Be Smart, Reduce Harm

HEALTH: AIDS EXPERTS CALL FOR FOCUS ON HARM REDUCTION, SEX ED



DATELINE: MEXICO CITY, Mexico, Aug 6 2008

Preaching abstinence to the young has not worked, and sex work has not been eradicated. Taking stock of these realities, experts at the 17th International AIDS Conference in Mexico this week are calling for a rethinking of public policies.

Why do policies ostensibly put in place to protect sex workers end up penalizing them? And why have drug users been denied key HIV prevention services? These are just two of the questions the experts are seeking to answer.

Billions of dollars have been poured into interventions, but the result is far from satisfying. The persecution of gay men -- who are now at the greatest risk of HIV infection -- continues. It seems that the demonization of disenfranchised populations has only intensified.

In 2007, 2.5 million people contracted HIV, bringing the total to more than 33 million. Less than one in 10 injecting drug users and only one in five sex workers has access to HIV prevention treatment.

Policies are shaped by "fashion, politics, financial constraint, economic theory and then supplemented by evidence," said Gerry Stimson, executive director of the International Harm Reduction Association. At times, there is an outright rejection of facts because they do not comply with a particular value system -- much to the detriment of those for which policies are made.

There are more than 20 years of evidence that harm reduction programs are an effective strategy to reduce the risk of HIV among injecting drug users. For this reason, it's strange that every country is not implementing these programs.

Similarly, comprehensive sexuality education programs -- as opposed to abstinence programs -- have been found to decrease unintended pregnancy, as well as reduce the risk of sexually transmitted diseases including HIV/AIDS, but many educational policies are still not supporting sex education.

The administration of President George W. Bush has consistently withheld funds for the U.N. Population Fund, primarily for domestic political reasons.

The $34 million that the U.S. has withheld each year is close to 10 percent of the fund's regular income. By not funding the leading voice for women needing reproductive health care and family planning, "the U.S. is significantly crippling efforts to improve women's lives across the globe," according to the U.N. Foundation.

In Iran, Arash Alaei and Kamiar Alaei -- both doctors -- have played a role in putting the issues of drug use and HIV/AIDS on the national health care agenda. They have worked closely with government and religious leaders to ensure support for education campaigns on HIV transmission, including those targeting youth, and for HIV and harm reduction programs in prisons.

At the end of June both doctors were reportedly detained by Iranian authorities. Their whereabouts are currently not known.

Arash was scheduled to speak at the International AIDS Conference here. A coalition of groups -- including Physicians for Human Rights -- has sponsored an empty chair with his name, to bring attention to the detentions.

Researchers and advocates are calling for governments to implement more realistic policies on controversial issues such as sexuality, education, homophobia, harm reduction and sex work.

Given the track record of public policy on HIV/AIDS, Nandinee Bandyopadhyay, associate director for HIV and Sexual and Reproductive Health at the Indian nonprofit PATH, said evidence is unable to drive policy.

It is time to base policies on "rights rather than what is perceived right or scientific or effective or even cost-effective," because public policy may not always be about "public good," and evidence can be "wrongly focused," Bandyopadhyay said.

Policies are often influenced by interest groups, religious and business leaders, based on their ideology or moral beliefs. Data is often seen "catering to competing constituencies of the elite," Bandyopadhyay said.

Bandyopadhyay said a recent amendment made to the Indian Immoral Traffic Amendment Bill 2006 is in contradiction to the facts and restricts penalties only to trafficking of persons for prostitution. "There is evidence that a majority of sex workers are in the profession by consent and a very small minority are trafficked," Bandyopadhyay said.

"Evidence is crucial, but just one small part of the ongoing advocacy for fairer, better and more effective global responses to drug use," Stimson said.

Sometimes policy makers are stumped by the policy guidelines made by U.N. agencies and donor countries.

For example, the longstanding stance of the Joint U.N. Program on HIV/AIDS, which has stated as a central HIV prevention strategy that sex work should be decriminalized, sex workers should be mobilized, and health and workplace conditions should be regulated, contrasts starkly with a U.N. guidance note on sex work released last year focusing on the "rescue" and "rehabilitation" of sex workers -- an approach that the agency had earlier emphatically criticized as being harmful to HIV prevention.

Punitive drug polices are given priority, according to Stimson, because of international drug control conventions, guidance from at the International Narcotics Control Board, activities of the U.N. Office on Drugs and Crime, and aid restrictions.

According to experts here the time has come to integrate human rights and public health imperatives, to look at on-the-ground evidence of what works and what does not, while framing policies and guidance on HIV prevention.

With 22,000 experts and activists gathered in Mexico City for the International AIDS Conference, policymakers should not have a hard time finding examples of best practices and lessons learned from all over the globe.

Author:    Zofeen T. Ebrahim,  Pakistan- India

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