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HIV and People Who Use Drugs Report

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Table of Contents
Introduction
The Situation on HIV and Injectable Drug Users
Gender issues
Current efforts
Recommendation
Conclusion
References

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Introduction

The United Nations general assembly special session on HIV/AIDS has agreed that by the year 2000, there were 36.1 million people with the HIV virus across the world (United States Congress, 1998 p.24-50). Only 10 percent of them come from developed countries while 90 percent are from developing countries. By the end of the year 1999, 10 million people were reported to be involved in injecting drug use in 136 countries and 114 of them reported HIV/AIDS cases resulting from IDU. 10 percent of the total reported cases of infection are caused by injection drug use (United States Congress, 1998 p.24-50).

The existing condition of the epidemic in a certain region can be termed as low-level, concentrated, or generalized depending on the prevalence levels of the virus in the specified demographic (John, 2001 p. 20-45). Cases of HIV can also be categorized according to their ways of transmission. According to the United Nations joint effort on AIDS (UNAIDS) sub-Saharan Africa has 26 million living with the virus. This translates to 70 percent of the total cases of HIV/AIDS (John, 2001 p. 20-45). The main mode of transmission is through heterosexual relations. In Asian countries such as China, Malaysia, Cambodia, Korea, Indonesia, Philippines, Thailand, Vietnam among others, and North Africa the prevalent mode of transmission is through unsafe drug injections while commercial sex work comes in second. In European and the Middle East countries as well as the southern part of Latin America sharing of needles accounts for 30-90 percent of infections n the regions (United States Congress, 1998 p.24-50).

The UN refugee group on HIV/AIDS prevention and care among IDU in developing and transitional countries was 2001 formed to keep the UNAIDS and other related sponsors updated on all developments on HIV infections among IDU in developing and transitional countries. The organization also seeks to verify information on international HIV epidemiology along with prevention and care measures to be adopted among IDU (). Accurate information on the number of IDU globally is not available regardless of the need for this information in planning for harm reduction (needle distribution or treatment) and distribution of the antiretroviral drugs among the IDU. This report seeks to highlight the research done on HIV and people who use drugs that expose them to possible infection by the virus.

The Situation on HIV and Injectable Drug Users

At the United Nations General Assembly Special Session in 2001, all countries pledged to join the fight against HIV/AIDS. Researchers have been working all over the world to contain the HIV virus and they have had a rough time trying to combat HIV because of its highly infectious nature. Studies on the human defense system and the virus have led to the discovery of current antiretroviral drugs aimed at suppressing the virus to ensure that it does not overpower the body’s defense system (Jacquelyn & Peter 1995 p.40). Notable progress has been made in fighting HIV/AIDS globally. However, the epidemic remains a development challenge in the whole world since it is a threat to human resources and thus bound to affect the development rate globally.

Based on statistics from the Population Reference Bureau, the number of infected people globally adds up to 36 million and the number could be on the rise if adequate measures are not taken soon enough (Jacquelyn & Peter 1995 p.46). The continent of Asia has the largest number of people; it holds almost half of the world’s population. It, therefore, plays a major role in depicting the future trends of the HIV/AIDS pandemic. If the numbers of infections increase in India, China, and Indonesia to the current levels in Cambodia and Thailand then the world will risk doubling the number of infected persons (Jacquelyn & Peter 1995 p.49). Such a phenomenon can impact negatively on the health systems and economies because of the large numbers that the hospitals will have to deal with and the amount of money the government will have to reallocate to the health sector to serve the rising need for health care.

East Asia and the Pacific (EAP) countries are part of the Asian continent. Population reference bureau says that this region (EAP) has a population of 2 billion people with 2.3 million among them infected with HIV/AIDS (United States Congress, 1998 p.24-56). Each country in East Asia and the pacific have different infection rates. In countries like Myanmar, Thailand, and Cambodia HIV/AIDS has been there for a long time and has spread quickly while countries like China and Vietnam have recently started to experience the epidemic. In most of these countries, the epidemic is spread through having unprotected sex especially among commercial sex workers and drug users who share needles and syringes as well as men who have unprotected sex with men. Most of the infected people come from these groups and their interaction with the others takes the infections to the general population. In China, the transmission of HIV is high through sexual intercourse with partners who inject themselves with drugs (Borowitz 2004 p.102).

