

It may be downloaded at:
http://www.ihra.net/Assets/23/1/HIVTop50Documents11.pdf

Cheers
Rob

Substitution therapy in C. Asia

Opioid Substitution Therapy (OST) is one of the most important components of a comprehensive harm reduction program. A new report out (see link below) outlines the state of OST in Central Asia, where PSI is one of the main development partners working with IDUs.

Rob

http://www.harm-reduction.org/images/stories/library/ost_final_2010.pdf?utm_source=IDPC+Monthly+Alert&utm_campaign=1761d6a25b-IDPC_March_Alert3_24_2010&utm_medium=email

$19

The Australian government has calculated the cost benefit of their harm reduction program. The study found an average "savings per syringe distributed" of $19. In other words, each needle going out saved the Australian tax payers $19 in other costs, had the intervention not existed (i.e. AIDS treatment, etc.)

You can download a brief summary at:

http://www.anex.org.au/downloads/Fact%20Sheet%20-%20NSP%20Return%20On%20Investment.pdf

This report might be useful in your advocacy work to convince partners that providing prevention services for drug users is a worthwhile endeavor with measurable results (including savings for tax payers).

Rob

HIV Counseling and Testing in Prisons

The WHO and UNAIDS have released new guidance on offering HIV counseling and testing in prisons. The technical paper and policy brief can be found at: http://www.who.int/hiv/pub/idu/tc_prisons/en/index.html

IDU in many countries face mandatory HIV counseling and testing (HCT) in prisons. They are not offered quality counseling and are not provided their test results. Advocacy around improved HCT is an important step in scaling up comprehensive harm reduction for IDU. These documents can be a helpful guides as individual country programs conduct advocacy with law enforcement and seek to improve services offered within prisons. Shifting perception of drug use from a public security concern to a public health concern takes time and advocating for comprehensive harm reduction in prisons is a major step in the right direction.

Hepatitis C and Syringes with Detachable Needles

A new study coming out of Yale has found the Hepatitis C virus survives in syringes with detachable needles longer than in syringes with an attached needle (i.e. an insulin syringe). http://inef.ie/?p=2976 Prior to this study, cohort studies among IDU populations in the US have found a higher HIV prevalence among populations using syringes with detachable needles than in those using a syringe with an attached needle.

Combined, these studies send a powerful message about needle and syringe distribution. Wherever possible, IDU should be encouraged to use syringes with an attached needle. A few thoughts for your programs:

1) Continue to meet the local IDU population with a needle/syringe that they will accept and use. The most important behavior is to ensure IDU are using sterile needles and syringes. If the local IDU population will not use a syringe with an attached needle, do not stop distributing the type of syringe/needle they will use.

2) Wherever possible, peer educators and other outreach workers should counsel IDU about the greater safety offered by a syringe with an attached needle. IDU should be encouraged to use this type of needle.

"Insite" - Vancouver's Supervised Injection Site

With the Winter Olympics in Vancouver, "Insite", Vancouver's supervised injection site has been in the press. Four articles at slate.com offer an interesting first hand account of the site. You can find the articles at: http://www.slate.com/id/2242828/entry/2242868/

The photo journal that accompanies the articles is particularly interesting: http://www.slate.com/id/2242828/slideshow/2242811/fs/0//entry/2242812/

Injecting Drug Use in Pakistan

In just four years, the HIV prevalence rate among Pakistan's IDU community has increased from 10.8% to nearly 21%. UNAIDS discusses how a lack of resources could impede outreach to this population at:

http://www.unaids.org/en/KnowledgeCentre/Resources/FeatureStories/archive/2010/20100204_Pakistan.asp

Check out some great photos taken in the community at: http://ow.ly/15PDt

Harm Reduction 201

The 2010 International Harm Reduction conference is fast approaching! The draft program was released and can be found at: http://ihraconferences.com/2010/sessions.php

Looking forward to seeing many of you in Liverpool!

Founding of Asia Network of People Who Use Drugs

Exciting news out of the 2nd Asian Consultation on the Prevention of HIV Related to Drug use. The founding of the Asian Network of People who Use Drugs was formally announced. This is a major step forward in advancing harm reduction in the region. To learn more visit www.anpud.org. PSI IDU platforms should start considering how we can work closely with ANPUD in program development and implementation.

Gender, HIV and IDU

The Eurasian Harm Reduction Network and Harm Reduction Knowledge Hub have launched a project to promote gender equality in HIV programming for IDU. Gender inequality is a topic of growing importance in the Harm Reduction community as implementers become more aware of the dangers of programming that is not sensitive to the gender dynamics of IDU driven HIV epidemics. Read more about the project and post your thoughts and comments at:

http://www.harm-reduction.org/news/1646-ehrn-launches-new-gender-project.html

For PSI platforms interested in ensuring their programs are providing the necessary services for female IDU, visit the IDU Kix page where resource on working with female IDU are provided.

Kenya and IDU

Exciting news out of Kenya. In its third National AIDS Strategic Plan, the Kenyan government has pledged to "ease restrictions on programmes that work with drug users and other at-risk groups whose behaviour has been criminalized".

The plan states, “Sex work, homosexuality and drug use are illegal in Kenya, and attempts to de-criminalise them have faced significant religious and cultural resistance among the population. However, based on new evidence, KNASP III will work with all most at risk groups and seek innovative ways to reduce HIV transmission. Programmes have been working with all these groups for many years, but under constraints, which KNASP III aims to alleviate systematically.”

This is a major step forward for harm reduction in sub-Saharan Africa. Kenya has one of the largest IDU populations in the region and barriers to working with the population have made programming difficult.

PSI continues to seek expansion of its IDU work into Africa. African platforms interested in IDU programming can access the "IDU in Africa" page on Kix and contact the IDU technical team to learn more on how to begin working with this key population.

Take home Naloxone

See below for a link to a new website on the topic of take-home Naloxone, a website run by independent academics and healthcare professionals aimed at raising the awareness and profile of the use of take-home naloxone as a mechanism for reducing drug-related death, and to provide a forum for discussing innovation, training and practice developments

http://www.take-homenaloxone.com/

NYC Brochure on Safe Injecting

New York City Department of Health recently published "Take Care and Take Charge", a brochure on safe injecting. See the brochure at the following link:

http://www.flickr.com/photos/paolomastrangelo/4243932008/in/set-72157623134888628/

This harm reduction approach seeks to ensure that people who are not yet ready to cease drug use, inject as safely as possible. Teaching safer injecting practices in a comprehensible and easy manner is a critical step in reducing drug related harms like HIV and overdose death.