HARM REDUCTIONHARM REDUCTION

HARM REDUCTION HARM REDUCTION آسیب آسیب کاهش کاهشBy : Dr SeddighBy : Dr Seddigh

HUMSHUMS

آسیب آسیب کاهش کاهش

مواد مواد انواع انواع

قانونیقانونی

قانونی قانونی غیر غیر

مشکل مشکل منشا منشا

اخالقی نظریه فرد اخالقی در نظریه فرد در

محیطی عدالت مدل مواد محیطی در عدالت مدل مواد در

کاهش مدل ماده با فرد ارتباط کاهش در مدل ماده با فرد ارتباط درآسیبآسیب

آسیب آسیب کاهش کاهش

عملی عملی استراتژی استراتژی

تبعات تبعات کاهش کاهش

آسیب کاهش آسیب جنبش کاهش جنبش

فازفاز 4 4

22 ضمنی ضمنی فاز فاز

صریح 2 2 صریح فاز فاز

اول اول مرحله مرحلهالکل ضمنی آسیب الکل کاهش ضمنی آسیب کاهش

پیشگیری پیشگیری مدل مدل

اندیشی مصلحت اندیشی مدل مصلحت مدل

قانونی قانونی سن سن

رانندگی رانندگی قوانین قوانین

استخداماستخدام

مالیات و مالیات فروش و فروش

ها ها برچسب برچسب

اول اول مرحله مرحلهضمنی آسیب ضمنی کاهش آسیب کاهش

پیشگیری پیشگیری مدل مدل

اندیشی مصلحت اندیشی مدل مصلحت مدل

استخداماستخدام

فروشفروش

مالیاتمالیات

هدف عنوان به هدف سیگار عنوان به سیگار

دوم دسته دوم سیگاریهای دسته سیگاریهای

دوم دوم مرحله مرحلهضمنی آسیب ضمنی کاهش آسیب کاهش

متادونمتادون

اپیوم اپیوم جانشین جانشین

زدایی زدایی سم سم

MTA methadone to abstinenceMTA methadone to abstinence

MMTPMMTP

آسیب کاهش سوم آسیب مرحله کاهش سوم مرحله

بیماری از پیشگیری بیماری مدل از پیشگیری مدل

معتادان معتادان اتحادیه اتحادیه

NEEDLE NEEDLE تعویضتعویض

جنبش جنبش تولد تولد

MERSEYSIDE MODELMERSEYSIDE MODEL

HIV VS DRUGHIV VS DRUG هدف نخستین و هدف تنها نخستین و تنها مرکز خارج مرکز دسترسی خارج دسترسی خدمات خدمات نواوری نواوری اجتماعی عدالت اجتماعی جنبش عدالت جنبش

چهارم چهارم مرحله مرحلهآسیب آسیب کاهش کاهش

بیماری پیشگیری از وسیعتر بیماری دیدگاه پیشگیری از وسیعتر دیدگاه

رفتار تغییر رفتار هدف تغییر هدف

شاملشامل

DV/IPV programs (“safety DV/IPV programs (“safety planning”);planning”);

dual diagnosis programs dual diagnosis programs (medication adherence);(medication adherence);

housing programs (“housing first”)housing programs (“housing first”)

آسیب کاهش برنامه اصلی آسیب عناصر کاهش برنامه اصلی عناصر

User involvementUser involvementAny positive changeAny positive changeSupportive agency policySupportive agency policyCollaborations with other Collaborations with other

providersproviders

ایران در خطر پر ایران داروهای در خطر پر داروهای

4040هرویین هرویین % % 2525تزریق تزریق % % مشترک سوزن حال مشترک شرح سوزن حال 5050شرح % % ایدز از ایدز آگاهی از 7575آگاهی % % خانواده خارج جنسی خانواده ارتباط خارج جنسی 5050ارتباط % % IDUS IDUS کرده کرده ازدواج 5050ازدواج % % COMMERICAL SEX WORKER COMMERICAL SEX WORKER

(CSW)(CSW)

The history of HIV/AIDS in IranThe history of HIV/AIDS in Iran

from a long time denial to from a long time denial to the breaking the the breaking the

silence.silence. Best practice of WHO/EMROBest practice of WHO/EMRO

Dec.17Dec.17thth 2005 2005

04/20/2304/20/23

Country ProfileCountry Profile southwest region of Asiasouthwest region of Asia .. 70 million population70 million population half half under 25 years.under 25 years. 70%70% under 29under 29 ..

Introduction:Introduction:

close to Afghanistanclose to Afghanistan (with 1300 km border) (with 1300 km border) that is the largest producer of opium in the that is the largest producer of opium in the

world.world. other regions such as Central Asia and other regions such as Central Asia and

Europe.Europe. It is estimated that there are It is estimated that there are 270,000270,000

injection drug users injection drug users (IDUs)(IDUs) in Iran in Iran and this has increased and this has increased

IDUs,IDUs, 80%80% of all known HIV/AIDS of all known HIV/AIDS cases in Iran. In addition,cases in Iran. In addition,

explosive HIV epidemics IDUs in explosive HIV epidemics IDUs in prisonsprisons. .

