Eastern Europe and Central Asia have lagged behind Western Europe and elsewhere in adopting harm reduction strategies to combat diseases spread by intravenous drug users who share dirty needles, with predictably unfortunate results. It’s time for governments in both regions to implement harm reduction strategies including opioid maintenance therapy and needle exchanges for addicts, argues Michael Kazatchkine, the Special Advisor to the Joint United Nations Program on AIDS (UNAIDS) in Eastern Europe and Central Asia, in a new opinion piece for BMJ.com.
- Harm reduction approaches have already demonstrated their effectiveness in Europe, North America, Australia and Asia, and is now gaining traction across sub-Saharan Africa, Kazatchkine notes.
- However they have virtually no presence in Eastern Europe and Central Asia, despite the fact that intravenous drug use is around four times higher than the global average in these regions, including heroin and methamphetamine, and HIV prevalence is also high. There are 3.1 million IV drug users across these regions and around 25% are HIV positive. Meanwhile only 35% of HIV patients in these regions are taking antiretroviral drugs; the risk of transmission is much higher among those who don’t.
- Reinforcing the need for harm reduction strategies, Kazatchkine notes: “The effectiveness of opioid maintenance therapy and needle syringe programmes in reducing the risk of HIV infection among people who inject drugs has allowed Western European countries to reduce the proportion of people who inject drugs among new HIV infections to less than 1-2%. Opioid maintenance therapy has further allowed a large number of people to regain normal family and working lives in the society.”