#36 XVIII. International AIDS Conference 2010

Success formula?

There are countries around the globe that have a rate of infection with HIV up to 60 % among injecting drug users, while others have constantly decreasing infection rates. Is there a recipe for success? Portugal and Iran are two examples for successful harm reduction policies.

In 2001, Portugal became the first European country to officially abolish all criminal penalties for personal possession of drugs, including marijuana, cocaine, heroin and methamphetamine. Critics feared at the time that a “drug tourism” movement would start. The result was contrary. A research commissioned by the Cato Institute found that in the five years after the start of decriminalisation, illegal drug use by teenagers had declined, the rate of HIV infections among drug users had dropped, deaths related to heroin and similar drugs had been cut by more than half, and the number of people seeking treatment for drug addiction had doubled.

National Co-ordination for HIV/AIDS infection is an initiative in Portugal that offers several programmes on harm reduction. Most successful is their the needle and syringe exchange programme. Maria Jose Santos, a nurse working for the programme, says that in 1993 the prevalence of new HIV infections among IDUs was up to 80%, but now it decreased to 42.5%. National Coordination also has substitution programmes and personnel that instructs drug users how to inject. In the future, Maria explains, National Coordination will also focus on giving out kits for sniffing cocaine and smocking crack. “We have to adapt to the changes on the drug market. We have the law but the community does not agree” she says. As a result there are no injection rooms in Portugal and also needle and syringe exchange is quite impossible in prisons.

A country you would least expect to be progressive: Iran

According to the International Harm Reduction Association (IHRA), harm reduction programmes are carried out in 93 countries. Yet they are often underdeveloped, need 25 times more money and the national coverage is too low.

Gerry Stimson, executive director of the IHRA, says that the best examples come from countries that you would least expect. “Introducing harm reduction has always been a struggle, but it has often succeeded in the most unlikely places”, Stimons says. “Iran is the leading country in the Middle East and Northern Africa regarding harm reduction – thanks to its highly educated medical elite and also because they worked with religious leaders so that harm reduction is consistent with Islam.”

By: Georgeta Bocse, Romania

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