The Canadian HIV/AIDS Legal Network (on behalf of a number of local and international durg policy organizations) made a recent submission to the UN Human Rights Council on the state of human rights and HIV in Kazakhstan.
The report "describes several key human rights priorities and provides recommendations for Kazakhstan’s Government to better respect, protect and fulfill human rights, consistent with its international obligations, in areas of particular relevance to an effective response to HIV."
This is an excellent read for anyone interested in the protection of human rights in the context of HIV public health activities. It is critical that project implementers be aware of potential and existing human rights violations and, where possible, advocate for policies that protect the human rights of people living with HIV and at high risk of HIV infection.
http://www.idpc.net/sites/default/files/library/UPR%20Submission%20Kazakhstan_FINAL%20(Sep%202009).pdf?utm_source=IDPC+Monthly+Alert&utm_campaign=9a0ed519d3-&utm_medium=email
Thursday, October 29, 2009
Friday, October 23, 2009
Wider distribution of Naloxone
Australian experts have called for the removal of barriers that prevent the drug naloxone from being easily available for peer administration after heroin overdose.
In a letter to the MJA, Professor Simon Lenton, Deputy Director of the National Drug Research Institute, along with colleagues from Melbourne’s Burnet Institute and the National Drug and Alcohol Research Centre, said that naloxone administration by peers has been shown to be a “remarkably safe” intervention to prevent deaths from heroin overdose. “We call on all Australian states and territories to immediately enact Good Samaritan legislation to legally protect laypeople using naloxone in emergency situations,” they said. They also called for the drug to be reclassified from a Schedule 4 (S4) to S3 or S2 to make it available over the counter. “Heroin overdose deaths are preventable. We need to take action now to enable peer-led intervention to reduce this serious outcome.” Nine years ago there had been a push to trial the distribution of naloxone to the peers of people at risk of a heroin overdose, but, as the heroin market was disrupted and use declined, the trials did not proceed, the authors said. However, they noted that overseas trials have shown that fears about naloxone, such as that it would be unsafe to administer or would encourage more risky drug use, had been proved to be unfounded. By December 2008 there were 52 programs in the United States that distributed naloxone to the peers of heroin users which had caused over 1000 documented overdose reversals, they said. MJA 2009; 191 (8): 469.
More at the site below:
http://www.psychiatryupdate.com.au/article/otc-naloxone-would-save-lives/503013.aspx
In a letter to the MJA, Professor Simon Lenton, Deputy Director of the National Drug Research Institute, along with colleagues from Melbourne’s Burnet Institute and the National Drug and Alcohol Research Centre, said that naloxone administration by peers has been shown to be a “remarkably safe” intervention to prevent deaths from heroin overdose. “We call on all Australian states and territories to immediately enact Good Samaritan legislation to legally protect laypeople using naloxone in emergency situations,” they said. They also called for the drug to be reclassified from a Schedule 4 (S4) to S3 or S2 to make it available over the counter. “Heroin overdose deaths are preventable. We need to take action now to enable peer-led intervention to reduce this serious outcome.” Nine years ago there had been a push to trial the distribution of naloxone to the peers of people at risk of a heroin overdose, but, as the heroin market was disrupted and use declined, the trials did not proceed, the authors said. However, they noted that overseas trials have shown that fears about naloxone, such as that it would be unsafe to administer or would encourage more risky drug use, had been proved to be unfounded. By December 2008 there were 52 programs in the United States that distributed naloxone to the peers of heroin users which had caused over 1000 documented overdose reversals, they said. MJA 2009; 191 (8): 469.