Figure 1. UNAIDS HIV Projections for East Asia and the Pacific

From the above projection from UNAIDS the number of people living with AIDS is likely to double in the year 2010 from the statistics obtained in 2005. Most of the infections in this region have been caused by sharing needles and syringes with infected persons therefore unrestrained HIV pandemic among IDU poses a danger to achievements made in terms of development. Over the years drug use has been on the rise due to conditions such as unemployment, homelessness or living in slum areas, commercial sex work, poverty, and drug trafficking. Engagement in drugs has served as some form of escape from the bitter realities of life among IDU which include discrimination in society (Robert M & Gary W 1997 pg 4-6).

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Drug use as a practice happens across all ethnicities and in both urban and rural areas among disadvantaged groups who do not have access to education on HIV and support programs for IDU. Social and political factors are also involved in the spread of HIV among IDU since factors like communication and migration have brought new drug administration and consumption techniques such as using and sharing needles and made known other drug trafficking routes creating an increase in drug supply resulting in the spread of HIV/AIDS.

Gender issues

Gender issues and drug use are interrelated. Men and women are affected differently by drugs depending on their role as either users or traffickers or care and support givers to IDU. Women are most vulnerable to the effects of drug use which include getting infected with HIV/AIDS. This is because of their rather submissive nature(Jerry D.&Fellisa R. 2000 pg76-156). Women who are drug users have a high chance of contracting the HIV virus because the drugs will make them lose control over their bodies making them an easy target of multiple sexual encounters with different partners. Moreover, women whose partners use drugs are likely to use drugs as a way of pleasing their partners or due to influence from their partners. (Robert M & Gary W 1997 pg 4-6) Women who engage in commercial sex use drugs to make their sexual experience more pleasurable. Being a girl child to drug users exposes them to the danger of rape or early introduction to sexual activities which will increase the chances of getting the HIV virus. As caregivers to drug users accidents from the needles used on the drug users can lead to getting women taking this responsibility infected.

Current efforts

The United Nations Development Programme Asia-Pacific Regional Programme on HIV and Development has been carrying out research on the role of IDU in spreading HIV/AIDS. The program seeks to expose how drug use can affect sustainable development and the way forward for the governments in the East Asia and Pacific region(Jerry D.&Fellisa R. 2000 pg76-156). Prevention of drug use infections is easier than control thus necessary action must be taken to prevent further infections through education of the people and introduction of harm reduction techniques. HIV and Development Programme has been undertaking outreach educating on the IDU in the region to make them aware of the consequences of their actions and how to keep themselves safe. These include drug substitution whereby they can administer the drugs differently apart from using injection. They are also giving them needles and syringes to avoid sharing (Robert M & Gary W 1997 pg 4-6).

The issue of HIV poses a possibility of slowing down development. On analyzing those most affected, they are members of marginalized groups in society. Developing countries are more affected because of the attention given to this issue by their governments. Slum populations in countries like Thailand and India who are stigmatized especially women and youths are worse off. (Jerry D.&Fellisa R. 2000 pg76-156) Remote areas experience deprived social and economic development thus they engage in drug production and trafficking creating economic dependence on the drug instead of economic independence. UNDP seeks to empower the rural areas through development projects which will avert the inhabitants’ dependence on drugs to a positive project which will promote sober economic empowerment.

Poverty encourages dangerous actions such as sharing needles in taking drugs. In order to discourage sharing of needles, UNDP has come up with projects to generate income in slums and rural areas as a means of engaging the people to get them off the streets and also be a source of income to support basic needs(Jerry D.&Fellisa R. 2000 pg76-156). This will considerably reduce instances of sharing needles and prevent further infections to other people. This is what UNDP wants to achieve so as to ensure millennium development goals are achieved in the EAP region(Jerry D.&Fellisa R. 2000 pg76-156).

