The New Frontiers of Harm Reduction

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The New Frontiers of Harm Reduction

• HIV and Non-Injecting Drug Use
• in Latin America
• Graciela Touzé
• Intercambios Asociación Civil
• Buenos Aires, Argentina
• www.intercambios.org.ar

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Latin America

• Rates of inequality are among the highest in the
  world.
• 47 million people living in extreme poverty.
• (World Bank, 2007)
• 1.6 million people are living with HIV.
• (UNAIDS, 2007)

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Cocaine use in Latin America

• Cocaine use is widely spread
• It has increased in most of the countries
• (UNODC, 2008)
• Injected, inhaled and smoked cocaine use related
  to HIV has been studied in some Latin American
  countries

4
IDU and HIV in Latin America

• IDU is more widespread in Argentina, Brazil and
  Uruguay
• Also reported in the Mexico-USA border and in
  Colombia
• Cocaine is the most common injected drug
• (Bastos et al Cook Kanaef, 2008)

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HIV and non-injecting drug use

• Higher prevalence of HIV infection among
  non-injecting drug users than in general
  population
• (Gyarmathy et al., 2002 Caiaffa et al., 2006
• Des Jarlais et al., 2007)

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HIV seroprevalence among non-injecting drug users

• Argentina
• 504 cocaine users 6.3 HIV (Rossi et al, 2008)
• 324 cocaine/amphetamine users 5.9 HIV (Vila
  et al, submitted)
• 170 coca paste users 2.9 HIV (Vila et al,
  2008)
• Brazil
• 132 crack users 7 HIV (Azevedo et al, 2007)
• 125 female crack users 1.6 HIV (Nunes et al,
  2007)
• Uruguay
• 367 cocaine users 9.5 HIV (Osimani et al,
  2005)

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Non-injecting cocaine use

• Cocaine is inhaled or smoked all over the region
  (UNODC, 2008)
• Crack cocaine has expanded in several Brazilian
  cities (Leukefeld et al., 2005 Blickman, 2006)
• Coca paste or basuco formerly well-known in
  Colombia, Bolivia, Chile, Ecuador and Peru has
  increased in Argentina and Uruguay since the late
  90s (Rangugni et al., 2006 Garibotto et al.,
  2006)

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Sexual transmission

• Crack and its close relationship to the sex trade
  has contributed to the spread of HIV through
  heterosexual transmission
• (Bravo, 2004 Nappo et al., 2004)
• HIV seroprevalences found among non-injecting
  cocaine users in Buenos Aires (6.3) and
  Montevideo (9.5) might suggest the important
  role of sexual transmission
• (Osimani et al., 2005 Rossi et al. 2008)

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HIV Seroincidence Buenos Aires (N504) and
Montevideo (N361)2000 - 2003
Positive on the sensitive (S) EIA and negative
on the less sensitive (LS) EIA Positive on
both EIAs
(Vignoles et al, 2006)
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Challenges

• Further research is needed on non-injecting drug
  use in order to build evidence based
  policies. (Cook Kanaef, 2008)
• Harms and risks associated with non-injecting
  drug use have been seldom targeted by integrated
  harm reduction initiatives.
• (Bastos et al, 2007)
• Examples of good practice are not yet integral
  components of comprehensive harm reduction
  packages.

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Discussion

• Social vulnerability of drug users related to
• High rates of social inequality
• Income disparity
• Poverty
• Frequent incarceration
• Violence
• Stigma
• Drug policies and responses
• HIV and harm reduction policies and practices
  need to be expanded