More at the site below:
http://www.psychiatryupdate.com.au/article/otc-naloxone-would-save-lives/503013.aspx
Monday, October 19, 2009
Vending Machines for Safe Injection
An interesting AP article came out last week describing the efforts of a harm reduction organization operating in Puerto Rico. Because the needle and syringe exchanges in that area operate only during daylight, vending machines with safe injection equipment cater to IDUs who may need access to clean equipment in the evening hours. This is an interesting and innovative way of getting the clean equipment to IDUs, and one which may be particularly effective in certain settings.
http://www.google.com/hostednews/ap/article/ALeqM5hjEbI7h0fP-FyJupR-waFrrmXstgD9BAI5SG0
http://www.google.com/hostednews/ap/article/ALeqM5hjEbI7h0fP-FyJupR-waFrrmXstgD9BAI5SG0
Thursday, October 8, 2009
Calculate your needle coverage
Harm Reduction Works has created an on-line calculator to help you estimate the extent to which the number of syringes being distributed to illicit drug users within an area compares to an estimate of the potential need for sterile injecting equipment.
See: http://www.harmreductionworks.org.uk/5_web/coverage_calculator/index.php
This could hel you think through your "Universe of Need" for IDUs, regarding needles/syringes.
Rob
See: http://www.harmreductionworks.org.uk/5_web/coverage_calculator/index.php
This could hel you think through your "Universe of Need" for IDUs, regarding needles/syringes.
Rob
Wednesday, October 7, 2009
A cocaine vaccine?
Immunization with an experimental anti-cocaine vaccine resulted in a substantial reduction in cocaine use in 38 percent of vaccinated patients in a clinical trial supported by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health. The study, published in the October issue of Archives of General Psychiatry, is the first successful, placebo-controlled demonstration of a vaccine against an illicit drug of abuse.
For more information on this ground-breaking finding, please see below.
http://www.drugabuse.gov/newsroom/09/NR10-05.html
The vaccine is not ready for widespread use yet. But this could become one way for PSI to do product-based drug demand reduction, wherever cocaine use is prevalent and widespread.
Rob
For more information on this ground-breaking finding, please see below.
http://www.drugabuse.gov/newsroom/09/NR10-05.html
The vaccine is not ready for widespread use yet. But this could become one way for PSI to do product-based drug demand reduction, wherever cocaine use is prevalent and widespread.
Rob
Tuesday, September 29, 2009
Harm Reduction - Defined
The International Harm Reduction Association has released a new detailed position statement defining "harm reduction". Although a term that many of us use daily, the term has been the subject of some debate. This definition encompasses both the public health and human rights dimensions of "harm reduction" and is a useful tool for even the most seasoned of IDU program implementers. The full statement can be found at http://www.ihra.net/Whatisharmreduction
Definition
‘Harm Reduction’ refers to policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families and the community.
Principles
The harm reduction approach to drugs is based on a strong commitment to public health and human rights.
Targeted at risks and harms
Harm reduction is a targeted approach that focuses on specific risks and harms. Politicians, policymakers, communities, researchers, frontline workers and people who use drugs should ascertain:
What are the specific risks and harms associated with the use of specific psychoactive drugs?
What causes those risks and harms?
What can be done to reduce these risks and harms?
Harm reduction targets the causes of risks and harms. The identification of specific harms, their causes, and decisions about appropriate interventions requires proper assessment of the problem and the actions needed. The tailoring of harm reduction interventions to address the specific risks and harms must also take into account factors which may render people who use drugs particularly vulnerable, such as age, gender and incarceration.
Evidence based and cost effective
Harm reduction approaches are practical, feasible, effective, safe and cost-effective. Harm reduction has a commitment to basing policy and practice on the strongest evidence available. Most harm reduction approaches are inexpensive, easy to implement and have a high impact on individual and community health. In a world where there will never be sufficient resources, benefit is maximised when low-cost/high-impact interventions are preferred over high-cost/low-impact interventions.
Incremental
Harm reduction practitioners acknowledge the significance of any positive change that individuals make in their lives. Harm reduction interventions are facilitative rather than coercive, and are grounded in the needs of individuals. As such, harm reduction services are designed to meet people’s needs where they currently are in their lives. Small gains for many people have more benefit for a community than heroic gains achieved for a select few. People are much more likely to take multiple tiny steps rather than one or two huge steps. The objective of harm reduction in a specific context can often be arranged in a hierarchy with the more feasible options at one end (eg measures to keep people healthy) and less feasible but desirable options at the other end. Abstinence can be considered a difficult to achieve but desirable option for harm reduction in such a hierarchy. Keeping people who use drugs alive and preventing irreparable damage is regarded as the most urgent priority while it is acknowledged that there may be many other important priorities.
