Countries in Asia-Pacific region have been urged to speed up providing services to protect people using drugs from HIV infection because injecting drug use is one of the major driving factors behind the regional epidemics.

According to key presentations and reports released during the 7th International Congress on AIDS in Asia and the Pacific (ICAAP) being held on July 1-5 in Kobe, west Japan, much of the current spread of HIV in Asian countries is attributable to injecting drug use, and there are signs that it is playing a bigger role in China and India's epidemics than previously thought.

In Indonesia, Nepal and Vietnam, rapid rises in HIV infection among drug injectors recently also appear to have spurred subsequent rises in HIV infection among non-injectors who have sexual risk behaviors, thus "kick-starting" wider epidemics.

"Drug-related intervention programs must be scaled up," said JVR Prasada Rao, regional director of the Regional Support Team of the Joint United Nations Program on HIV/AIDS (UNAIDS).

"There are some individual success stories here and there. But in terms of coverage, still the population of drug users who are covered is very low," he said.

Unfortunately, this mirrors the situation in much of the Asia Pacific region where injection-related HIV epidemics are currently raging.

"We have more than enough evidence that AIDS in Asia is driven largely by populations of injecting drugs users, due to high levels of needle sharing," added Tariq Zafar, keynote ICAAP speaker from Nai Zindagi, a nongovernmental organization providing street-based services for drug users in Pakistan.

"Although abstinence from drugs is the final way out, not all who inject and share are ready for abstinence -- nor do they have access to drug treatment services. For the rest, there needs to be a way to prevent them from sharing or even injecting," he said.

The Kobe Congress has brought together the latest information and opinions linking drug use and the Asia Pacific HIV/AIDS epidemic, but according to some delegates, the significance of drug use as the key "engine" for HIV/AIDS in the region has been understood for some time. (more)

Executive Director of the Asian Harm Reduction Network Ton Smits said some of the new data at the conference is important in identifying the spread of HIV from drug users into the broader community, but that what is urgently needed is action from those governments who have already made a commitment to acting on the crisis.

"What we are hearing this week are further important pieces in the evidence puzzle, but is not really telling us anything we didn 't already know," said Smits. "What we need is urgent action from the governments and other institutions that have made explicit commitments to do something about the crisis engulfing people using drugs in Asia," he said.

Due of its proximity to the major producers of the world's illegal heroin, and because of entrenched poverty in many places, Asia is home to the largest populations of injecting drug users in the world.

According to UN statistics, in 2004, for example, opium cultivation in Afghanistan grew by 64 percent, which promises increased trafficking and a steady supply of high-grade heroin for the Asia Pacific region as well as other countries.

Because of the difficulties people face in stopping using drugs, and because other detoxification or treatment services are often scarce, a more pragmatic approach is to reduce the impact and risk- associated effects of drug use.

"Harm reduction" is about reducing the harms of drug use, both to drug users and the wider community, without necessarily reducing drug consumption, said Smits.

One element of harm reduction is "substitution therapy" -- a treatment approach that helps opium-related drug users to reduce the withdrawal symptoms and craving when drug use is stopped or reduced.

Methadone is one of the oral medications used for the substitution therapy, Smits suggested. Because users taking methadone are far less likely to inject drugs, it also has a significant impact on reducing their risk of HIV infection.

On the eve of the ICAAP congress, the World Health Organization (WHO) announced that it had added methadone to the WHO List of Essential Medicines -- a roster of drugs endorsed by WHO, and recommended for basic use by health services throughout the world.

"This is important," said Peter Piot, executive director of the UNAIDS. "Nations who want to provide methadone in their programs will now have easier access."

ICAAP delegates are also keen to broaden the way harm reduction services are viewed. Rao argued that programs have to be more comprehensive, since needle and syringe exchange and methadone substitution are important, but just one part of the harm reduction and treatment continuum.

"I think you have to look at several of these elements and put them together in the form of a package," he said.

Five to 10 percent of the world's HIV infections are reportedly due to injection drug use. But HIV/AIDS transmission among people injecting drugs and their social networks is preventable, and there is evidence that HIV among this group has a large effect on the dynamics of HIV spread, and so the control of HIV in the general population also needs HIV prevention among injection drug users.

"Closing our eyes to these marginalized populations and behaviors will not make them go away," said Karen Stanecki, who leads the Monitoring the AIDS Pandemic group of leading AIDS experts. "Supporting prevention services for these populations will reduce their risk to HIV and will help prevent the spread to the wider population."

Source: Xinhua