At the 19th International Harm Reduction Conference in Barcelona in 2008, a partnership between AHRN and CDC Taiwan was formed to showcase the Taiwanese experience with implementing and scaling up harm reduction services and policies. Indeed, Taiwan represents a unique space in Asia for harm reduction service delivery, both because of the impact of those services on HIV transmission and on crime rates, but also because of the political leadership from the highest levels of government. From that partnership emerged an opportunity to organize a exposure visit for high level government officials and civil society representatives from two South East Asian countries which took place in November 2008. This exposure visit also allowed AHRN to capture and document the evolution of the Taiwanese harm reduction services and gather perspectives from a range of key stakeholders on the harm reduction roll-out in Taiwan (see the Exposure Visit report).
With the hope of sharing with key constituents and colleagues in the region an example of effective harm reduction, AHRN and CDC collaborated to produce a short film. The final product was launched at the 20th International Harm Reduction Conference in Bangkok in April 2009.
The first part of the film gives and overview of the situation in Taiwan in terms of drugs and HIV as well as a bit of history on the emerging HIV epidemic among injecting drug users. The second section provides an overview of harm reduction service delivery in Taiwan, from needle and syringe exchange programs to methadone maintenance treatment. Finally, the third section captures the voice of a recovering drug user who reflects on his own harm reduction experience, both as a user and now as a peer educator for a local NGO.
We are pleased to provide an abridged version of the film to our members and colleagues on this website. If you would like to get your own DVD copy of the film (full version), please do not hesitate to contact info@ahrn.net . For more information about harm reduction in Taiwan, download the IJDP article“The Changing Epidemiology of Prevalent Diagnosed HIV Infections in Taiwan, 1984-2005.”
See also further below recent news items on Taiwan’s harm reduction successes!
HEALTH-ASIA: Taiwan Blazes a Trail to Help Drug Users with HIV
25/04/09 by Marwaan Macan-Markar Taiwan is emerging as a beacon of hope for countries across Asia grappling to stop the spread of theAIDS epidemic among injecting drug users (IDUs), a major risk group.
The Asian island came in for praise at an international conference here for a successful public health initiative that saw an over 50 percent plunge in the number of new HIV cases among IDUs over a three year period. In 2005, Taiwan recorded its highest number of new reported cases of people infected with the killer virus - over 3,300 - nearly twice the number recorded the previous year. But, by the end of 2008, the new HIV cases had dropped to 1,752 cases. The secret to the country’s success was a humane approach to help IDUs through a nation-wide harm reduction campaign, Sheng Mou Hu, the health minister at the time, told participants at the international Harm Reduction conference, held in the Thai capital this week. "Time proved we were right," he said. "Our approach was that harm reduction should be based on human rights."
Consequently, the Taiwanese IDUs were not viewed as criminals for their drug habit - they were presented to the public as "patients" in need of help. The public health initiative launched in 2006 ranged from greater screening and monitoring of drug users living with HIV, a needle exchange programme, and a drug replacement therapy with methadone. Yet, the initiative sparked a strong public outcry, according the former health minister. "We had a lot of resistance from the media and parliament," he said.
"No other country in Asia can match Taiwan’s achievement in launching and sustaining this harm reduction programme," said Ton Smits, executive director of the Asian Harm Reduction Network (AHRN). "In most countries across the region, drug control policies are in direct conflict with HIV-related policy, undermining harm reduction programmes in the region."
"In southeast Asia, only three percent of people who inject drugs have access to harm reduction services," added the head of AHRN, which is based in the northern Thai city of Chiang Mai. Furthermore, "harm reduction funding in Asia is facing a financial crisis. There is a 90 percent resource gap to be met for 2009." Encouraging signs have emerged in four Asian countries - China, Malaysia, Thailand and Vietnam - which are heading in the same direction that Taiwan has since 2006. They have taken tentative steps to help IDUs through a public health approach, marking a break from the long tradition of dealing with IDUs through strict law enforcement measures.
But, the region has a long way to go, given that IDUs are ranked as one of the major vulnerable communities through which HIV is transmitted. "It is estimated that in China in 2006, slightly fewer than half the people living with HIV are to have been infected through use of contaminated injecting equipment," states a 2008 report by the Joint United Nations Programme on HIV/AIDS (UNAIDS). "Similar scenarios are estimated to be occurring in parts of India, Pakistan and Vietnam." Asia currently is home to over five million people living with HIV, out of the global total of 33 million HIV cases. IDUs number close to 16 million people across 158 countries, according to information released by the International Harm Reduction Association (IHRA), the hosts of the Bangkok conference. "The overwhelming majority [80 percent] live in low- and middle-income countries."
"The prevalence of HIV among injecting drug users varies considerably around the world," added a conference background note. "It is estimated that there may be three million injecting drug users who are HIV positive." Some estimates put the number of IDUs at over 6.6 million. Yet, resources to help this vulnerable community are limited, adding to the burden IDUs face. "Only 2-3 percent [200-300 million U.S. dollars] of all the available resources for AIDS is spent on harm reduction," says Gerry Stimson, executive director of IHRA. "If we are serious about reducing HIV infection amongst injecting drug users then we are going to need between two billion U.S. dollars and three billion U.S. dollars this year and the next."
"Many of us who are drug users and activists are demanding treatment," says Paisan Suwannawong, co-founder of Thai AIDS Treatment Action Group. "Drug users are punished. Treatment should start by looking at us as human beings." Failure to help IDUs living with HIV condemns them to an earlier death than those people living with HIV who are not drug users. "For someone who is in their 20s with HIV in the developed world, access to antiretroviral drugs ensures they can have 40 more years," says Michael Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. "But IDUs live 12 years less," said the head of the fund that finances health programmes through governments and non- government organisations to combat the three killer diseases in the developing world.