Dignity and compassion
Harm reduction practitioners accept people as they are and avoid being judgemental. People who use drugs are always somebody’s son or daughter, sister or brother or father or mother. This compassion extends to the families of people with drug problems and their communities. Harm reduction practitioners oppose the deliberate stigmatisation of people who use drugs. Describing people using language such as ‘drug abusers’, ‘a scourge’, ‘bingers’, ‘junkies’, ‘misusers’, or a ‘social evil’ perpetuates stereotypes, marginalises and creates barriers to helping people who use drugs. Terminology and language should always convey respect and tolerance.
Universality and interdependence of rights
Human rights apply to everyone. People who use drugs do not forfeit their human rights, including the right to the highest attainable standard of health, to social services, to work, to benefit from scientific progress, to freedom from arbitrary detention and freedom from cruel inhuman and degrading treatment. Harm reduction opposes the deliberate hurts and harms inflicted on people who use drugs in the name of drug control and drug prevention, and promotes responses to drug use that respect and protect fundamental human rights.
Challenging policies and practices that maximise harm
Many factors contribute to drug-related risks and harms including the behaviour and choices of individuals, the environment in which they use drugs, and the laws and policies designed to control drug use. Many policies and practices intentionally or unintentionally create and exacerbate risks and harms for drug users. These include: the criminalisation of drug use, discrimination, abusive and corrupt policing practices, restrictive and punitive laws and policies, the denial of life-saving medical care and harm reduction services, and social inequities. Harm reduction policies and practice must support individuals in changing their behaviour. But it is also essential to challenge the international and national laws and policies that create risky drug using environments and contribute to drug related harms.
Transparency, accountability and participation
Practitioners and decision makers are accountable for their interventions and decisions, and for their successes and failures. Harm reduction principles encourage open dialogue, consultation and debate. A wide range of stakeholders must be meaningfully involved in policy development and programme implementation, delivery and evaluation. In particular, people who use drugs and other affected communities should be involved in decisions that affect them.
Definition
‘Harm Reduction’ refers to policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families and the community.
Principles
The harm reduction approach to drugs is based on a strong commitment to public health and human rights.
Targeted at risks and harms
Harm reduction is a targeted approach that focuses on specific risks and harms. Politicians, policymakers, communities, researchers, frontline workers and people who use drugs should ascertain:
What are the specific risks and harms associated with the use of specific psychoactive drugs?
What causes those risks and harms?
What can be done to reduce these risks and harms?
Harm reduction targets the causes of risks and harms. The identification of specific harms, their causes, and decisions about appropriate interventions requires proper assessment of the problem and the actions needed. The tailoring of harm reduction interventions to address the specific risks and harms must also take into account factors which may render people who use drugs particularly vulnerable, such as age, gender and incarceration.
Evidence based and cost effective
Harm reduction approaches are practical, feasible, effective, safe and cost-effective. Harm reduction has a commitment to basing policy and practice on the strongest evidence available. Most harm reduction approaches are inexpensive, easy to implement and have a high impact on individual and community health. In a world where there will never be sufficient resources, benefit is maximised when low-cost/high-impact interventions are preferred over high-cost/low-impact interventions.
Incremental
Harm reduction practitioners acknowledge the significance of any positive change that individuals make in their lives. Harm reduction interventions are facilitative rather than coercive, and are grounded in the needs of individuals. As such, harm reduction services are designed to meet people’s needs where they currently are in their lives. Small gains for many people have more benefit for a community than heroic gains achieved for a select few. People are much more likely to take multiple tiny steps rather than one or two huge steps. The objective of harm reduction in a specific context can often be arranged in a hierarchy with the more feasible options at one end (eg measures to keep people healthy) and less feasible but desirable options at the other end. Abstinence can be considered a difficult to achieve but desirable option for harm reduction in such a hierarchy. Keeping people who use drugs alive and preventing irreparable damage is regarded as the most urgent priority while it is acknowledged that there may be many other important priorities.
