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Obama drug policy encourages activists in developing world

At Bangkok meeting, they cheer support for needle exchanges but urge further steps toward 'harm reduction.'

By Correspondent of The Christian Science Monitor / April 21, 2009

Boys in Bangkok, Thailand, line up for AIDS medication. President Obama's support for policies like needle exchanges have heartened activists who promote disease prevention over punishing drug use.

Andy Nelson/The Christian Science Monitor/FILE

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Bangkok, Thailand

Policymakers around the world have been watching closely as a new United States administration sets out its strategies on a variety of global challenges. And in the field of international public health, President Obama's policy choices are causing a stir among those who treat drug addiction.

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Reversing a decades-old policy, the Obama White House has approved federal funding of needle and syringe exchanges, which have been pioneered in liberal cities like Seattle. The police chief there, Gil Kerlikowske, is expected to be confirmed next month as national drug czar.

The shift in US policy is broadly welcomed by advocates of "harm reduction," an approach to drug use that puts public health and education before law enforcement. They see the changes as a vital step by a country that for decades has viewed illegal drugs almost exclusively through the lens of prohibition.

"The US has been a big block on harm reduction at the international political level.... It's beginning to change, and it's changed quite suddenly," says Gerry Stimson, executive director of the International Harm Reduction Association, which is holding its annual conference this week in Bangkok.

Proponents of harm reduction want to see the US go much further in overhauling its drug policy. Equally crucial, they say, is US support for international programs in developing countries where millions of injecting drug users (IDUs) are at risk of contracting HIV/AIDS, slowing other recent gains in fighting the disease.

US diplomats still object to the inclusion of harm reduction in United Nations counternarcotics declarations, though it's been adopted by virtually all UN agencies. And Obama has yet to tinker with Bush-era rules that ban the use of US foreign aid money to fund needle exchanges for drug users.

Experts on HIV/AIDS argue that needle exchanges, peer-led education, and substitute therapies such as methadoneoffer a proven way to prevent new infections among IDUs. But only a fraction of the $14 billion spent globally last year on tackling the disease went into such programs, says Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

The US government is the largest single contributor to the UN-backed fund. Mr. Kazatchkine says it faces a $4 billion shortfall in funding over the next two years, as recession-hit donors cinch their belts.

Handling dirty needles

In Thailand, which won praise in the 1990s for reducing HIV infections by promoting condoms in its sex industry, up to half of surveyed drug users test positive for the disease. Outside of sub-Saharan Africa, transmission via dirty needles accounts for roughly 30 percent of all HIV cases. In eastern Europe, Russia, and Asia, this practice is blamed for the majority of new infections, say health workers and UN officials.

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