Pseudoscience and Christian bigotry

First of all, from what I understand from doctors, that’s [pregnancy] really rare. If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.

US Republican Senator Todd Akin, August 19th 2012

Some doctors have told me that health outcomes are worse for gay and lesbian people, and gay activists themselves point to health problems. I mean this in the widest sense, not just HIV-AIDS but rates of cancer, alcoholism and other disease.

Sydney Anglican Archbishop Peter Jensen, September 10th 2012

An interesting article headed When did it become okay to bag Christianity? was published in Mamamia recently.

The author recounts hearing what appears to be a fairly unjustified anti-theistic rant directed at Christians, then poses some queries as to why such criticism is common. Common in various media and comedy sketches. Of course this applies also to drama, casual discourse, public debate and genuine lobbying for equal rights.

Perhaps the question should have been phrased differently, or presented as an observation. Christianity particularly, has practitioners adhering to many different practices, beliefs and intention. Regrettably there are those who ignore the privacy of faith and wield their version of Christianity as if it were authoritative. Or worse, an absolute truth or blueprint for life. Everyone’s life.

It is this constant song of demand that the only life we know be discarded in servitude or demoted to a test run that sustains a deep and painful wound in the Australian psyche. The strange mix of fundamentalism and patronising insistence that others must live by an unwelcome moral code is at once offensive and utterly absurd. The intellectual paucity upon which it rides is truly astonishing.

Yet it is the message of Christianity as put forward by those in a position to command media attention, those who lobby or horrifically as revealed in recent years, those who seek to indoctrinate our children at public schools. The scale of material wealth enjoyed by the institutions that protect and nurture this archaic message and sadly defend those known to have abused so many children is not lost on Australians.

That religious institutions based on Christianity and the faith of Christianity are not one and the same, is not always clear. This may explain why it’s seemingly “okay to bag Christianity”. On the most recent episode of Q&A on Australia’s ABC, Aussies were treated to some splendid bigotry and misogyny from Anglican Archbishop Peter Jensen. Such views would and do disgust many Christians. He also spoke of the message of Jesus Christ and the positives associated with this. This view would be celebrated by all Christians.

Therein lies much confusion and the source for criticism of Christianity. It may not be Christianity in it’s entirety or individual Christians that are intended to be “bagged”. Yet the inordinate wealth, control and unwanted influence afforded truly unpleasant individuals based upon what is essentially a belief in magical beings, does not sit well with the progressive 21st century mind. Christianity remains a most irritating influence and/or manifestly detrimental force for so many that “bagging” or mocking, is not surprising.

The divisive and deceptive nature of many messages pushed out by Christian identities is reflected in the above comments. In both instances we see an appeal to authority. Toss in the claim some doctors have said this or that and apparently one has the opportunity to trot out whatever bigoted opinions one would like to be fact. In both cases it backfires because “doctors” in general say nothing of the sort.

Hence no proper research was attempted but the faux impression of having sought informed consensus is bravely put forth. Worse, these are smart men so this author will assume they knowingly lied. I hasten to add Jensen followed with, “I do not know whether there is sound evidence for this or not”. Which far from saving him should rightly raise questions about his access to Google or who on earth advises him. At the time, the claim had already been in the headlines for five days.

Hiding behind dodgy “research” is nothing new for Christian bigotry. The myth that homosexuality and paedophilia are linked has been the topic of bogus, offensive, pseudoscientific and at times bizarre reporting. Quite benign findings are breathlessly reported as evidence of children in danger from gay men. For example, one source from the US Family Research Council (Advancing faith, family and freedom) is cited:

In The Gay Report, by homosexual researchers Karla Jay and Allen Young, the authors report data showing that 73 percent of homosexuals surveyed had at some time had sex with boys sixteen to nineteen years of age or younger.

The wording seeks to convey that gay men have overwhelmingly had sex with teens, whereas “at some time” conveniently distorts consensual legal sex. Exactly the type of findings we’d expect with heterosexuals.