Dignity and compassion
Harm reduction practitioners accept people as they are and avoid being judgemental. People who use drugs are always somebody’s son or daughter, sister or brother or father or mother. This compassion extends to the families of people with drug problems and their communities. Harm reduction practitioners oppose the deliberate stigmatisation of people who use drugs. Describing people using language such as ‘drug abusers’, ‘a scourge’, ‘bingers’, ‘junkies’, ‘misusers’, or a ‘social evil’ perpetuates stereotypes, marginalises and creates barriers to helping people who use drugs. Terminology and language should always convey respect and tolerance.
Universality and interdependence of rights
Human rights apply to everyone. People who use drugs do not forfeit their human rights, including the right to the highest attainable standard of health, to social services, to work, to benefit from scientific progress, to freedom from arbitrary detention and freedom from cruel inhuman and degrading treatment. Harm reduction opposes the deliberate hurts and harms inflicted on people who use drugs in the name of drug control and drug prevention, and promotes responses to drug use that respect and protect fundamental human rights.
Challenging policies and practices that maximise harm
Many factors contribute to drug-related risks and harms including the behaviour and choices of individuals, the environment in which they use drugs, and the laws and policies designed to control drug use. Many policies and practices intentionally or unintentionally create and exacerbate risks and harms for drug users. These include: the criminalisation of drug use, discrimination, abusive and corrupt policing practices, restrictive and punitive laws and policies, the denial of life-saving medical care and harm reduction services, and social inequities. Harm reduction policies and practice must support individuals in changing their behaviour. But it is also essential to challenge the international and national laws and policies that create risky drug using environments and contribute to drug related harms.
Transparency, accountability and participation
Practitioners and decision makers are accountable for their interventions and decisions, and for their successes and failures. Harm reduction principles encourage open dialogue, consultation and debate. A wide range of stakeholders must be meaningfully involved in policy development and programme implementation, delivery and evaluation. In particular, people who use drugs and other affected communities should be involved in decisions that affect them.
Thursday, September 24, 2009
AIDS Vaccine Trial Shows Partial Protection
Extremely exciting news today. The results from an AIDS vaccine study in Thailand has shown the vaccine to be partially protective (31.2%) against the HIV virus. While this does not mean that a vaccine is around the corner, it is a huge step forward.
For First Time, AIDS Vaccine Shows Some Success (New York Time, Sept. 24,2009)
By DONALD G. McNEIL Jr.
A new AIDS vaccine tested on more than 16,000 volunteers in Thailand has protected a significant minority against infection, the first time any vaccine against the disease has even partly succeeded in a clinical trial.
Scientists said they were delighted but puzzled by the result. The vaccine — a combination of two genetically engineered vaccines, neither of which had worked before in humans — protected too few people to be declared an unqualified success. And the researchers do not know why it worked.
“I don’t want to use a word like ‘breakthrough,’ but I don’t think there’s any doubt that this is a very important result,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, which is one of the trial’s backers.
“For more than 20 years now, vaccine trials have essentially been failures,” he went on. “Now it’s like we were groping down an unlit path, and a door has been opened. We can start asking some very important questions.”
Results of the trial of the vaccine, known as RV 144, were released at 2 a.m. Eastern time Thursday in Thailand by the partners that ran the trial, by far the largest of an AIDS vaccine: the United States Army, the Thai Ministry of Public Health, Dr. Fauci’s institute, and the patent-holders in the two parts of the vaccine, Sanofi-Pasteur and Global Solutions for Infectious Diseases.
Col. Jerome H. Kim, a physician who is manager of the army’s H.I.V. vaccine program, said half the 16,402 volunteers were given six doses of two vaccines in 2006 and half were given placebos. They then got regular tests for the AIDS virus for three years. Of those who got placebos, 74 became infected, while only 51 of those who got the vaccines did.
Although the difference was small, Dr. Kim said it was statistically significant and meant the vaccine was 31.2 percent effective.
