Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users

Many groups whose behavior places them at high risk for contracting HIV/AIDS, such as men who have sex with men, commercial sex workers, and injecting drug users, are stigmatized and abused, and in some cases their behavior is criminalized. Such harsh social and legal environment has been prevailing in many countries in the world(1,2). Injecting drug use (IDU) is the major cause of AIDS in Eastern Europe, Russia, and much of Central and Southeast Asia. Given the complexity and long-term nature of the problem of drug use, an AIDS prevention strategy for injecting drug users cannot rely solely on efforts to stop injecting drug use. Rather, it should follow a harm reduction approach, which incorporates a spectrum of strategies ranging from safer drug use to managed drug use to no drug use(2). Combating HIV-AIDS in industrializing countries requires improving the conditions under which people are free to choose safer life strategies and conditions for themselves and future generation(3).

When the epidemic of HIV among injection drug users was recognized, the response in Canada's largest cities was to institute more accessible needle and syringe exchange programs, and this has been credited, along with the existing sale of needles in pharmacies, with keeping infection rates quite low until recently. A Vancouver health board in September 2003 implemented a proposal for safe injection rooms, where users have provided with clean equipment and medical backup if needed, but no threat of arrest, generated considerable controversy all over the North America. This initiative was an example that indicates the willingness to look beyond punitive models and consider more health based responses to the drug addiction and related problems. Ultimately, the recent evaluation of safe injection room initiative published in the CMAJ has pointed the way of change(4). These outcomes must be highly publicized in the international media to encourage policy makers to implement more public health approaches to drug addiction related problems. In addition policy makers must be aware that there are a whole range of promising interventions that go far beyond the ones mentioned above, and these interventions must implement not only for vulnerable groups, but also members of the general population.

Refernces;

(1) Desapriya, E.B.R., Stigma of AIDS needs to be overcome. BMJ. 2004; 329(7465):573.

(2). Heffernan J. Best practices for preventing AIDS. J Ambulatory Care 2004;27: 190-1.

(3) Ruger JP. Combating HIV/AIDS in developing countries. BMJ 2004;329- 121-2.

(4) Wood, E.,.Kerr, T., Small, W., Li, K., Marsh, D.C., Julio S.G. Montaner, J.S.G. Mark, M.W., Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users CMAJ 28, 2004; 171 (7).

Conflict of Interest:

None declared