Though I fully support the expansion of harm reduction in Myanmar, backpatting the country for leading others in the region is facile. The speed of expansion of methadone in Myanmar is glacial. And a prize for leading the region on some aspects of harm reduction could be claimed by Bangladesh, Vietnam, or even China.
The best time to expand harm reduction in Myanmar was ten years ago. The second best time is now.
Jamie
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Saving lives, preventing HIV transmission
Portia Larlee
Mizzima
4 September 2014
A progressive response to drug addiction has given Myanmar the distinction of leading the region in harm reduction strategies, a pragmatic approach to dealing with one of the world's most debilitating health problems.
The Ministry of Health embraced harm reduction - which seeks to minimise the harm caused by addiction - in 2004 and began providing methadone at four pilot sites in Myanmar in 2006.
Since then, the ministry has established 35 methadone treatment sites throughout the country with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, a donor organisation based in the United States.
Myanmar is ahead of other countries in the region, said Dr Hla Htay, who manages the ministry's National Drug Abuse Control Program, of which methadone treatment is a part.
Methadone is a prescription drug administered orally under medical supervision to people dependent on heroin and is an opioid substitute.
Opioid substitution therapies, including methadone, reduce unsafe injecting practices and the risk of HIV transmission among people who inject drugs, says a study published in 2007 by the London-based International Journal of Drug Policy.
The study, "Adherence to HIV treatment among IDUs [injecting drug users] and the role of opioid substitution treatment", said another benefit of the therapies was improved compliance with antiretroviral treatment for those with HIV.
A UNAIDS report published in March this year put the prevalence of HIV among injecting drug users in Myanmar at 18.7 percent and said that about 0.5 percent of those aged 15 and above were HIV positive.
There are about 75,000 injecting drug users in Myanmar, Dr Hla Htay told Mizzima Business Weekly.
He said National Drug Abuse Control Program had 6,786 patients enrolled in methadone treatment in June 2014. The figure exceeds the target for 2015 and demonstrates the need to expand the program, Dr Hla Htay said.
“We have nine percent of people who inject drugs [in Myanmar] receiving methadone treatment, but we need to cover more,” he said. “Global Fund is not enough; we need to request the government to invest in harm reduction so we can do more.”
Methadone treatment was available in 77 countries and was being provided to eight percent of people throughout the world who inject drugs, Dr Hla Htay said.
“It [methadone treatment] is expensive, but we have to try to reach everyone; this is how we can reduce HIV," he said.
In 2005 the World Health Organisation endorsed methadone and buprenorphine, another opioid substitute, as essential medicines. However, a study published in 2009 by AIDS a British-based scientific journal, estimated that fewer than two percent of people in Southeast Asia who inject drugs have access to opioid substitutes.
In Myanmar, it is grassroots NGOs such as the Asian Harm Reduction Network that are helping to fill the gaps in methadone treatment through services such as providing clean needles and syringes.
The AHRN began operating in Myanmar in 2003 under a memorandum of understanding with the Ministry of Home Affairs' Central Committee for Drug Abuse Control. It now works in cooperation with the Ministry of Health and runs six drop-in centres and clinics in Kachin State and two in Shan State.
The AHRN also works with the Ministry of Health to provide methadone treatment.
The AHRN's technical director, Willy De Maere, said the ministry was striving to "scale up" the number of people on the methadone program to 10,000 by the end of 2016.
Among the challenges faced by Mr De Maere and his team at the AHRN are dilemmas at the intersection of public health and narcotics control.
Article 13 of Myanmar's colonial-era 1917 Excise Act prohibits the making, selling or possession of syringes and other apparatus used for injecting “any intoxicating drug,” a crime for which the maximum penalty is six months' imprisonment or a fine of 1,000 rupees.
Mr De Maere said the Ministry of Home Affairs' Central Committee for Drug Abuse Control had adopted “a common sense approach” to harm reduction and although the outdated law was rarely enforced it did result in “impacts on risk behaviours”, such as sharing needles.
“Of course you don't only have CCDAC; you have the police,” he said. “So it remains something legally that might give you problems and even if it's not enforced ... whenever there is a crackdown, they [people who inject drugs] will not have a clean needle on them out of fear of arrest.”
Generally, on an “individual level,” the CCDAC has been very supportive of harm reduction practices, said Mr De Maere.
“Of course they [CCDAC] have other things to do like [drug] supply reduction,” he said. “But they [CCDAC] know that addiction is chronic and relapsing; they really understand harm reduction.”
Support from law enforcement helps to influence public opinion about often misunderstood practices, said Mr De Maere.
“Having public support from law enforcement looks really good,” said Mr De Maere who praised Myanmar for leading other Southeast Asian countries in accepting harm reduction.
“Honestly, Myanmar has been ahead in harm reduction in the region for a long time,” he said. “In Thailand you don't see such a supportive law enforcement environment – and it's still the war on drugs.”
Myanmar is also ahead of some European countries, including Belgium, where Naloxone - an antidote for heroin overdoses - is still a controlled drug and not easily accessible, he said.
Mr De Maere said addiction had been “more endemic” in Myanmar because of poppy cultivation and poverty - mainly in Shan and Chin states - and harm reduction was an appropriate response.
“Addiction, as we know, is a chronic brain disease and in Myanmar you have the highest quality heroin in the world, so you have the best painkiller, in all senses of the word,” he said.
“People are not necessarily only taking it because they want to get high, but taking it because sometimes they have no other recourse.”
This Article first appeared in the September 04, 2014 edition of Mizzima Business Weekly.
http://www.mizzima.com/opinion/features/item/12536-saving-lives-preventing-hiv-transmission