Dr. Fauci said that scientists would seldom consider licensing a vaccine less than 70 or 80 percent effective, but he added, “If you have a product that’s even a little bit protective, you want to look at the blood samples and figure out what particular response was effective and direct research from there.”
The most confusing aspect of the trial, Dr. Kim said, was that everyone who did become infected developed roughly the same amount of virus in their blood whether they got the vaccine or a placebo.
Normally, any vaccine that gives only partial protection — a mismatched flu shot, for example — at least lowers the viral load.
That suggests that RV 144 does not produce neutralizing antibodies, as most vaccines do, Dr. Fauci said. Antibodies are long Y-shaped proteins formed by the body that clump onto invading viruses, blocking the surface spikes with which they attach to cells and flagging them for destruction.
Instead, he theorized, it might produce “binding antibodies,” which latch onto and empower effector cells, a type of white blood cell attacking the virus.
Whatever the vaccine does, he said, it does not seem to mimic the defenses of the rare individuals known to AIDS doctors as “long-term nonprogressors,” who do not get sick even though they are infected. They have low viral loads because they block reproduction in some way that is still mysterious.
“If we knew what immune response did it, we’d be able to be a lot more efficient in targeting it,” Dr. Kim said.
Also, the RV 144 tested in Thailand was designed to combat the most common strain of the virus circulating in Southeast Asia. Different strains circulate in Africa, the United States and elsewhere, and it is not clear that the vaccine would have similar results, even in modified form.
The thousands of Thais chosen were a cross-section of the Thai young adult population, not just high-risk groups like drug injectors or sex workers, Dr. Kim said.
One of the substances that were combined to make RV 144 is Alvac-HIV, from Sanofi-Pasteur, a canarypox virus with three AIDS virus genes grafted onto it. Variations of Alvac were tested in France, Thailand, Uganda and the United States; it was found safe but generated little immune response.
The other, Aidsvax, was originally made by Genentech and is an engineered version of a protein found on the surface of the AIDS virus; it is grown in a broth of hamster ovary cells.
It was tested in Thai drug users in 2003 and also in gay men in North America and Europe; it did not protect them against infection, and Genentech spun off the rights to develop the vaccine.
In 2007, two trials of a Merck vaccine in about 4,000 people were stopped early; it not only failed to work but for some men seemed to increase the risk of infection.
Combining Alvac and Aidsvax was a hunch by scientists: If one was designed to create antibodies and the other to alert white blood cells, might they work together even if neither worked alone?
Mitchell Warren, executive director of AVAC, the AIDS Vaccine Advocacy Coalition, which pushes for vaccines and other forms of prevention, was enthusiastic about the trial data.
“Wow,” he said. “This is a hugely exciting and, frankly, unexpected result. It changes our thinking in ways we hadn’t anticipated.”
“We often talk about whether a vaccine is even possible,” he added. “This is not the vaccine that ends the epidemic and says, ‘O.K., let’s move on to something else.’ But it’s a fabulous new step that takes us in a new direction.”
Mr. Warren said the finding showed the need for large human trials, expensive as they are. Studies in mice and monkeys have not been good at predicting what would work in people, and small human trials in which researchers test results by looking for antibodies in blood have limited value.
Dr. Fauci agreed.
“This is not the endgame,” he said. “This is the beginning.”
For First Time, AIDS Vaccine Shows Some Success (New York Time, Sept. 24,2009)
By DONALD G. McNEIL Jr.
A new AIDS vaccine tested on more than 16,000 volunteers in Thailand has protected a significant minority against infection, the first time any vaccine against the disease has even partly succeeded in a clinical trial.
Scientists said they were delighted but puzzled by the result. The vaccine — a combination of two genetically engineered vaccines, neither of which had worked before in humans — protected too few people to be declared an unqualified success. And the researchers do not know why it worked.
“I don’t want to use a word like ‘breakthrough,’ but I don’t think there’s any doubt that this is a very important result,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, which is one of the trial’s backers.
“For more than 20 years now, vaccine trials have essentially been failures,” he went on. “Now it’s like we were groping down an unlit path, and a door has been opened. We can start asking some very important questions.”
