GHW Irish AIDS Day 2017: HIV is a political crisis – Harm reduction is a political response

By Mina Kazemi, Key Correspondent for the Irish Forum for Global Health

Addiction is not a crime, or a moral failing, and not a bad choice, but a health problem

-Canada’s Minister of Health, Jane Philpott, during the opening ceremonies of the 25th International Harm Reduction Conference in Montreal, Canada in May 2017 [1].

The Minister’s statement suggests that addiction and the resulting health problems cannot be addressed successfully through insisting on behavioural change, but rather they require the creation of environments in which behaviours occur safely. Her statement urges us to move away from the discourse that health (HIV included) is an exclusively personal responsibility and ‘correct’ behaviour is the solution – an approach which contributes to a culture of stigma and victim-blaming.

‘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 drugs without necessarily reducing drug consumption” [2]. It focuses on the prevention of harm, and the implementation of safe and dignified spaces for people who use drugs. Harm reduction includes services such as needle and syringe programmes (NSPs), safe injection sites, opioid substitution therapy (OST) and other drug dependence treatment, in addition to HIV testing and counseling, prevention, and treatment of sexually transmitted infections (STIs) and stigma reduction initiatives. Although it has been known since the early 1990s that HIV among people who inject drugs (PWID) can be effectively controlled by harm reduction, there is still a lack of political will for harm reduction in many countries [3].

In the European context, harm reduction is under threat. Austerity measures and poor political support undermine harm reduction services at a time when injecting drug use, HIV, and hepatitis C rates are on the rise in Bulgaria, Romania, Poland, Greece and Hungary [4]. In Ireland, new cases of HIV among PWID are increasing, and in 2016 more new HIV diagnoses were reported in this group than in previous years [5]. In 2015, the HSE’s Health Protection Surveillance Centre reported that new diagnoses of HIV among PWID were up by 81% compared to the previous year [5]. Although there has been a shift in Ireland’s approach, with recent legislation for the country’s first supervised injection site, more political pressure is needed. Commenting on recent developments of drug policy in Ireland, Tony Duffin CEO of Ana Liffey Drug Project said,

The recent enactment, in Ireland, of the Misuse of Drugs (Supervised Injecting Facilities) Bill 2017 was an important leap in the right direction. It is crucial that our leaders are supported to continue to be brave and progressive with regard to drug policy. In the coming years Ireland should introduce further harm reducing and rehabilitative drug policies that are proven to manage the drug problem better and improve the situation for us all.

A report by Harm Reduction International (HRI) and the Eurasian Harm Reduction Network (EHRN) provides a snapshot of the political climate of harm reduction in European countries, including Ireland [4]. The report states that harm reduction services in Ireland are primarily left up to civil society, namely NGOs. The report does acknowledge that, in 2017, the Irish government committed to support the introduction of a pilot supervised injection facility; however, austerity measures have resulted in budget cuts of up to 30% since 2008, impacting the funding of harm reduction and wider drugs services [4]. These funding restrictions jeopardize existing services and restrict service providers’ ability to engage in essential harm reduction advocacy. Notably, the proportion of funding directed to harm reduction in Ireland is unknown. For example, 51.7% of the planned budget in 2015 was allocated to health-related activities, meaning that harm reduction was grouped together with a wide range of other health interventions [4]. Significantly, over one-quarter of this budget was allotted to public order and safety, which includes drug law enforcement, reminiscent of a ‘war on drugs’ mentality.

Strong support for harm reduction is needed immediately if Ireland hopes to avoid the downward path of other European countries with similar experiences of economic hardship, increased drug use and HIV incidence. A new National Drug Strategy is currently being drafted, and continued lobbying and political pressure is crucial to ensure a comprehensive harm reduction strategy for Ireland [4]. If civil society works to influence the policy agenda and urge policy makers to make harm reduction a priority, Ireland can depart from the trajectory of countries “in crisis” [4].

Similarly, in the Canadian context, “Nice speeches do not save lives. Actions do” [6] – particularly action on the implementation of progressive and evidence-based policies that address root causes without marginalizing and stigmatizing the very people who should benefit from such policies [6].

Walking through the streets of Dublin, unexpectedly, a poster plastered on a sideboard catches my attention:

Corporate greed, Government inaction, Public indifference. HIV is a political crisis.

Photo by author – spotted in South Dublin, and traced back to the activist and advocacy work of ACT UP Dublin, a non-partisan group of individuals united in anger and committed to direct action to end the HIV/AIDS crisis. Within their mission, ACT UP Dublin is committed to advocating for ‘a drug policy that prioritises health rather than crimininalising people who use drugs’ 

The time is now: HIV is a political crisis and harm reduction is a political response. Everyone has a role to play. The urgency is real and we must end the indifference.

June 2017

Mina Kazemi moved from Canada to Dublin to work for 2 months as a Professional Intern at the IFGH from May-June 2017. Her interests lie in health and human rights, and the complexities around HIV. She studied Global and Public Health at the University of Toronto and London School of Hygiene & Tropical Medicine, and has gained relevant experience working at the Desmond Tutu HIV Foundation in Cape Town, Dignitas International, and McMaster University in Indigenous health research. Recently, Mina presented a paper at the Canadian Association for HIV Research (CAHR) conference. In July 2017, Mina will take on the research coordinator role for the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study at Women’s College Hospital in Toronto where she hopes to continue to engage with the community and work collaboratively towards evidence-based policies that best represent people living with HIV.

Sources

1. Hodgson, I. (2017, May 23). Policy and harm reduction: What about the people? Retrieved June 14, 2017, from Citizen News Service: http://www.citizen-news.org/2017/05/policy-and-harm-reduction-what-about.html
2. Harm Reduction International (2017) What is harm reduction? A position statement from Harm Reduction International. Retrieved June 14, 2017, from https://www.hri.global/what-is-harm-reduction
3. Wodak, A., & McLeod, L. (2008). The role of harm reduction in controlling HIV among injecting drug users. AIDS , 22 (2), S81-92.
4. Cook, C. (2017). Harm reduction investment in the European Union: Current spending, challenges and successes. Harm Reduction International, London, UK.
5. Health Protection Surveillance Centre (2015). Surveillance Reports: HIV in Ireland, 2015 – In Brief. Health Protection Surveillance Centre, Dublin, Ireland.
6. Mary, J.-F., Westfall, J., Gagnon, M., & Dodd, Z. (2017, June 26). They Talk, We Die: Silent Protest at the International Harm Reduction Conference. Retrieved June 27, 2017, from Volteface: http://volteface.me/talk-die-global-day-action/