An in depth article by Mark E. Pietrzyk, Homosexuality and child sexual abuse: science, religion and the slippery slope, followed the 2006 resignation of US Congressman Mark Foley. We read in part in the conclusion:

A number of recent studies and articles have attempted to discredit the gay rights movement by linking homosexuality to pedophilia.  These writings have either cited articles in the scientific literature alleging to show that homosexual males are more inclined to molest children than heterosexual males, or they have attempted to demonstrate an inevitable trend toward toleration of pedophilia by employing the “slippery slope” argument.

However, the very scientists that are cited in support of the contention that gays are more likely to be molesters explicitly reject the idea that homosexuals pose a disproportionate threat to children.  […]

In fact, the Judeo-Christian tradition and many other religious traditions tolerated and even affirmed pedophilic relationships for centuries.  The contemporary taboo against such relationships developed only a little over one hundred years ago…

On Q&A Jensen was lending credence to Australian Christian Lobby head Jim Wallace’s argument that the “gay lifestyle” leads to death 20 years earlier than heterosexual estimates. Perhaps relying on Modelling the impact of HIV disease on mortality in gay and bisexual men, published in 1997, Wallace certainly chose to ignore the important follow up paper, Gay life expectancy revisited, by the same authors.

They open with this paragraph:

Over the past few months we have learnt of a number of reports regarding a paper we published in the International Journal of Epidemiology on the gay and bisexual life expectancy in Vancouver in the late 1980s and early 1990s. From these reports it appears that our research is being used by select groups in US and Finland to suggest that gay and bisexual men live an unhealthy lifestyle that is destructive to themselves and to others. These homophobic groups appear more interested in restricting the human rights of gay and bisexuals rather than promoting their health and well being.

Wallace might like to buttress his bigotry with the solidly debunked “gay obituary study” published by the head of Family Research Council (a documented Hate Group) Paul Cameron, with Playfair and Wellum. Choosing only obituaries these guys “concluded” gay men die at 43. I’m sure this came as quite a shock to all the living gay men from the same generation over 43 years of age. Especially as the sample had no living subjects and further skewed it’s results by sampling only urban openly gay men.

Today, with antiretroviral drugs mean life expectancy from the time of diagnosis with HIV is over 40 years. So, these chaps had to zero in on a particular time period and ignore living subjects. Average age of death from AIDS was around 40 years. 20% of gay men would die of AIDS in the period before drug treatment. According to Steven Ross, even if we crank that up to 50% Cameron’s mean lifespan of 43 years requires healthy gay men to die at 46. Said differently, if healthy gay men died at 70 those with AIDS would need to die at 16.

Then there’s the group of bigoted evangelicals I personally enjoy catching out in their abuse of science. The conservative anti-drug lobby continues to produce junk science arguing measures to control blood borne virus spread have failed. They remain at the forefront of efforts to undermine the methodology of expert panels who conclude illicit drug prohibition tactics in present form are quite damaging. An assorted group of Christian fundamentalists bent on faith based practices, it is quite sad to see them attack Christian run faith based charities.

When Drug Free Australia published an attack on research supporting Vancouver’s safe injecting site under the guise of science, Mark Wainberg, professor of medicine and director of the McGill University AIDS Centre concluded in part:

In my view, the allegations that have been made by ‘Drug Free Australia’ are without merit and are not based on scientific fact. In contrast, it is my view that the work that has been carried out by the team of Thomas Kerr et al is scientifically well-founded and has contributed to reducing the extent of mortality and morbidity in association with the existence of the safer injection facility. . . . The University of British of British Columbia should be proud of the contributions of its faculty members to the important goal of diminishing deaths due to intravenous drug abuse.

Thus in all three examples the demonstrable abuse of existing science or presentation of pseudoscience to justify or defend outright discrimination is clearly demonstrated. The quest for abstinence – forced if need be – in all it’s forms certainly leads to bigotry.

Clearly the discrimination and abuse levelled at members of the LGBTI community has a demonstrable impact on health and lifestyle. For gay Christians or those raised in Christian families the effects of bigotry can be negatively life changing. If Wallace was honest he would admit that his identified lifestyle problems of drug abuse, self harm and suicide would reduce without his bigotry.

