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6 –
Daily Update
– DAY FOUR – Thursday 23 April 2009
Taking action against HIV - a handbook
for parliamentarians
can be vital tool for
harm reduction campaigners to
advocate with politicians, Ralf Jurgens,
the founding director of the Canadian
HIV/AIDS Legal Network told delegates.
The handbook provided background on
HIV and outlined the serious threats faced.
'Progress has been made but the situation
remains grave,' Mr Jurgens said. The
handbook was launched in 2007 in Manila,
where at the first global parliamentary
meeting on HIV and Aids, 150 members
voted to use it and bring it to the attention of
fellow parliamentarians. The handbook gave
detailed and practical guidance on HIV law
but also focused heavily human rights.
'Universal access [to antiretroviral drugs] will
never be achieved without much greater
attention to human rights' stressed Mr
Jurgens. 'Governments need to take
leadership on protecting the human rights of
populations who don't attract public
sympathy, such as men who have sex with
men, and drug users.'
Jenny Kelsall from Vivaids, a peer-based
drug users organisation in Australia, talked
about how user groups could further the
human rights of drug users. While
acknowledging that Australia's human rights
record was good compared to some other
countries – 'their stories make our cries
sound like the bleatings of small children' –
Ms Kelsall said there were still some serious
abuses of human rights perpetrated on
Australian drug users. Invasive physical
searches and abusive police investigations,
as well as drug users being denied
employment and facing the threat of having
their children taken away, left left them
isolated and criminalised with no sympathy
from the wider population who may feel they
had got their 'just desserts', she said.
'You need to engage with drug users if you
want them to use services,' she added. 'The
best harm reduction service in the world
doesn't work if people don't engage with it.'
THE LINK BETWEENHIV, TB AND INJECTING DRUGUSE
is loud and clear,
supported by clear statistical evidence. In a series of presentations on
Wednesday, the need for an integrated programme of services was
reinforced as a key component of harm reduction.
Of the estimated 16m injecting drug users (IDUs) globally, some 3m
are currently infectedwithHIV. IDUs contribute a significant 10 per cent
to newly infected HIV cases. In the Asia-Pacific region, the situation is
even more complex.
According to Christian Gunneberg of theWorld Health Organization
(WHO), the percentage of IDUs with HIV ranges from 11.5 per cent in
India to 41.5 per cent in Nepal and 42.5 per cent in Indonesia. Mukta
Sharma of SEARO, WHO, also confirmed that in the Southeast Asia
region, HIV prevalence among IDUs is around one-third.
The risk of IDUs acquiring tuberculosis (TB) is equally high. Studies
show that IDUs have 10 to 30 times more chance of becoming infected
with TB – a risk up to 50 times higher in prisons. TB is a curable and
manageable disease, but with inadequate treatment it can be fatal – as
for the large number of IDUs who die within a year of contracting TB
bacilli. Multiple drug resistance among IDUs with TB and HIV is another
significant phenomenon in countries such as Russia and India. Co-
existent TB and HIV infections among IDUs increase the risk of
morbidity and death tremendously. There is a great need for integrating
services for IDUs with TB and HIV components.
Dmytro Sherembey from Ukraine described the positive changes
over the past ten years following such a development. 'Until 1995,
IDUs with TB or HIV, or both, had no other option than wait for death,'
he said. 'There were no services available at all, no access to healthcare.
People used to die not of diseases but because of lack of treatment and
proper support. The healthcare system provided only old beds and
inadequate diet.'
Sherembey said he and his colleagues in the All Ukrainian Network
of PLHIV battled for the rights of IDUs, and in 2008, there was a marked
change to partial access to healthcare services for IDUs in Ukraine. He
hopes that further progress will be made in Ukraine and in other parts
of the world too.
'This is our small story of a big victory. We must continue our
advocacy efforts if we have to save our friends and families,' he said.
The case is strong, the need for working with a collaborative
approach on TB and HIV among IDUs is urgent, and networking
between various levels of healthcare systems will be crucial. There is
often a disconnection between tertiary level care, primary health care
services and the community, and the situation is exacerbated in
countries with a dominant private healthcare system. Nevertheless,
action taking a participatory approach may show good results in the
years to come. It's never too late.
Joint working on healthcare cannot wait
Prakash Tyagi
of Health and Development
Networks comments on Wednesday's sessions on
integrating services for HIV, TB and drug users
Engagement can pave way for human rights
Jenny Kelsall: user groups can further human
rights issues