quarta-feira, março 09, 2005
A voz dos utilizadores de drogas injectáveis
Intervenção de Mauro Guarinieri, presidente do EATG, na 48ª sessão da CND das Nações Unidas em Vienna:
I speak to you today on behalf of a group of people living with HIV, treatment advocates and allies from 28 European countries, including western and eastern Europe, and the Commonwealth of Independent States. Our mission is to advocate for full and equal access to HIV treatment and care for all those in need, including injecting drug users, who number over 13 million worldwide according to recent estimates.
A theme of this year's CND is community mobilization. HIV prevention experts, too, speak often of the importance of including those who are at risk as key actors in developing behavioural norms for risk reduction. But when the issue is epidemics concentrated among drug users, our commitment to community mobilization clashes with longstanding and well-established prejudices. The absence of the voices of drug users at fora like this one speak to the difficulty of turning community rhetoric into action. Drug users still receive little or no sympathy from the general population or from government officials in most countries. They are still widely stigmatised, treated badly by various institutions, and denied access to effective treatment, prevention and care. It is this stigma that makes it possible to put restrictions on life-saving programs such as methadone maintenance without any political consequences. Imagine the outcry if we decided to make illegal heart medication, or insist that people with diabetes received no treatment unless they stop eating cakes.
Some nations argue that such rigid policies, particularly regarding methadone, are required by the UN conventions or by scientific research. But the conventions were all developed before broad awareness of huge AIDS epidemics driven by injection, and their interpretation must be weighed against international covenants that require nations to safeguard the health and human rights of vulnerable populations. In some countries, the conventions are too easily distorted into a tool to justify ambivalence about drug users that is neither required by the conventions and that contradicts all best practices of public health. The fact that injecting drug use accounts for 10 percent of all new HIV infections globally, and one out of three new HIV infections outside Africa- the fact that, as Mr. Piot noted this week, the world's fastest epidemics are all in places where the majority of infections are related to injection, shows the glaring and destructive price the world is paying.
There is no moral rationale for these figures . Wherever they live, injecting drug users do not want to get infected with HIV. If offered clean needles and other harm reduction services, they will gladly use them. I myself, as a drug user in Italy in the 1980s, have thought often about how glad I would have been for the opportunity to use a clean needle. As someone living with HIV for more than twenty years, I have had plenty of time to think. Like many people in that era, I injected in a rush, often without cleaning -not because I didn't care, but because the risk of arrest seemed like the most immediate danger. Even those who went to a pharmacy to buy a needle, faced the possibility of being stopped or questioned. Today, after effective harm reduction measures have offered drug users in Italy the means to protect themselves and their communities, the rate of HIV transmission decreased dramatically. For me, methadone, a treatment I used for years, allowed me the opportunity to move away from daily injection and toward professional development. More generally, it has been repeatedly shown to reduce HIV transmission, overdoses, crime, heroin use, and to increase adherence to HIV treatment.
While misguided HIV prevention efforts are horrific on their own, even more troubling is the inability of those already infected to obtain access to antiretroviral treatment. This is particularly important for regions such as Asia, Eastern Europe, the Newly Independent States and Central Asia, where as many as 80% of HIV+ individuals are active drug users and yet less than 1% of them have access to antiretroviral treatment. To some extent this is due to the overall lack of HIV medicines to treat anyone living with the virus. Yet there are more insidious reasons that HIV positive drug users and members of other vulnerable populations are not able to obtain treatment, and HIV-infected drug users who turn to doctors for help often have doors slammed in their face. As with harm reduction, evidence is not always sufficient to overcome prejudice. Numerous studies offer convincing evidence that well-designed, supportive programs can help injecting drug users adhere to ARV therapy and enjoy improved quality of life. Drug users are still told to go without.
I understand clearly the arguments in favour of drug free treatment-I myself was director of a drug free facility for several years. But I wouldn't be here today without having access to non-judgmental services such as low-threshold methadone maintenance programs. Unfortunately, my government is about to stop funding methadone as well as needle exchange and invest only in strategies that demand abstinence from drugs. Other governments make methadone illegal, or say that harm reductionis a term to avoid.
In fact, what is to be avoided is the process of replacing science with ideology. What is needed is a shared goal of full, equal and universal access to prevention, treatment and care for all people with HIV/AIDS and for all those those at risk. What is needed is policy that recognized the moral imperative of saving lives. Current approaches mean thousands of HIV infections, and precisely the kind of human suffering signatgories of prevention have pledged to avoid.