A few months ago I went to a rally in support of harm reduction services outside a UNAIDS meeting in Chiang Mai. The rally was organized by the Thai Aids Treatment Action Group (TTAG)and the People Living With HIV/AIDS (PLWHA) network of Northern Thailand.
Harm reduction is an approach to public health that is meant to be a progressive alternative to the complete prohibition of certain potentially dangerous activities or choices in society, such as drug use and prostitution. The rally was intended to voice to the international community, and in particular the UN, that TTAG and affiliated/supportive individuals and organizations are strongly in favor of broad implementation of harm reduction initiatives in Thailand. This could include needle exchange programs, condom distribution in prisons, and a number of other possible initiatives.
The idea behind harm reduction is that some people choose to use drugs or engage in other high risk behaviors. Instead of a complete ban on these behaviors, harm reduction aims to mitigate the health risks and other potential dangers that the behaviors can cause. Harm reduction also addresses the legal framework in which these behaviors are carried out.
Some examples of harm reduction are widely accepted in societies worldwide, while others are much more controversial and are the subject of heated political and moral debate - for example: needle exchange programs, safe injection sites, and heroin maintenance programs.
In Chiang Mai, the focus of the rally was simple. Q: "What do we want?" A: "Harm reduction!". Inside the meeting I don't know what was discussed, or what conclusions the UN and the numerous other participating organizations came to. What I found particularly interesting was watching it from the outside. It seemed so simple, in a world dominated by convoluted language, diverse political considerations, and limitations on the activities that can be funded, to see the meeting of a straightforward demand with the sprawling international organization tasked with responding to the AIDS epidemic. It isn't simple though. An initiative that works and that benefits people? An initiative that people are asking for? Nevermind that.
US policy on HIV/AIDS prevention programs is a good example of the disconnect between what is proven to be effective, and what programs are actually able to be implemented. William Easterly discusses this in his book White Man's Burden:
To make things even worse, the religious right in America is crippling the funding of prevention programs to advocate their own imperatives: abstain from sex or have sex only with your legally married spouse. Studies in the United States find no evidence that abstinence programs have any effect on sexual behavior of young people, except to discourage them from using condoms... The religious right threatens NGOs that aggressively market condoms with a cutoff of official aid funds, on the grounds that those NGOs are promoting sexual promiscuity. Pushed by the religious right, Congress mandated that at least one third of the already paltry PEPFAR (President's Emergency Plan for AIDS Relief) prevention budget go for abstinence only programs.
This is just one example, and unfortunately it is all too common for political, religious or moral opinions and beliefs to stand in the way of what should be a very pragmatic process. Instead of responding to considerations like: what programs work and what programs benefit the most people, much more complex factors come into play. The issue becomes something more like: what programs work and what programs further my personal (or my county's, or my organization's) political, moral and religious preferences? Or, what programs work and what programs are politically and socially acceptable in the country in which I am working?
It seems to me that when a program works, like many harm reduction initiatives do, that should be what is really important. But then again, I'm new at this. I can say that I have met people and organizations that are aware of the realities and the obstacles that stand in their way and work tirelessly within the system to get their programs running while simultaneously working to change the system itself, and I find their efforts both inspiring and encouraging.
As for harm reduction in Thailand, I have hope that slowly but surely it be more broadly accepted and implemented, and that it will benefit people in a very real way.