19th International AIDS Conference: Why including drug users is important

I’ve spent most of this week sick with the flu.  Not my favourite past time, however it did give me the opportunity to spend some time following the tweets from the 19th International AIDS Conference in Washington D.C.  #AIDS2012 (Big shout out to @HarmReduction  and @HughStephens for keeping me in the loop!)

While much of what I have read on Twitter the last few days was great, I was disappointed to hear that people who use drugs or who worked in the sex industry from outside of the U.S. were effectively shut out from the conference by dint of the  country’s immigration laws.

Prospective entrants to the U.S. are required to respond to the following two questions in an application for a visa:

  1. Are you or have you ever been a drug abuser or drug addict?
  2. Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been engaged in prostitution or procuring prostitutes within the past 10 years?

Answering yes to either question results in a denial of permission to enter the country.  You can read more detail about this in an excellent article by Peter Staley here.

Nothing about us, without us

As I read more about how people who use drugs or had engaged in sex work were unable to attend the conference it reminded me of a story that I was told very early in my journey working in the alcohol and other drugs sector.

I had been working in the alcohol and other drugs sector for less than a year when I was asked to attend some training.  At that time my home town of Melbourne was awash with cheap heroin and the news media was regularly screaming about inappropriately discarded injecting equipment.  The facilitator of the training some how got onto the topic of retractable syringes, something that seemed to me at the time to be an elegant solution to the perceived risk of blood borne virus transmission via needle stick injury.  The retractable needle syringe pulls  the needle back into the barrel once the plunger has been fully depressed making needle stick nigh on impossible.  The training facilitator spoke about a working group that met to discuss the merits of the idea.  Apparently amongst the participants of the working group was a peer educator.  After what the facilitator said had been a lengthy discussion, the peer educator who had been quiet throughout, stated that the idea would simply not work as people would only half depress the plunger before handing on the syringe to the next person.  There would not even be an opportunity to try and bleach the equipment for the lack of a better option (like completely sterile equipment for each person).  Apparently that was the end of the conversation and thankfully we never saw retractable needle syringes dispensed in Victoria.

I have no way of knowing the facts of the story.  I wasn’t there, but for some reason it was this particular story that was the wake up call for me.  It’s the story that I think of whenever we start talking about the importance of including people who use drugs in the conversations about health policies, initiatives and strategies that are going to affect them.  It is for this reason I assert that the International AIDS Conference was missing an important component to the solution.

Harm reduction is founded upon amongst other things a sense of pragmatism.  As Elizabeth Pisani pointed out in her excellent TED talk, what appears rational for one person is completely illogical or non intuitive for another, dependent upon their perspective.  We as harm reduction workers need to be guided by people who use drugs, we need their perspective to be able to form a pragmatic response to health issues and most of all we need to demonstrate respect for them as our equals, as stigma kills just as surely as non sterile injecting equipment.

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