If HIV is of genuine concern he would accept stable, monogamous relationships and of course marriage, reduce the risk of not knowing the HIV status of a partner. Instead he prefers to cite a Danish study that found brief relationships of around 18 months. He might not let on this was a sample of young men aged 18-21 years. In fact same sex civil unions are rather boringly unlikely to differ from the general population.

Wallace’s claims are surely demonstrably false. What is more shocking than Jim’s predictable bigotry is his attempt to link choice to sexual orientation. In arguing that smoking reduces lifespan by up to a decade and we educate children not to smoke, he’s suggesting we should similarly educate about the dangers of the “gay lifestyle”.

Of course as Jim tells it he was misrepresented by “gay activists”. Just as his anti-Islamic, homophobic ANZAC Day tweet was a misrepresentation by “twitter activists”. In both cases Aussie Christians vocally distanced themselves from him and his mess. His knack for denial is almost impressive.

Fortunately this debacle will have a notably positive outcome. More children being educated not to listen to Jim Wallace and the outmoded Australian Christian Lobby.

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Reject that and you belong in hell

In God We Teach follows the story of a high school student who recorded his history teacher proselytising for Jesus.

In Kearny New Jersey, student Matthew LaClair recorded teacher David Paszkiewicz preaching about Jesus. An avowed “anti-Darwinist”, who places god before all and concludes academic freedom includes the freedom to preach and not teach, at one time Paszkiewicz informs his history students:

He (Jesus) did everything in his power to make sure you could go to heaven. So much so that he put your sins on his own body, suffered your pains for you and is saying ‘please accept me, believe’.

You reject that and you belong in hell.

During a high school christian club meeting Paszkiewicz allows students to articulate the fundamentalist view that immorality thrives through “endorsing” evolution. One student suggests that people would, “… grow cold and empty. You grow cold to people with disabilities. You grow cold to an after life. There is no after life. Why not do what you want? Why not steal? Why not assault people?”.

Paszkiewicz calmly tells the student attendees;

The world doesn’t understand this but believers do. Teaching Darwinism, is something that’s going to take peoples eyes off of god, especially Jesus Christ. […]

It may be against the law to teach Creationism as fact, but that doesn’t mean it’s wrong.

With the town backing the wayward teacher, Matthew LaClair does what clearly had to be done to defend the right to public education and the separation of church and state.

An excellent documentary by vic Losick. Read more at In God We Teach or visit Vimeo.

Global Commission on Drug Policy: HIV Report

FULL REPORT HERE

On Tuesday June 26th the report’s release was streamed live

Drug War tactics driving up HIV/AIDS

The Global Commission on Drug Policy recently released yet another report condemning illicit drug prohibition and the War on Drugs.

Entitled The War on Drugs and HIV/AIDS – how the criminalisation of drug use fuels the global pandemic the report lists 6 key dynamics behind the trend.

1.) Fear of arrest drives persons who use drugs underground, away from HIV testing and HIV prevention services and into high risk environments. 2.) Restrictions on provision of sterile syringes to drug users result in increased syringe sharing. 3.) Prohibitions or restrictions on opioid substitution therapy or other evidence based treatment result in untreated addiction and avoidable HIV risk behaviour. 4.) Conditions and lack of HIV prevention measures in prison lead to HIV outbreaks in incarcerated drug users. 5.) Disruptions of HIV antiretroviral therapy result in elevated HIV viral load and subsequent HIV transmission and increased antiretroviral resistance. 6.) Limited public funds are wasted on harmful and ineffective drug law enforcement efforts instead of being invested in proven HIV prevention strategies.

Let’s forget “drug war” and call this problem what it is. Treating drug use as a criminal offence. Now, just by raising that image we’re into different waters entirely. Pointing to problems with the criminal model immediately evokes suspicion of compulsory promotion of illicit drug use. We’re conditioned to assume if we don’t punish drug use, it will be everywhere and bring about a host of nasty outcomes.