The World Bank in East Asia and the Pacific is concerned about the development challenge posed by IDU. As such it has been awarded grants to be used in developing policies that control drug production and use in the region. Strategies such as fostering development in most affected areas to inculcate behavior change have been encouraged by the World Bank because development comes with empowerment and this gives an alternative to those who are affected. Their involvement in development will reduce and possibly stop their involvement in drugs because of existing responsibilities. Rehabilitation programs have been financed by the World Bank to act as a bridge between the IDU and society(Robert M & Gary W 1997 pg 4-6). After their rehabilitation, they are placed somewhere to contribute positively to society for a changed perception among people from their stigmatized past position in society.

Social, economic, and political changes have been exposing the citizenry of the EAP to political instability, economic recessions, and social degradation which makes most of the underpowered people engage in dangerous activities such as indulging in massive drug trafficking and use and commercial sex work to support families making them vulnerable to infections(Jerry D.&Fellisa R. 2000 pg76-156). The World Bank has pressed for a review of policies likely to destabilize the countries in the EAP region to ensure stability and avoid desperate measures by the people. It aims to lower and eventually eradicate HIV transmissions among IDU. Most countries are focusing on the eradication of drugs instead of the development threat which these drugs bring about through encouraging the spread of HIV. World Bank wants the EAP countries to focus on preventing HIV infections first.

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UNAIDS is working together with countries to establish community-based support programs where IDU can come together to support one another in changing their lifestyles to be drug-free. Those who are out of injectable drug use share their encounters on how they managed to overpower their addictions. Through sharing others are encouraged to try and overcome their addictions too. These community-based programs have experts to guide the members through the discussion sessions and give those who are not completely reformed on ways of staying safe such as avoiding sharing of needles at all costs and substitution methods of taking drugs. They are taught on practicing safe sex to protect themselves from getting infected or infecting others(Jerry D.&Fellisa R. 2000 pg76-156). They are also advised to take HIV tests to help them live an informed life.

Countries in the EAP have different rates of infection. Some of them like Cambodia and Thailand have a high number of people living with HIV/AIDS while others like China and India have lower numbers. The World Bank and UNDP are emphasizing their efforts in the most affected areas like Cambodia in terms of financial allocations and intensity of allocation of different programs to control HIV infection rates there(Robert M & Gary W 1997 pg 4-6). However, the need to keep the levels of infections in less affected countries such as china as low as it can get has not been forgotten.

United Nations International Drug Control Programme (UNDCP) has been working together with governments in the EAP region since 2000 to monitor drug production and trafficking in the various EAP countries. They want the supply of drugs lowered to reduce consumption rates. The importation of drugs is being monitored to ensure that they conform to the set laws. Along with the laws against drug trafficking, they are carrying out campaigns in and out of schools to educate people on drugs and safe drug use among IDU(Jerry D.&Fellisa R. 2000 pg76-156). Positive outcomes have been experienced in areas where education has been done on promoting safe in cultures among IDU.

The EAP region has dedicated its resources to research centers to come up with suitable policies which are to be implemented in the various countries and harm reduction programs to take care of IDU (Jerry D.&Fellisa R. 2000 pg76-156).

Recommendation

There is evidence of an effort by the EAP countries to counter the increasing number of infections due to engaging in unsafe drug-taking. However, enough has not been achieved with regards to containing the number of HIV infections among IDU. This has been caused by various reasons. Further, The policies in place at the moment are not supporting the existing community-based programs to control HIV infections. This has made it difficult to control drug-taking behaviors among IDU. Therefore there is a need for consultations between the government, the people, and the international bodies on policy development and implementation. The governments also need to check on their institutional capacity to ensure that they can implement these policies.

