Meet the Expert: Prevention

Nick Crofts, Director, Centre for Harm Reduction, Macfarlane Burnet Centre in Medical Research and Public Health, Australia.

Dr Crofts highlighted many of the barriers to effective HIV prevention measures for drug users. But he also showed that there is some light at the end of the harm reduction tunnel. While he began the session in a critical manner he moved on quickly to compare lessons learnt from drug user organisations abroad, such as SHARAN in New Delhi, to lessons learnt from his work here in Melbourne. Speaking on the issue of initiation into injecting, he questioned when people learn to inject "do they learn to inject safely?" Some of the main reasons for drug use - lack of meaningful social existence - arise because families, schools and other social institutions have failed to provide meaningful environments for young people. Drug use fills that void. He described research carried out by the Centre for Harm Reduction in Melbourne that indicates that people get involved in problematic drug use, not because of issues of class or ethnicity, but because of a lack of employment options. The session covered many other topics: barriers to harm reduction (policing and public security, lack of treatment options); examples of grass roots programs in Asia that are tackling the IDU problem at its source; and the many challenges ahead. Speaking after the session Dr Crofts said that one of the major barriers to effective interventions amongst drug users was the fact that "drug use is conceptualised as being so antisocial that drug users are not seen to deserve the same considerations that other members of society get. In particular, they don't have access to basic health care measures especially primary health care, or means to protect themselves from blood-borne viruses". Dr Crofts also discussed some of the social and political barriers facing all countries, using the word "Asia" cautiously because it defines such a vast and diverse regions. He said "Asian cultures, like every culture on earth, are trying to come to grips with and understand what drug use is about".

But there was also hope in his message. When asked about any positive signs in the struggle to prevent blood borne viruses Dr Crofts said, "The ways different groups in Asia are finding ways to work with police and public security in developing effective approaches to the twin problems of drug use and HIV are very encouraging". The session and the expert comments by Dr Crofts and many of his colleagues pointed to the fact that we still have a long way to go before we can confidently say HIV epidemics cause by drug use have been controlled or even contained. Until such time, more work is need by researchers, governments, harm reduction programs and communities as a whole to make drug use and drug users into a more manageable problem.