Mostly, we’re well conditioned to associate drug use with crime and to see it as criminal. Stitched on to this is the pop culture image from which we draw stereotypes. My favourite is one I often refer to as Quinn Martin. Quinn Martin Productions brought us Streets Of San Francisco and a host of other unrealistic 1970’s TV Cop shows. If you wanted a crime – it was drug related. A bad guy or a weak willed loser? Toss in a druggie.

Of course, I’m not suggesting we imagine this. The reality is criminals are made from associating in criminal circles and from being incarcerated, regardless of the reason. How this fits in with the drug-crime punishment model was addressed recently by eminent Australians who authored the Australia 21 Report. They state:

The prohibition of illicit drugs is killing and criminalising our children, and we are all letting it happen

Rather than legalisation alone, that report discussed regulation, decriminalisation and de-penalisation. Far from being an open slather free ride these measures involve control, certain losses of freedom, the need to demonstrate responsibility and a major focus on rehabilitation back to a productive and useful lifestyle. What they don’t involve is the destruction of lives and sustaining criminal enterprise at huge cost to the community.

Yet in Australia we do very well managing HIV/AIDS in injection drug users [IDU]. 16 million use IV drugs globally. Almost 20% live with HIV. Fortunately, Australia managed to keep that level at 3%, and a significant number of that sample were at higher risk statistically from acquiring HIV from another high risk behaviour. This level remained stable for decades.

So the question does arise. Apart from acknowledging shocking human rights abuses, tragedy in many nations and an ongoing source of disease and corruption, what policy aspects need we mull over?

Since the Howard years Tough On Drugs initiative and emergence of groups like Drug Free Australia lobbying against expanded protective measures, the level of HIV in IDU jumped to 4%. It remains an exquisite example of how just a few years of delayed and abandoned Harm Reduction responses, increased punishment and disinformation about Harm Reduction efficacy has an immediately devastating impact on HIV control in Aussie IDU.

The fact that this collective undermining of Harm Minimisation occurred during a period when Harm Reduction services, research and supporting evidence expanded rapidly in Australia is testimony to how effective disinformation and intuitively themed attacks on evidence can actually be.

Still, as of April this year we remain extremely fortunate thanks to Harm Reduction:

HIV in IV Drug Users matched to Harm Reduction

The single greatest sabotage of Harm Reduction initiatives under the auspices of John Howard, was the suppression of a heroin on prescription trial in 1997. This had strong bipartisan support and the Federal Health Minister, four States and the ACT were excited about the decision to go ahead. Under instructions from then ANCD head Major Brian Watters – later to become a Board member of Drug Free Australia – Howard immediately vetoed the decision.

Exactly how many HIV cases, ruined lives and deaths this led to is impossible to estimate, and I would err toward a minimal estimate. Still, 15 years later we can assume the body pile is now somewhat impressive. In what is unique insight into how Howard in turn manipulated the zealots who tried to manipulate him, he never flinched on needle exchange.

To his credit he continued to fund over a thousand outlets across Australia, with some specialising in bulk dispensing, others in hard core risk management. Abandoning these programmes was insanity, despite conservative lobbyists being convinced he might do so. Yet to Howard, being seen to usher in heroin prescription – “free heroin” – as shock jocks called it was political suicide.

Despite strong support for our official policy of Harm Minimisation, which accommodated extreme spending against smuggling (Supply Reduction), this is how he presented his thoughts in 1998:

The policy of zero tolerance of drug taking in this country is a wholly credible policy and policy that ought to be pursued more vigorously by government and by people who are concerned about the problem.

Of all the lies he told, this remains one of my favourites. There was no such policy beyond words. He seemed to despise everyone equally. Which was essential for the politician he became. All that mattered to Howard was Howard, and securing votes. Manipulating drug workers, users, science advisers, policy experts and voters over what was a social crisis at the time was pure business.