History and Policy of Addiction during 1980-2004 in History and Policy of Addiction during 1980-2004 in IRANIRAN

1980-2000 at the beginning; • Policy was: - prison for drug users - Execution of drug dealers • at the beginning, - 100/000 – 150/000 user - Most non injection - Intensive border control ( Construe of sement walls and border control with 3000 army solders)

Results:Results: - Increseing rate of addicts; from 100/000-150/000 ) Non official 1980) - 2/1 millions (1999 UNODC) - 3/2 millions (2000 MOH)

04/20/2304/20/23

4000 solders given their lives.- Increasing prisoners by %150 capacity - judicial files %60

- Loss of family stractuer

- Lowring of age

- Increasing TB and HIV/AIDS Increasing TB and HIV/AIDS in prison and drug users comunitee and their familyin prison and drug users comunitee and their family..

Setting:Setting: Kermanshah Kermanshah two milliontwo million

drug use drug use 5 percent5 percent highest rate in Iran and highest rate in Iran and

one percent aone percent aInjecting Injecting

The HIV problem was The HIV problem was

ignoredignored psychosocial supports for psychosocial supports for

drug users were drug users were rare.rare.

First step :First step :Local policyLocal policy Started in Kermanshah :Started in Kermanshah : Accepting Accepting HIV cases, DUs and STIsHIV cases, DUs and STIs (in Triangular (in Triangular

clinic) .clinic) .

link NGO ,GO, religious and key persons.link NGO ,GO, religious and key persons.

unlabeled centerunlabeled center

friendship relationfriendship relation vs medical relation. vs medical relation.

end of 1999end of 1999

syringes and medical caresyringes and medical care

consultationconsultation

1-2 patients/week1-2 patients/week to to 50-60 patients/day50-60 patients/day..

Include Include partners, partners, familiesfamilies, networks, networks, and the , and the boarder boarder communities.communities.

Develop activities in usersDevelop activities in users’ natural environment ’ natural environment PersonalizePersonalize prevention for each person at risk .prevention for each person at risk .Giving attention toGiving attention to sensitivity sensitivity of of cultural, cultural,

racial/ethic, and genderracial/ethic, and genderConfidentialityConfidentiality and and not registeringnot registering the ID of the the ID of the

clientsclients

Triangular clinicsTriangular clinics

freefree of charge: of charge: EducationEducation consultationconsultation HIV testing (VCT)HIV testing (VCT) Care :Care :

vaccinationvaccination

post exposure prophylaxispost exposure prophylaxis

Prevention of mother to child transmit ionPrevention of mother to child transmit ion

TB and OIs Diagnosis, care, and Prophylaxis.TB and OIs Diagnosis, care, and Prophylaxis.

Anti retroviral treatment.Anti retroviral treatment.

Cont ‘Cont ‘

Sexual Transmitted Infection care. Sexual Transmitted Infection care. Drug users care:Drug users care:

Harm reductionHarm reduction in the center and outreach : in the center and outreach :

1.Needle exchange program,1.Needle exchange program,

2.Condom Promotion2.Condom Promotion

3.MMT3.MMT

4.Detoxification4.Detoxification

5.Rehablitation 5.Rehablitation

The rate of HIV infection in The rate of HIV infection in drug users by education leveldrug users by education level

The majority of drug users are illiterate or at a primary The majority of drug users are illiterate or at a primary education level, but the routine HIV information was in education level, but the routine HIV information was in newspapers, pamphlets and posters that this group could newspapers, pamphlets and posters that this group could not read.not read.

28.0

72.0

31.3

68.8

18.1

81.9

7.6

92.4

0.0

100.0

0.0

100.0

4.9

95.1

16.1

83.9

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

pe

rc

en

t

postive negative

Cont’Cont’

PeerPeer education programs education programs PsychosocialPsychosocial supports for infected and supports for infected and

affected people affected people ReferralReferral services to specialist centers services to specialist centers OutreachOutreach programs (recently) programs (recently) Follow upFollow up of clients at home (limited home of clients at home (limited home

care)care)

PLWHA PLWHA and Drug users and Drug users committeecommittee

self help groupself help group information sharinginformation sharing collection of syringescollection of syringes prevention with high risk groupsprevention with high risk groups music groupmusic group sportssports providing seminarsproviding seminars

Student committeeStudent committee volunteering in preventionvolunteering in prevention work work

National committee

Technical subcommittees•Information&education • Research&evaluation•Harm reduction•Social support•Counseling,care & treatment

Provincial committees