Results of the trial of the vaccine, known as RV 144, were released at 2 a.m. Eastern time Thursday in Thailand by the partners that ran the trial, by far the largest of an AIDS vaccine: the United States Army, the Thai Ministry of Public Health, Dr. Fauci’s institute, and the patent-holders in the two parts of the vaccine, Sanofi-Pasteur and Global Solutions for Infectious Diseases.
Col. Jerome H. Kim, a physician who is manager of the army’s H.I.V. vaccine program, said half the 16,402 volunteers were given six doses of two vaccines in 2006 and half were given placebos. They then got regular tests for the AIDS virus for three years. Of those who got placebos, 74 became infected, while only 51 of those who got the vaccines did.
Although the difference was small, Dr. Kim said it was statistically significant and meant the vaccine was 31.2 percent effective.
Dr. Fauci said that scientists would seldom consider licensing a vaccine less than 70 or 80 percent effective, but he added, “If you have a product that’s even a little bit protective, you want to look at the blood samples and figure out what particular response was effective and direct research from there.”
The most confusing aspect of the trial, Dr. Kim said, was that everyone who did become infected developed roughly the same amount of virus in their blood whether they got the vaccine or a placebo.
Normally, any vaccine that gives only partial protection — a mismatched flu shot, for example — at least lowers the viral load.
That suggests that RV 144 does not produce neutralizing antibodies, as most vaccines do, Dr. Fauci said. Antibodies are long Y-shaped proteins formed by the body that clump onto invading viruses, blocking the surface spikes with which they attach to cells and flagging them for destruction.
Instead, he theorized, it might produce “binding antibodies,” which latch onto and empower effector cells, a type of white blood cell attacking the virus.
Whatever the vaccine does, he said, it does not seem to mimic the defenses of the rare individuals known to AIDS doctors as “long-term nonprogressors,” who do not get sick even though they are infected. They have low viral loads because they block reproduction in some way that is still mysterious.
“If we knew what immune response did it, we’d be able to be a lot more efficient in targeting it,” Dr. Kim said.
Also, the RV 144 tested in Thailand was designed to combat the most common strain of the virus circulating in Southeast Asia. Different strains circulate in Africa, the United States and elsewhere, and it is not clear that the vaccine would have similar results, even in modified form.
The thousands of Thais chosen were a cross-section of the Thai young adult population, not just high-risk groups like drug injectors or sex workers, Dr. Kim said.
One of the substances that were combined to make RV 144 is Alvac-HIV, from Sanofi-Pasteur, a canarypox virus with three AIDS virus genes grafted onto it. Variations of Alvac were tested in France, Thailand, Uganda and the United States; it was found safe but generated little immune response.
The other, Aidsvax, was originally made by Genentech and is an engineered version of a protein found on the surface of the AIDS virus; it is grown in a broth of hamster ovary cells.
It was tested in Thai drug users in 2003 and also in gay men in North America and Europe; it did not protect them against infection, and Genentech spun off the rights to develop the vaccine.
In 2007, two trials of a Merck vaccine in about 4,000 people were stopped early; it not only failed to work but for some men seemed to increase the risk of infection.
Combining Alvac and Aidsvax was a hunch by scientists: If one was designed to create antibodies and the other to alert white blood cells, might they work together even if neither worked alone?
Mitchell Warren, executive director of AVAC, the AIDS Vaccine Advocacy Coalition, which pushes for vaccines and other forms of prevention, was enthusiastic about the trial data.
“Wow,” he said. “This is a hugely exciting and, frankly, unexpected result. It changes our thinking in ways we hadn’t anticipated.”
“We often talk about whether a vaccine is even possible,” he added. “This is not the vaccine that ends the epidemic and says, ‘O.K., let’s move on to something else.’ But it’s a fabulous new step that takes us in a new direction.”
Mr. Warren said the finding showed the need for large human trials, expensive as they are. Studies in mice and monkeys have not been good at predicting what would work in people, and small human trials in which researchers test results by looking for antibodies in blood have limited value.
Dr. Fauci agreed.
“This is not the endgame,” he said. “This is the beginning.”
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