British Columbia did introduce heroin on prescription in 2005. 5 years later the effects of the combined measures on HIV were compelling:

British Columbia: HIV infection matched to Harm Reduction initiatives

Similar success from heroin on prescription is found in every nation to usher in trials and programmes. Sadly, Australia was ready before the Howard years. We were in fact, world leaders. Now it’s a different story. We have one Medically Supervised Injecting Facility that ran as a successful trial for 11 years.

Seven of those 11 years were due to disinformation and sabotage from conservatives. In October 2010 the Kenaelly NSW State government passed a Drug Misuse and Trafficking Amendment bill to ensure the Centre became permanent. 11 years of moral panic was, at least legislatively, silenced.

Whilst actually attacking Harm Reduction initiatives, confusing methadone and buprenorphine with illicit drugs and muddling the lot in with AFL drug policy, Alan Jones delighted us with his wisdom on “Harm Minimisation”, in mid 2007 [MP3 here]. Obnoxious, offensive and completely ignorant of facts it is also somewhat representative of Aussie views today:

So today Australia has a long, long way to go before we do, if ever, fully recover from the rise of anti-drug conservatives under John Howard. They did far more damage than just raise HIV infection by 1% in injection drug users. Our fluency with progressive policy and public maturity has been undermined. Australia waits, on pause.

33 million people live with HIV today. Outside sub-Sahran Africa IV drug use accounts for 1/3 of new infections. For almost 15 years annual HIV infections have been falling on a global scale. Except for seven countries wherein HIV infections increased by about 25% primarily due to IV drug use.

The “drug war” is full on in Eastern Europe and Central Asia and unsurprisingly 5 of these 7 countries are in these boundaries. In the last decade people living with HIV in these areas has close to tripled. Russia has resisted Harm Reduction measures keeping methadone illegal and charging users for needle possession. As this demographic is actively abused by law enforcers the motivation to use needles based on access convenience and minimal time is heightened. The results are clear:

HIV infections – Russian Federation

Thailand has impressively cut HIV infection in workers in the famous tourist attracting sex industry from 40% in the mid 1990’s to around 5% today. This pulled male clientele infection rates down in parallel. At the same time fierce drug war tactics led to 2,500 “death squad” murders in 2003 and HIV is up to 1 in 2 IDU in some regions. A comparison of different demographics for HIV infection is compelling:

THAILAND: HIV infections per demographic

In a splendid example of stupidity the USA reinstated it’s 21 year ban on federal funding for needle exchange programmes only 2 years after ending it. A stark lesson for Australia, constantly under the assault of disinformation from anti-drug group Drug Free Australia, can be found on page 9 of the GCDP Report.

Recently in reviewing the history of Harm Reduction and HIV, I noted the stark difference between not just nations, but regions within nations favouring HR as a powerful controller of HIV spread. Similarly today it can be seen that in nations with extreme law enforcement, and regions within the USA with the most intense law enforcement that HIV levels are higher than those with low law enforcement.

For instance, a study of the 96 largest US metropolitan areas found that measures of anti-drug “legal repressiveness” were associated with higher HIV prevalence among injectors and concluded: “This may be because fear of arrest and/or punishment leads drug injectors to avoid using syringe exchanges, or to inject hurriedly or to inject in shooting galleries or other multiperson injection settings to escape detection.”

DFA fallaciously – and skillfully – report the exact opposite. Similarly DFA urge for dedicated Harm Prevention measures, described already on this blog as crude behaviour modification. Whether through blind or biblical force the aim is to do just that: force drug users to stop by changing behaviour. Forget the addiction and crush the symptom.

The easiest way to do this is control the environment. Enter compulsory detention. What DFA have called “compassionate detention”. The models they are considering are terrifying. Not only is HIV infection spread through these centres, they fail to offer any addiction treatment. Forced abstinence is associated with high fatality relapse.

Once infected with HIV criminal and punitive approaches act as a disincentive to testing and treatment. Requirements to be drug-free in order to receive treatment (as in Sweden) and denial of certain rights like child custody and employment correlate directly to higher HIV/AIDS fatalities. Confidentiality breaches and stigma impact frequently due to law enforcement regardless of country.

