Harm reduction in Asia and the Pacific: an evolving public health response

The initial challenge to the public health community was to gain acknowledgment of the existence of both epidemics—of drug injecting and of HIV among people who were injecting. Many original national medium-term AIDS plans from countries in the Asian region did not even mention injecting drug use as a component of the national epidemic, despite evidence from early in the course of the epidemic of explosive spread, high prevalences and the central role of epidemics of HIV among people who inject drugs (PWID) in driving national epidemics. The second challenge was to gain recognition that these epidemics of HIV among and from PWID mattered and that it was necessary to control HIV spread among PWID to stop the national HIV epidemic. This challenge was increasingly taken up by the growing NGO sector, with harm reduction programs springing up in most countries in the region, most often in very adverse circumstances. In 1997, these programs came together at the International Harm Reduction Conference in Hobart to form the Asian Harm Reduction Network, which became the lead advocacy body for harm reduction responses in Asia. These early harm reductionists also took on the next challenge, that of convincing authorities that something could be done to address and control these HIV epidemics and that it was worth doing. Official points of view, on the part of both national health and criminal justice sectors, were generally opposed to these positions: that there was nothing to be done about HIV among PWID (a view held for various and mostly spurious reasons) and that anyway, it did not matter because the epidemic would remain confined to populations of PWID, a group seen universally as socially undesirable, if not worse. Allied with the deeply felt desire to stamp out drug use, which was seen as a threat to Asian societies, this stance militated strongly against the adoption of effective measures—measures for the effectiveness and safety of which there was by then a large body of international evidence [2].