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Problem solving 101…leave judgment out of the equation

Somebody brought this to my attention recently. It’s a piece I published in the Jakarta Post several years ago at a time when Indonesia was struggling with these issues. There was an enormous backlash against a suggestion in parliament that a harm-reduction model be applied in Jakarta to combat the growing problem of HIV/AIDS. Predictably, it was the religious right who bleated about this approach encouraging drug use, sexual promiscuity, and homosexual practices. The only difference between their reaction and the ones we have all seen here in the West is that theirs came primarily from Islamic fundamentalists rather than Christian fundamentalists.


Harm reduction and the fight against HIV

Patrick Guntensperger


 It’s a well worn cliché that education about HIV is needed in order to combat the lethal virus. However, it’s not just a lack of understanding of the scientific details of HIV and AIDS, but also a failure to understand the disease’s moral, social and legal implications that impedes our attempts to control the spread of the virus.

AIDS and HIV, the virus that causes it, come with considerable emotional baggage that muddies the waters when we are trying to deal with the disease. Unlike say, diabetes or cancer, the victims of HIV are demonised and all too often treated as pariahs; the suffering caused by the virus itself can be less acute than the suffering caused by the stigma attached to the disease. When AIDS was first detected and identified inNorth America, it was thought of as a “gay disease”. It appeared to have vectored out from a very promiscuous gay flight attendant so the first identifiable group of sufferers were his sexual contacts; other gay men throughout the world.

Little was known about AIDS at that time, not even that it was caused by the virus that would soon be known as HIV. How it was spread was not even known, although sexual contact was quickly pegged as the probable mechanism. With that pedigree, AIDS was not considered by most governments to be deserving of much investigation or research funding; after all, it was a seen as disease restricted to gay men and spread by sexual activity.

The general public’s perception was that it was of little concern to them and that if the homosexual population wanted to avoid the disease, they ought simply to stop having homosexual sex. A more radical view, expressed by a number of influential American religious leaders, was that the disease was God’s punishment for the “sin” of homosexuality. The implication was that to combat the disease, therefore would be to attempt to thwart God’s holy retribution.

But the disease started to be found among yet another marginalised group: intravenous drug users. And the rate of the disease’s spread was beginning to alarm epidemiologists. Unfortunately, in many people’s view, junkies were no more deserving of support than queers. The result has been that the search for a cure and the battle to control the spread of HIV and AIDS has carried an enormous social and political burden that simply doesn’t exist with equally lethal but non-communicable diseases.

Now that HIV is known to be spread by blood and, to a lesser degree, other body fluids and is not restricted to homosexuals or drug addicts, there is a stronger social will to find a cure. Great steps have been made in developing drugs that extend the life expectancy of those infected, but a cure has not yet been found. It is the spread of the virus that must be addressed in order to give us time for the researchers to find that cure. Unfortunately mitigating the social and moral stigma attached to HIV and AIDS has not kept pace with the work done on the purely medical aspects of the disease.

Harm reduction techniques can unquestionably slow the spread of HIV. But there is great social resistance to the implementation of those techniques as a result of completely non-medical attitudes toward the virus and the disease itself. Since the virus can be spread by behaviour that is morally unacceptable to many, efforts to diminish the impact of that behaviour are met with disfavour.

It is widely known that the routine use of condoms would have an enormous impact on the spread of HIV. And yet there are those who fight strenuously against sexually active teenagers being encouraged to use them, the argument being that to encourage their use would be to condone or even encourage sexual behaviour among young people.

And now that the spread of HIV is most evident among intravenous drug users, harm reduction methods provided to drug addicts would be enormously beneficial. If we could erase the stigma of the disease and leave any moral objections to drug use out of the equation, we would see that efforts have to be made to ensure that injection drug addicts have access to sterile needles and are educated in antiseptic injection techniques.The old model just doesn't work

Moral objections to hard drug use have to be put aside and it must be recognised that denying addicts the use of sterile needles encourages the spread of a deadly disease. And this disease has no social or sexual boundaries. It will not stay among those of whom society disapproves; it crosses every border and every social stratum and reaches out to kill our friends, neighbours and family members.

To ensure that drug addicts have sterile injection devices is neither to condone nor to encourage drug addiction. People do not decide against becoming a junky because they determine that it would be too hard to find a clean syringe, nor do they choose to become an addict because they think they know of a source of needles. But if a source of sterile needles is available to those who are addicted, the spread of this disease can be slowed down; maybe even slowed down enough to allow us to find a cure before someone in our family dies.



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