This leads to higher circulation of HIV in the community as treatment has been shown to reduce HIV transmitted via blood and body fluids. As such it is vital all demographics in all communities can be reached through treatment which ultimately leads to prevention.

Incarceration also increases HIV infection and Australia is heading toward a USA type model which has 25% of prisoners listed as HIV positive. Fortunately our initial lower levels in the IDU population will protect us significantly from such a nightmare. Unusually, prison needle exchange is resisted strongly. DFA play the key lobby role nationally and prison guard unions seem intent to deny evidence in favour of their health.

Australian prison guards profit enormously from selling syringes to prisoners. Secondary to money is the control of prison dynamics, control of prisoner behaviour and the essential control of these transactions in corruption entire. A syringe is power in the prison setting. The sooner we remove this tool from guards and protect prisoner health with clean exchanges, the better.

Resources spent on law enforcement are resources not spent on health initiatives generally, on a global scale. With drug crime and infection encouraged by the former and lessened by the latter, it is clear we face a major global challenge. Public health is the first principle of drug control.

Settings where HIV prevention measures have been curtailed as a result of economic concerns have been particularly vulnerable to increases in HIV risk among injection drug users. For instance, a greater than 10-fold increase in newly diagnosed HIV infections among injecting drug users has recently been reported from Greece during the first seven months of 2011.

Australia remains incredibly lucky and indeed most fortunate in this global picture. What cannot be ignored and what must be cautioned against is our slow morphing into a landing pad for USA styled conservative disasters. DFA is an arm of Drug Free America Foundation and act at their bidding. DFAF have their “division”, the Institute on Global Drug Policy who fund the Journal of Global Drug Policy and Practice.

This is no journal but a vehicle for lobbying against progressive drug policy primarily that which targets HIV control. All get together and play at the Swedish based World Federation Against Drugs which similarly is nothing like a “world federation”. What they strive for is patently out of this world.

As today’s most brilliant minds accept the evidence condemning prohibition, the global Drug Free Whomever groups seek to defend the UN Drug Conventions that originated in 1961.

Fortunate we may be, but complacent we cannot afford to become.

Harm Reduction: How Australia Stopped HIV

In 1985 before the introduction of needle and syringe programmes (NSP) 90% of Australian injection drug users reported sharing injection equipment. By 1994 following introduction of NSPs this figure had fallen to 20%. In 2009 this figure was around 15% possibly reflecting the constant number of distributions from NSP programmes over the previous decade.

One of the most powerful modes of resistance to the spread of HIV/AIDS is Harm Reduction (HR) measures.

In Australia, HR exists as one of three pillars of Harm Minimisation (HM) – our official illicit drug control policy. The other two pillars are Supply Reduction and Demand Reduction. Reduction in supply receiving the lions share of funding directs energy at reducing international and domestic supply. Reduction in demand receiving less funding delivers programmes and initiatives designed to reduce the demand for drugs within communities.

Harm Reduction receiving the least funding from the HM pile targets the harm to individuals that eventuates from behaviour. HR has always drawn condemnation from conservative groups because of the association with drug use and sex. Initially men who have sex with men (MSM). Then later through maximal exploitation of drug using pop culture. Nonetheless, study after study comparing countries and districts within countries to have implemented HR or not done so, show a stunning success in favour of HR.

This post will look almost exclusively at IV drug use. HR for Injection Drug Users (IDU) includes provision of clean needles and sterile water, swabs, sharps containers for disposal and specialised filters capable of removing bacteria. Opioid Substitution Therapy (OST) including methadone and buprenorphine and safe injecting facilities are pivotal aspects of HR. Heroin on prescription is not available in Australia but has shown unprecedented success as a HR measure where it has been implemented.

Despite the evidence supporting HM as an effective policy and the reality that Supply Reduction [law enforcement] is the most highly funded pillar, Aussies are still subject to notions such as “Tough on drugs” and code words such as Drug Free Australia’s Harm Prevention. Intuitively it sounds fine. Why minimise harm if you can prevent it?

