The 22nd International Harm Reduction Conference took place in Beirut, Lebanon, during April 3-7, in the Middle East and North Africa (MENA) region where it faces diverse and rapidly changing patterns of drug, tobacco and alcohol use. Despite the fact that harm reduction has been adopted in policy and practice in more countries than ever before, significant gaps remain in the response. Also lack of coverage on harm reduction programs and the capacity of civil society to respond to harm reduction issues remain low in much of the world, therefore, 'Building capacity, redressing neglect' was made the theme of this annual international conference.

The Asian Harm Reduction Network (AHRN) in collaboration with the International Harm Reduction Association (IHRA) organized a Asia-regional Harm Reduction meeting on April 6, 2011 to discuss how civil society could collaborate and promote harm reduction, and collectively strive to achieve more sensible, humane and effective drug policies in the region. "It was a real opportunity for all of us who are working on harm reduction to meet and discuss and come up with some plan to enhance what we are doing" said Ronny Waikhom, coordinator, AHRN.

Civil society engagement has been variable in harm reduction initiatives in the region. "It depends on who they are, where they are, who is supporting them, so we have a range of stakeholder organizations in this region and most of these organizations are driven by the contextual factor such as the available funding that they have, the issues around. So it depends on those area if they share the right donor, if they share the right issue, if they have the same agenda, then they better collaborate genuinely" said Waikhom.

"When there is no genuine collaboration with the civil society or lack of harmony and synergy between civil society and those who implementing programs, then the program impact can be severely undermined. Also in such situations, monitoring of programs is sub-optimal which compromises program outcomes," said Waikhom.

"This has been happening quite commonly across the world especially in Asia where you will find money from different sources being put into similar programs in the same region. This is clearly a waste of money and time when we are facing severe resource constraints. Also we have another major challenge that is lack of coordinated response at the local level. Our experience clearly shows that there are major difficulties in trying to monitor a program in a region when there are lot of different actors due to poor coordination," said Waikhom.

Achieving millennium development goals (MDGs) is a clear priority in every community including those of injecting drug users (IDUs). Despite the well-documented benefits of harm reduction approaches to HIV prevention, particularly among IDUs, service coverage is abysmally low throughout Asia. With about 30 percent of new HIV infections in the region associated with drug use, there is a very real and urgent need to scale-up harm reduction services.

"Injecting drug use has ated as a catalyst for HIV epidemics at the onset of the pandemic in many Asian countries. The sharing of injection equipment is a very efficient way to transmit HIV from one person to the next," said Dr. J.V.R. Prasada Rao, then-director of the Regional Support Team of the Joint United Nations Program on HIV/AIDS (UNAIDS), to CNS in 2008. CNS and AHRN are partners promoting harm reduction approaches in the region.

"Once HIV enters the IDU network, it spreads very rapidly and an injecting drug use-related HIV epidemic kicks off in a country. This is what happened in China, Indonesia, Vietnam and the northeast of India" had said Dr. Rao.

"If we have to achieve MDGs, harm reduction must be sustained and scaled up so that every person who needs harm reduction services, is able to access them in a safe and dignified manner. Also services for hepatitis C (HCV or Hep-C) must be scaled up so that they are affordable, accessible and available to those most in need and where they need," said Waikhom.

"We also need policy harmonization on HIV, IDU and harm reduction. Lack of policy harmonization and criminalization of drug use has severe adverse public health outcomes," said Waikhom.

With HIV prevalence rates of between 20 and 85 percent among IDUs in some Asian countries, governments have no excuse for not responding to the issue by integrating harm reduction approaches into HIV prevention and treatment programs and scaling up interventions.

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