Here is an undated piece from the WHO SEARO website. In the six years from 2007 to 2013 the HIV prevalence among people who inject drugs in Mandalay declined from 38% to 5%. This is certainly a dramatic decline. Death, outmigration, decreased incidence, or a combination of these factors are likely responsible.

Not a single word about methadone.

Jamie

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Mandalay: Needle and syringe programmes cut HIV infections and save lives
WHO SEARO
undated

Mandalay, Myanmar – Like many cities and regions of Myanmar, the city of Mandalay has long been challenged by HIV epidemics, with people who inject drugs (PWID) the most severely affected key population. However, in recent times, Mandalay has witnessed a sharp fall in new HIV infections thanks to evidence-based public health interventions such as the provision and distribution of clean needles and syringes to PWID.

Myanmar has a long history of opium cultivation dating from the 18th century. By the 1980s, local manufacture and use of heroin had become common. As heroin use spread due to availability, accessibility and affordability, the transition from inhaling to injecting the drug soon followed. In 1993, the prevalence of HIV among PWID exceeded 74% in some parts of Myanmar due to contaminated needles and syringes being widely shared. However, over the past decade or so, considerable efforts have been made to prevent and reduce HIV infections among PWID across the country.

As with a number of other cities, Mandalay also focused its attention on developing a strategic HIV program and targeting efforts to reduce infections among PWID. As national resources were scarce to address the twin challenges of HIV and the injecting of drugs, the international community came forward to assist with the response, supporting the government and civil society organizations to work better together to address the situation.

In 2007, a study found the prevalence of HIV among PWID in Mandalay was 38%. There was a growing awareness that such high levels of infection required a more focused and collaborative response by both government and non-government organizations to curtail the PWID HIV epidemic.

The concept of harm reduction as an intervention to address the health and well-being of PWID, including the reduction of blood-borne pathogens such as HIV and hepatitis C virus, was gaining ground as a practical public health response. A key NGO with a significant presence in Mandalay is the Myanmar Anti-Narcotics Association (MANA), which established a needle and syringe programme (NSP), and started connecting with PWID by recruiting and employing peer educators and outreach workers.

Recalling the start of this initiative in Mandalay, Gary Reid, who has worked extensively on public health issues concerning PWID globally, says “It was clear at that point, unless something innovative was introduced to reduce HIV infection among PWID in Myanmar, we would not see the desired results. MANA had to act quickly and decisively.”

Needle and syringe programmes are based on scientific evidence, and are prioritized and endorsed by WHO and other UN partners working on HIV prevention among PWID.

“MANA approached influential societal leaders in the areas where it operated, including senior law enforcement authorities and local government leaders, to support what many at that time viewed as a controversial public health response to tackle HIV,” Reid recalled. “A lot of advocacy went into rolling out and eventually sustaining this harm reduction initiative.”

In 2010, MANA distributed 64,000 needles and syringes among PWID and the return rate of used injecting equipment was 62%. Needles and syringes were distributed to PWID congregating at various sites in Mandalay.

As MANA’s efforts were strengthened, more and more PWID began accepting the importance of clean needles and syringes, and this behavior change resulted in a dramatic decline in HIV infections among this key population.

Despite lingering sensitivity and controversy associated with the distribution of needles and syringes under the mistaken perception that NSP promote the injecting of drugs, for which there is no evidence, MANA scaled up its work, and in 2012 distributed up to 400 000 needles and syringes to PWID, with a return rate of 82 %.

The results were dramatic. In 2013, a study among PWID found that the prevalence of HIV had declined to 5%. The implementation of NSP in addition to other health-specific interventions has successfully prevented the spread of HIV as well as reduced other harms associated with drug use.

“Not only in Myanmar, but the world over, there’s clearly a very strong correlation between the use of clean needles and syringes and a sharp drop in HIV among people who inject drugs,” says Reid. “This is an example of how an enabling environment rather than punitive action towards drug users and other key populations can effectively address the challenge of HIV and other infections associated with injecting drug use, including hepatitis C. Community-led advocacy can change minds and hearts, and result in better health outcomes. I’ve seen this time and again over more than 20 years of working with key populations, law enforcement authorities and the judiciary in so many countries.”

Dr Razia Pendse, Regional Advisor, HIV and Sexually Transmitted Infections at the WHO South-East Asia Regional Office, concurs. “Despite overwhelming public health evidence demonstrating the effectiveness of harm reduction interventions, many decision-makers remain reluctant to implement or scale-up these best practices. Intense advocacy, grounded in solid evidence, is often required to initiate and sustain effective harm reduction programmes, and overcome the needless controversy attached to them.”

WHO has long maintained that where there are barriers to implementing harm reduction interventions, there is a need to create a supportive policy, legal and social environment that facilitates equitable access to prevention and treatment for all, including people who inject drugs. WHO has also reiterated the need for appropriate models of service delivery, health systems strengthening and strategic information to guide harm reduction programmes in Member States.

The WHO South-East Asia Regional Health Sector Strategy on HIV 2011-2015 includes needle and syringe programmes among the comprehensive set of interventions that should be implemented for HIV prevention, treatment and care of people who inject drugs.

http://www.searo.who.int/entity/hiv/mandalay-needle-and-syringe-programmes-cut-hiv-infections/en/