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Tuesday 5 April 2011 – DAY TWO –
Daily Update
– 3
THE MENA REGION
was one of the few where there was limited
knowledge of the HIV epidemic, Ghina Mumtaz told the
Harm
reduction developments in Middle East and North Africa
session.
She had helped to carry out a research project with the aim of
gathering, analysing and synthesizing all of the available evidence on
the epidemiology of HIV among injecting drug users in the region,
using hundreds of data sources.
Although these were of variable quality, there had been a
noticeable improvement of the data in recent years, she said. There
were around 1m injecting drug users in the MENA region,
constituting 0.2 per cent of the population. Around 50 per cent
reported sharing of needles and syringes, she said, with the average
age of first injecting between 20 and 28 years old. There were also
overlaps between sexual risk behaviour and injecting drug use.
Injecting drug use was an important mode of transmission in
Afghanistan, Bahrain, Libya, Tunisia, Pakistan and Iran. The latter
two had the highest HIV rates among injecting drug users, she said,
with injecting drug use accounting for transmission in two thirds of
Iranian HIV cases.
‘There are concentrated HIV
epidemics in Iran and Pakistan,
emerging HIV epidemics in
Afghanistan and Egypt and at least
“outbreak-type” epidemics in
Algeria, Bahrain, Libya, Oman,
Morocco and possibly Tunisia.’
There was low/zero prevalence in
Lebanon, Jordan, Kuwait, Saudi
Arabia and Syria, she said,
although available data for many
was poor.
‘HIV prevalence among injecting
drug users in the region remains in
the low to intermediate range,’ she
said. ‘But we are seeing high-risk behaviour, which means there is
potential for further spread. We need to expand HIV surveillance and
HIV testing, as well as prevention and treatment services. And there
is a great need for national harm reduction programmes.’
THERE WAS LESS THAN ONE PER CENT
prevalence of HIV in
Morocco, Amina Latifi told delegates in the Harm reduction
developments in Middle East and North Africa session. She was
involved in a programme, implemented in 2009, to provide
psychological and social support for injecting drug users living with HIV.
IDUs constituted 13 per cent of Moroccans living with HIV, she said.
The programme, which was now in its third phase, allowed access to
quality care, anti-retroviral treatment and counselling. ‘Of the 26,000
people in Morocco with HIV we only cover 4,256 of them – most people
are unaware of their status and are diagnosed late. The testing is
available, but not the education.’
Distribution of methadone had only begun in June of last year, she
said. ‘Currently, 77 people are in receipt of this although we
anticipate the numbers will soon be much higher.’ The programme
had also been helped by Morocco’s national AIDS programme in
partnership with the Global Fund, which allowed it to capitalise on
activities at a national level to enlarge and institutionalise it.
The psychological and social programme monitored people’s
therapy, she said, as well as facilitating access to care and allowing
drug users to be independent and integrated into a society where
drug use was criminalised and stigmatised. ‘People can be afraid to
ask for care because of this stigmatisation,’ she said.
The programme had now been accredited with a wide range of
bodies and was helping to deliver extensive training for mediators and
medical staff, as well as providing judicial support and organising social
occasions and outings – ‘so that people can be far away from the eyes
of the people who stigmatise them’. ‘We will continue to fight
descrimination and stigmatisation against people with HIV and people
who use drugs,’ she told the conference.
Helping to battle
stigma in Morocco
Harm reduction vital to stop HIV spread in MENA
Gina Mumtaz:
‘We are
seeing high-risk behaviour.’
FEMALE IRANIAN DRUG USERS FACED A RANGE OF
PROBLEMS
beyond those immediately related to drugs, Shabnam
Salimi told delegates. There had been no official data on female
drug use in Iran, which had prompted her to help set up a study.
‘The aim was to explore the characteristics of drug users seeking
treatment, and to track improvements,’ she told the conference. A
clinic for female drug users was established in 2007, with focus
groups and in-depth interviews used to build up an accurate picture
of the situation. ‘Interview questions are normally adapted from
Western countries, but we needed to hear our clients’ own voices.’
The study interviewed 40 female drug users, with a median age of
37. Eighty-seven per cent used heroin, 69 per cent opium, 27 per
cent stimulants and 12 per cent cannabis, while 79 per cent smoked
cigarettes compared to just 2 per cent of the Iranian female
population as a whole. Of the heroin users, 88 per cent smoked the
drug rather than injecting.
Twelve per cent had a history of injecting drugs, with HIV
prevalence at 5 per cent. ‘However, no one reported sharing injecting
equipment,’ she said. Reasons for leaving treatment included stigma
or wanting to carry on enjoying taking drugs, but male dominance
was also a very significant factor. ‘If their partners didn’t use drugs
then they didn’t allow them to access treatment because they
thought the clinic was not a good place to be. But if their partner did
use drugs, they didn’t allow them because they wanted someone to
take drugs with.’
Stigma for female drug users in Iran was far worse than for men.
‘I asked them their greatest wish for themselves. They said “what we
want is to be healthy”. I hope that policy makers and decision makers
give them the support that they need to make that a reality.’
Problems compounded for
female Iraniandrug users