Yet on examination “harm prevention” is the abandonment of HM for the reintroduction of Just Say No approaches. Known to have had deleterious effects on self esteem, no effect on lowering drug use and providing the field upon which drug use flourished, Just Say No quite simply failed, and failed Epically. Today of course, skeptics are well aware of how beliefs and behaviours are reinforced through attacking them. Harm Prevention even more so is code for punitive, custodial and forced behaviour control.

It is at times perplexing as to why so much energy is spent on attacking HM entirely. Supply Reduction however is based in part upon the reality that people want, seek, use and enjoy illicit drugs. Education to accompany this is open and honest – not promotion of illicit drug use . Yet to the conservative mind the idea that their children, friends or the community at large is the demographic from which drug demand comes, is morally untenable.

With HR it is aspects of this pillar that equally cannot be accepted. To the conservative mind, just as condoms cause AIDS and promote sexual promiscuity so too do clean needles, safe injecting facilities and safe injecting education encourage drug use. Drug Free Australia write:

We need to re-focus our drug policy and practice on an approach that prioritises primary prevention, if we are to see any real change in the health and wellbeing of our current and future generations of young people. We need to acknowledge that Australia has one of the highest rates of drug use, because of a priority on Harm Minimisation rather than Harm Prevention, and we now need to take a leaf out of the books of the policy makers in the UK and United States. Both these countries have given greater emphasis to prevention initiatives, while still aiming to help people who are drug dependent, to recover.

The towering dishonesty inherent in this nonsense is typical of the tactics used by DFA in what has become over just a few years, one of the most immoral lobbying groups on the illicit drug landscape. Australia has high levels of cannabis use and abuse. This is handy in arguing that we have high drug use generally. A synopsis of the above is simply: Harm Minimisation has caused Australia to have one of the highest drug use levels in the world. We should be doing what America and the UK do.

The UK get a mention because they reclassified cannabis to a Class B (like speed/other amphetamines) from a Class C drug and punish users accordingly. Of 2.3 million USA prisoners in 2010, over 65% or 1.5 million meet DSM IV medical criteria for substance abuse or addiction. On top of this another 458,000 have a history that meets DSM IV criteria for addiction, were under the influence when they committed their crime, committed a crime to finance the purchase of drugs or were incarcerated for a drug law violation.

Between 1960 and 1990 official crime rates in Finland, the USA and Germany were similar. Incarceration in Finland dropped 60%, remained stable in Germany and quadrupled in the USA, driven primarily by drug convictions.

Today around around 80% of USA prisoners are incarcerated due to illicit drugs. 11% are receiving some type of “treatment”. The last thing Aussies need is a dose of the USA nightmare.

What of the impact of changing our strategy on HIV and consequently other types of blood borne virus transmission? The graph below is from a TED talk by Sereen El-Feki, vice-chair of the Global Commission on HIV and the law:

HIV infection in Injection Drug Users

Whilst Thailand and Russia have ignored Harm Reduction and Australia and Switzerland have embraced it the USA and Malaysia employed only some Harm Reduction techniques. Should Australia embrace USA tactics our prison population will explode, HIV infection in IV drug users will increase by about eight times the present rate and treatment – presently some of the best in the world with plunge to 11%. The cost to the public health purse would simply gut present programmes and destroy any hope of improvement for say, dental, mental health, public hospital care, nursing home care etc.

There is a 4 minute out-take from Sereen El-Feki’s TED talk in April this year below. Or download MP3 here.

The first case of AIDS was reported in Australia in 1983. At that time morbidity rates to rival World War II were expected. Following the innovative approach of HR, levels of infection in all demographics fell from 2,500 per year to 500 in the decade following inception of HR. This infection rate has remained stable.

