This commentary piece in The Lancet documents the current challenges and advances being made in Taiwan in terms of HIV prevalence and harm reduction. As the authors state, “Taiwan is entering a new and dangerous phase” in terms of its HIV epidemic, with reported cases more than doubling between 2004 and 2005, and estimated prevalence suggesting one of the greatest infection rates in Asia. The authors also report “enormous increases in the amount of heroin smuggled into Taiwan”, and in injecting drug use.
In response to these concerns, Taiwan set out to learn from its Asian neighbours, many of whom had already embraced harm reduction in response to injecting drug use-related HIV epidemics. The authors specifically mention the contributions of Professor Gerry Stimson (IHRA Executive Director) and Dr. Alex Wodak (a member of the IHRA Executive Committee) – who visited Taiwan in 2005. Consultations with harm reduction experts and visits to harm reduction programmes prompted the Taiwanese Government to embark on a pilot programme of syringe exchanges, methadone maintenance therapy (including in prisons), free HAART (Highly Active Anti-Retroviral Therapy) and community-based programmes for men who have sex with men.
This article demonstrates the influence that the international harm reduction movement can have on national policies and decision making. Harm reduction is a scientifically proven response to HIV/AIDS, hepatitis B and C and a range of other drug-related health harms. The Taiwanese experience demonstrates how, even in politically challenging environments, the pragmatic nature of the harm reduction approach can win out. As well as the recent embracing of harm reduction, the NGO and civil society presence in Taiwan is growing and, as early as 1990, a law was passed to protect the human rights of people living with HIV/AIDS for treatment, education, and employment.
This commentary on Taiwan (along with many of the other articles in this edition of The Lancet) demonstrates the potential for harm reduction in the region, but also the on-going challenges that face these nations. As The Lancet states in its editorial summary, “opportunities for collaboration across all borders must be taken. Strategies that work, such as needle-exchange or methadone-maintenance programmes, need to be scaled-up, and consistently used along trafficking routes”.
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