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Wednesday 12 2013 –
Daily Update
– 3
Tackling TB must be a
‘harm reduction priority’
‘Access to TB services remains horribly low,’ said Annabel Baddeley,
in yesterday’s session on harm reduction relating to the
tuberculosis epidemic. ‘We need to encourage stakeholders to be
more mindful of TB in collaboration with services.’
Injecting drug users were more at risk of TB, she said, as their
immune system could be impaired by lifestyle factors such as poor
housing and nutrition. Those in prison were entering ‘highly infective
centres’ and the risk of TB was consistently higher in inmates,
particularly those sharing equipment. Stigma, discrimination and
lack of continuity of care after release could add to the risk.
‘Addressing TB among people who inject drugs is a public health
priority,’ she said. ‘Harm reduction stakeholders should increase
efforts to reach this at-risk group by including TB interventions in
their services.’
TB had become an increasingly important issue for the drug
using community, said Mat Southwell, who got involved in
developing a practical advocacy guide in his role as a drug user
activist. Referring to HIT’s document,
TB Advocacy Guide for People
who Use Drugs
, he explained how drug users from around the world
came together to contribute to a ‘rich resource’. The key messages
included challenging stigma and criminalisation while giving access
to anti-retroviral therapy and integrated services.
‘We have to bring services to a common place, rather than
expecting people to run around looking for them,’ he pointed out.
Dickens Bwana, a programme manager in Tanzania, gave his
experience of working at grassroots level, particularly in making TB
care possible at home. Witnessing the exclusion and stigmatisation
of a drug user attempting to gain treatment had prompted his
organisation to integrate harm reduction into their services.
‘With stigma attached to drugs,
plus HIV, plus TB – you can see that
these people need help,’ he said. TB
was the leading cause of mortality
among injecting drug users,
exacerbated by poorly ventilated
consumption rooms – a breeding
ground for infection – and
interrupted treatment. Harm
reduction education was needed on
how to inject drugs and the
importance of using condoms, as
well as places to test for and treat
the disease. Médicins du Monde had
supported the opening of the Down
to Earth medical centre in Dar Es
Salaam, a ‘friendly open door’ where
trained volunteers offered
interventions such as TB screening, HIV testing and referral to
methadone programmes.
In addition, TanPUD (the Tanzanian network for people who use
drugs) were giving training sessions to educate on treatment.
‘Addressing TB among drug users should be a harm reduction
priority,’ he said.
Be the voiceof change
Although the scientific evidence for harm reduction interven-
tions was incontrovertible, Douglas Bruce of Yale University
told the
Researching the values and impacts of harm
reduction
session, the interventions had not been scaled up.
‘Often there’s a call to ethics – is it right to give people
syringes? We’re going to remove
suffering by reducing HIV and
hepatitis C rates, so surely that’s
good?’ he said. Often the
arguments put forward by
governments were simply that it
was wrong to support anything
that promotes addiction, as that
would ‘violate a moral imperative’.
Rather than causing harm,
however, NSPs were a link to
treatment and other services, he
stated, ‘so failure to provide NSP
is more likely to violate an
imperative to protect human life’.
For some societies, it was
simply a case of adhering to
traditional values and the social
norms of previous generations, he
said. ‘So you don’t think about
ethics – you just do what your
elders did. But what if your elders
had endorsed slavery? If it’s
ethical, then we should be the
voice of change.’
Other societies, meanwhile,
while quick to agree that harm
reduction interventions were
ethical, were slow to provide the funding. ‘But needles are cheap,
and HIV treatment and drugs for hepatitis C are very expensive. So,
even economically, we should be investing in NSP. Governments
and society should invest in the things that improve public health.’
On that subject, Andrea Wirtz of the Johns Hopkins Center
for Global Health told delegates about a report commissioned
by the World Bank on how interventions in four countries could
impact on risk behaviours.
The countries – Kenya, Ukraine, Pakistan and Thailand –
were chosen partly for their political diversity, she said. The
researchers established both a conservative and optimistic
impact matrix for each country, and found that impressive
reductions in the number of new infections were possible when
harm reduction and antiretroviral therapy programmes were
‘expanded to ambitious yet achievable targets’.
‘Not all programmes are alike,’ she said. ‘The implementation
of NSPs may have different impacts in different countries – if
programmes aren’t accessible and acceptable, then they won’t
be used. And while antiretroviral therapy is powerful, people
who use drugs often have the least access to treatment. That’s
something we must all work to change.’
‘Needles are
cheap, HIV
treatment
and drugs for
hepatitis C
are very
expensive.’
DOUGLAS BRUCE
‘Integrated
services.’
DICKENS BWANA