We all want our families and communities to be safe and healthy. There is no debating this fact. Should anything threaten the very fabric of our society, it is natural to put up a protective barrier and confront it.
For decades, governments across Asia have pointed to drug use as a serious threat to public health and social order. The response, in many cases, has been a series of heavy-handed crackdowns, all in the pursuit of ensuring that society is "drug free".
But, what if such tactic to eliminate a threat, ends up being more harmful than the threat itself?
The pursuit of the "drug free" goal has severely damaged our communities. People have been unjustly beaten, forcibly detained, tortured and even killed, while Hepatitis C and HIV epidemics rage among at-risk populations of drug users. Despite all the crackdowns, drug use remains a problem in every country.
Given this failure, it is only right to consider alternative approaches, such as harm reduction. Built on the principles of compassion, dignity, human rights and evidence, harm reduction is shown to offer solutions that foster safer, healthier communities.
In the past 20 years, alongside its pursuit of a drug-free region, Asia has slowly made strides in increasing the availability of harm reduction services, as well as access to treatment for HIV and viral hepatitis. However, a new report from Harm Reduction International (HRI) shows that harm reduction in Asia is beginning to flat-line, and is continuously at risk of being undercut by punitive crackdowns on drug use.
Since 2016, the number of countries in Asia implementing programmes to prevent blood-borne infection and drug-related deaths fell to 15, with Laos and the Philippines stopping services althogether. Many regions that need these services do not have them, and where harm reduction is available, access and retention rates in programmes remain low.
In addition, countries are not adapting to emerging trends. The region is witnessing an increase in the use of amphetamine-type stimulant (ATS), without an increase in harm reduction to keep people safe. Informational leaflets or kits to ensure people use ATS more safely are just two examples of services that can improve health.
Most worryingly, women often suffer the most from our current drug policies, and are being left behind in the existing harm reduction response. Women's experiences with drug use and the drug trade differ from men's. In societies where women are idealistically painted as nurturing or pure, their involvement with drugs make them more vulnerable to physical and sexual violence, exploitation and stigmatisation. One recent finding from Indonesia showed that more than half of women who inject drugs were victims of intimate partner violence.
Harsh drug policies are compounding this problem. In the criminal justice system in Asia, while women make up a smaller percentage of the prison population compared to men, they are the fastest growing group of prisoners. We cannot expect to build up our societies when their foundation -- our families -- are being continuously torn apart.
Advancing harm reduction and our response to drug use begins with simple steps -- meet people where they are at; give honest and pragmatic information; create programmes and responses around their needs, rather than imposing unrealistic goals; and ensure their meaningful involvement throughout the process.
There are pockets of hope in Asia following these principles. Myanmar operates one drop-in centre for women that provides primary health care, and counselling to promote safer injecting. Outreach programmes exist to address ATS use, too, with a peer programme in Indonesia helping connect people to physical and mental health services. Programmes like these must be expanded on.
Ultimately, though, progress in harm reduction will continue to be stunted if we don't address a prevailing and growing culture in many Asian countries -- one that still believes in punishment as the most effective way to deal with any behaviour it deems deviant. In the Philippines alone, where the current president famously called for an all-out "war on drugs", the past two years has seen thousands of people killed and tens of thousands more deprived of liberty.
Countries in the region find themselves at a crossroads. Do they want to continue with their pursuit of unattainable goals that harm our communities? Or, do they want to follow the evidence and implement policies and practices that do the reverse?
Initiatives that emanate from a harm reduction framework -- that prioritise health and welfare, guarantee human rights, and promote social justice -- save lives. The evidence for this has grown remarkably over the years, and will only continue to do so.
Harm reduction works. This is no longer up for debate.
