What is the mandate of the Asian Harm Reduction Network?

I've been with the AHRN ever since its inception which was in 1992 in Tasmania at the Harm Reduction Conference. I have seen it grow from that level to the level of political and economic clout that it has today. AHRN has come to point where it is an extremely important agency, not only in Asia, but globally. For example the UN cannot come out in open support of providing harm reduction for drug users, so they work through the AHRN to make statements and support it from a secondary point of view. This sort of political maneuvering and advocacy that is going on is extremely valuable for the UN system itself in its direct response to marginalized communities in HIV/AIDS as well as to the beneficiaries. Once policies and commitments to work with the Harm Reduction framework filter down there will be a tremendous impact on the streets to the beneficiaries--drug users and street workers for example. So at the moment it may seem that the AHRN is not servicing many of its constituencies, but I think it's all a process of consolidation of its own mandate--advocacy, networking, providing information, access and linking people together.

How has the attitude toward drug users changed?

Again I think that the climate, especially in Asia, is now pretty significantly changing from what we had, say ten years ago when it was almost a crime to talk about drug users. Now it's become more possible to say 'I'm a drug user.' There's a positive change occurring in the Asian region--I'm not saying in all countries--but in some countries there's a very humane approach that is beginning to be adopted. I think a large amount of the credit would go to the AHRN and nongovernmental organizations that have been very loud in advocating these rights. There are also a lot of the people on the ground working in the area of drug users who have been made aware of the issue of HIV/AIDS. People are also less afraid of speaking out and acknowledging that they use drugs because there is more understanding.

What harm reduction tools are used and how do they reconcile with domestic laws?

In 1999 the UN Asia Pacific Inter-Country Team (APICT) did an assessment of policies and laws that hinder or facilitate HIV/AIDS prevention in seven countries in Asia. By a process of research and documentation is has become clear that there are actually not many countries that have very strict laws against possession or buying syringes. Many countries are ambiguous about that--you can go into a pharmacy and buy syringes. But the point is that drug users often don't have the money to buy syringes everytime they need to inject. The AHRN has been really successful in its advocacy role. For instance they have been in Indonesia and here they took the Indonesian health minister for a tour of needle-exchange programs in Melbourne. The Director of the AHRN has the uncanny skill of working with the highest level of bureaucracy and bringing in the public health perspective. It has had a lot of impact to make people change their perspective of needle exchange. Needle-exchange is not the only harm reduction tool available. It's a very effective one and it's very well evaluated and tested. But things like methadone and drug substitution are in the Asian context much less threatening. In the Asian context it is hard to argue the case for handing out needles to drug users. But if you tell people "I want to give drug users treatment so they don't use heroin," then the response is much more positive. There are different approaches you use with different people. You have to be skillful in maneuvering toward a situation where harm reduction is more acceptable.

How do you combat the mentality of society toward drug users and argue the case that drug users should be protected from HIV/AIDS?

We don't use words like combat. That's exactly the militaristic rhetoric that has occurred about drug users. There are a few arguments. One is the epidemiological argument that drug users get infected, but then drug users aren't islands in themselves. They have girl friends and wives, so if they get infected there is a possibility that they might infect their partner and then children and then the community. This seems to be very effective and is globally accepted.

The other is the economic argument in that its much easier to treat drug use with simple medication than to treat an HIV-infected drug user after a few years. It's much more costly, much more labor-intensive and you've actually condemned the person to death. This argument also works in most major democratic countries or institutions. HIV/AIDS is a very expensive illness. The costs on the family are also huge--the loss of the main breadwinner in the family. Like in Africa where entire villages, entire communities have died--the situation could very quickly become similar in Asia.

In my perspective at least, the South Asian region is about five-eight years behind the African experience. Already we are looking at deaths due to HIV, but we because of our system we are unaware of this occurrence. Only when it occurs on a larger, massive scale will we realize that its upon us.

So this is how we can argue for much more compassionate funding for HIV prevention. Again HIV affects the most productive levels of society--people who are 14-15 years start experimenting with sex and, maybe, drugs. It makes sense to do intensive prevention work with the very young who will then become leaders of our nations and contribute immensely to our economic and social growth.

The critical element is when you toss in drug use, people stand on morality and moral issues. The criminalisation of the so-called illicit drugs has no real rationale behind it. Until 1924 the United States had heroin in cough syrups. It's very hard to sit through all the issues that are intermingled in this. And then we're brought up with years of social and moral thinking and we fail to look at drug users with better perspective.

There is much more openness now though. For example in India we have managed to create so much opinion for harm reduction activities for drug users that the government now has plans for harm reduction programs rather than the usual detox programs. A lot of pros and cons have been weighed out and regional countries are now seeing the value of going down the harm reduction way among drugs.

Has the incidence of drug use increased in India?

We work in poor communities, in slums, and we've been working with that target group for years. We set up a drop in center and develop programs locally so drug users actually come and find us now. Drug use in the last ten years has grown pretty significantly, but I think there are indications, at least in Delhi, that it has stabilized at a level since 1990, though the numbers are really high. We project some 80-90 thousand use heroin out of which about 20 percent inject.

Has there been a change on the ground in India?

From day one to now I've seen a quantum change, and it's still occurring. For one we've managed to move from a project in one city to five cities. The government now is interested in drug substitution, needle exchange and harm reduction services. They look to us to resource the training. This major shift has occurred in the past 3-4 years. There has been a major shift in the way our government views drug use issues.

The government funds drug treatment programs--there are 550 in India--and now the health ministry wants a harm reduction expert to work in each of these centers. The state aid cells in India have also been mandated to fund needle exchanges in cities. Of course the bureaucracy is slow and money is slow to come, but the intent is now there.

You also see it everyday of your life with the drug users, or former drug users. People who were dirty weak malnourished are now cleaner, come about with much more optimism. We need to have research to prove this, but in our everyday lives we see a change.

The issue is getting a lot of play here. But beyond that do you think the cause of harm reduction for drug users has gained anything from this conference? For drug use issues I think this conference is the best that has happened so far. Even if you look at Durban, the international conference, there were small patches of drug use theme, mainly in posters. But here there is a drug use theme and session everyday.There has been an enormous recognition of how injecting drug use is driving the epidemic in this region.

There have been so many sessions dedicated to drug use here. Conferences outside your own country give you time to share and gain knowledge from people who work in the same field. The Ministerial Meeting means that there's a lot of interest in the issue of HIV/AIDS. And these ministers and whoever else has come with them will go back to their countries taking the message that harm reduction among, say, drug users works. I'm certain that has a ripple and snowball effect.