The governments should work together with international bodies like the United Nations to acquire information that will be used in educating everyone whether engaged in drugs or not to create an informed society. The progress of the education programs should be published as this may serve to encourage other people in and out of the EAP region. Moreover, Community based programs need to be strengthened since they reach those affected more. Activities in the community programs help in creating a better understanding of the challenges posed by HIV and IDU. Organizations and bodies dealing with HIV among IDU in the different countries in the region should work together to ensure proper networking and joint effort in their mission to reduce HIV infections on IDU.

Gender issues are interrelated with drug use therefore in addressing the issue of IDU one must seek to address gender issues too. Suggested Prevention methods must be suitable for both men and women for them to be adopted by the different groups at risk of infection. In addition, the Human rights of IDU must be upheld to change the stigma associated with them in society. This will be necessary for their rehabilitation and incorporation into society.

Donor agencies must realize the impact of HIV on development in EAP and thus allocate funds to assist in tackling this development threat. Society needs to be educated on respecting women. Women IDU should be supported and not condemned. Their support will foster change in their lifestyle.

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Conclusion

The EAP region has an impact on the world’s economy because it has almost half of the world’s population. If the rise in HIV infections among IDU in the EAP countries is not checked, the rate of development is bound to slow down. The respective governments should address this matter more seriously and prevent it from worsening(Jerry D.&Fellisa R. 2000 pg76-156). This problem can be addressed by streamlining the policies in place and redirecting funds towards enhancing rehabilitation programs. The United Nations and the World Bank have supported the EAP region through harm reduction and equitable development projects to reduce drug consumption and promote safe living. Such projects and programs should be stepped up for positive feedback in the future (Jerry D.&Fellisa R. 2000 pg76-156).

References
Borowitz ,M. Addressing HIV/AIDS in East Asia and the Pacific. World Bank. IBRD.2004.112
United Nations International Drug Control Programme (UNDCP).World Drug Report. United Nations Office for Drug Control and Crime Prevention, United Nations Office on Drugs and Crime.
International Narcotics Control Board. Report of the International Narcotics Controls Board for 2005.United Nations Publications. (1998)
CDC HIV/AIDS Prevention: Special Report Authors Centers for Disease Control (U.S., Centers for Disease Control (U.S.), Centers for Disease Control (U.S.) Publisher U.S. Dept. of Health and Human Services, Public Health Service, Centers for Disease Control, 1991
United States Congress. The Spread of HIV and Aids in Developing Word. United Nation Congress. 1998. pg 23-67, 87-190
John Hatton. Global Health: Joint U.N Programme on HIV/ AIDS. Need to Strengthen Countries. Cambridge University Press. 2001. pg 12-45, 67-78, 89- 134
Jacquelyn Haak Flaskerud, Peter J. Ungvarsk. HIV/AIDS: Aguide to Nursing Caring, 3rd Edition.University of Michigan.1995. pg
Mark Jenkins, Robert E. Larsen. HIV/AIDS: Practical, Medical, and Spiritual Guidelines for Daily Living when you’re HIV-positive. Hazelden. 2000. pg Edward Alcomo. AIDS: The Biological Basis. 3rd Edition. 2003. pg 30 – 166
Mead Over, Julian Gold, Indrian Gupta, Subhash Hira & Elliot Marseille. HIV/ AIDS: Treatment and Prevention in India.”Modelling the Cost and Consequences. Word Bank. 2004. pg Ch. 2,3,4
Jerry, D & Fellisa, R. The Person with HIV/ AID: Nursing Perspectives.3rd Edition. 2000. pg 1-76, 97-138, 156-167(Jerry D.&Fellisa R. 2000 pg76-156)
Mark Jenkins, Robert E. Larsen. HIV/AIDS: Practical, Medical, and Spiritual Guidelines for Daily Living when you’re HIV-Positive Hazelden. 2000. pg 12-45, 56- 67, 78-123
PM, Pyeett, BR Haste & Snow , J. Risk Practises For HIV/ AIDS and Other STDs Amongst Female. AIDS CARE. 1996. pg 34- 56, 67- 87, 98-178
Rorbet, M. & Gary, W. Against Death: the Practice of living with AIDS. Gordon & Breach. 1997. Ch 4, 5, 6

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