At the time, initiation of clean needle supply contravened the states Drug Offensive which, already highly criticised, had regrettably escalated drug use and criminalisation via the failed “Just Say No” approach. The pilot programme ran from St. Vincents Drug and Alcohol Service on November 13 1986. It was run in the suburb of Darlinghurst. An evaluation recommended they should be adminstered by social workers, drug agencies, pharmacies, medical professionals and urged:

The urgent widespread introduction of needle exchange programmes in all states and territories

There needed to be an amendment to the Drug Misuse and Trafficking Act following which NSW pharmacies sold “anti-AIDS kits”. By mid 1989 there were 40 public outlets run across Sydney. By 1994 there were 250 outlets run by NGOs, government agencies and pharmacists distributing 3.5 million syringes annually. For the year 1993-1994 10.3 million syringes were distributed across Australia. The USA with 15 times the population of Australia distributed 8 million syringes in 1994-1995.

More comprehensive analyses refuted the concerns of increasing drug use. No increase in drug use was seen in any country that had instigated needle exchange and more so, attendance at rehabilitation and abstinence programmes had increased. Australia’s Commonwealth Department of Health (now Dept. of Health and Ageing) estimated that 25,000 cases of HIV were averted in the 12 years from 1988 – 2000 due to needle exchange alone.

The infection rate among Aussie IDU sat at around 3%. Users who were also MSM had an infection rate of 27%. In Russia where HR for drug users was denied, the figure for IDU was between 75 and 90%. One study in 1997 looked at 81 European cities with and without needle exchange programmes. Seroprevalence (measured from the presence of HIV within blood taken from used syringes) increased 5.9% annually in cities without clean needle distribution, and decreased 5.8% in cities with needle exchange.

In an astonishing comparison, Edinburgh with no NSP experienced a 65% HIV infection rate amongst IDU. Glasgow, less than an hours drive away and with NSP experienced a 4.5% increase in HIV infection amongst IDU. The one issue Australia faced was return of used syringes. Users were placing them in sharps bins. Yet to return any syringes to Exchanges meant risking being questioned by police. A used syringe is evidence of illicit drug use and this acted as a disincentive to return items for safe disposal.

Of note however is that fears and front page headlines of beach goers and joggers stepping on syringes and undergoing “agonising waits” for blood tests to be cleared of HIV infection are out of proportion. HIV dies very quickly once outside the body and syringes on beaches have been discarded into drains, washed out to sea and then beached. Nonetheless despite the absence of actual transmission it is an unpleasant experience which can be lessened by removing all offences for possession of a used syringe.

Clearly, Australia’s decision to take the necessary steps and bring together members of drug using demographics, gay rights advocates and prostitutes collectives and allow them to consult upon and shape this programme was one of it’s greatest public health initiatives ever.

Between 2000-2009 NSPs have averted 32,050 new cases of HIV and 96,666 Hepatitis C infections. Needles distributed increased from approximately 27 million to 31 million in that decade. For every one dollar invested, four dollars have been saved. 140,000 Disability Adjusted Life Years were gained over the same decade.

Still, conservative biblical fundamentalist group Drug Free Australia boldly inform us that Return On Investment is quite wrong and should show an expense. In earlier posts you can access from the tag on the right, I highlight how they cherry pick phrases and select data out of context. At other times they simply dismiss WHO findings based solely on the reviews of just one Swedish researcher, Dr Kerstin Käll.

So to be very clear, Dr Kerstin Käll, working for the Swedish government who are dodging UN demands to establish more Needle Exchanges and accelerate HR or remain in breach of the international right to health, conducted no research but criticised methodology that was favourable of NSP success. Her own research argues regular testing for HIV is more of a prevention – yes prevention – than clean needle supply.

It’s easy to get confused because whilst Käll supports NSP programmes as reducing hepatitis C in prisons DFA refute any change in HCV attributable to NSP programmes… anywhere. They also lobby stridently against the establishment of needle exchange in Australian prisons. Of course, despite the evidence above they insist the impact of NSP on HIV is “inconclusive”.

Ultimately it’s irrefutable how successful Harm Reduction has been in controlling the spread of blood borne viruses. Paramount amongst these is HIV, Hepatitis C and Hepatitis B. The most significant and visionary measure to now apply would include steps to decriminalisation and regulation.

Today however, this is where Australia is falling behind.