Hong Kong Harm Reduction

The following article is by Judy Chang [AHRN] who interviewed me to contribute information on Hong Kong’s harm reduction situation.

Hong Kong is a study in contrasts. A city of multiple personalities, it has managed to absorb people and cultural influences from around the world. The rich live, work and play in uncomfortably close proximity to the poor, reflecting the city’s striking income inequality – considered the highest in the developed world. It is a city where Prada and Gucci stores are as ubiquitous as Starbucks and McDonalds, whose sidewalks are peopled with domestic migrants workers sitting on cardboard sheets chatting away and playing cards on their day off, staking their claim on the small square of public space that is freely available to them.

Hong Kong’s moniker as the ‘City of Contrasts’ can also be used to aptly describe its harm reduction landscape: Innovation and progressiveness sit side by side with conservative and reactionary attitudes. Known as the gateway of Asia, Hong Kong’s strategic location has made it a hub for opium and heroin traffic. Opium produced in the Golden Triangle has traditionally travelled by sea from Thailand to Hong Kong or Taiwan, where it is processed into heroin for local use or shipped to overseas markets. With an increase in cross border trafficking since 1997, more frequent and higher quantities of drugs have been moving into the Hong Kong market. Though drug trends and patterns of drug use change over time, heroin has remained the drug of choice, particularly amongst the over 30 population. (CRDA 2009)

Historically Hong Kong has been a regional leader in its approach to drug use, and has been looked to as a best practice model within Asia. During a time when the mainstream approach to drug use was predominantly conservative, the Hong Kong government chose to take a progressive path in learning from and applying harm reduction strategies. Since 1972, there has been a rapid scale up of Methadone Maintenance Treatment (MMT), with the key objective to ‘provide a readily accessible, legal, medically safe and effective alternative to continued illicit opiate drug use’. (Lee 2007)

Today the Hong Kong MMT program is characterized by an open door policy, with low thresholds for admission, retention and readmission, no waiting time, no need for referral or appointment, easy accessibility, high coverage, low cost, high efficiency and protection of client confidentiality. There are 20 methadone clinics situated throughout Hong Kong, which provide treatment to some 6000-7000 clients daily. Serving as an entry point to HIV prevention messages and services, methadone clinics provide a variety of designated resource materials and distribute free condoms. Studies have shown a correlation between the provision of MMT and the low HIV prevalence rate amongst IDUs (6%) in Hong Kong (Wong et al 2010). Success of the MMT program is due to the government’s foresight and commitment to a rational, evidence-based approach to treatment. Not surprisingly, the model of Hong Kong’s MMT program has been documented as a ‘Best Practice’ by the Joint United Nations Programme on HIV and AIDS (UNAIDS 2006), and used as a reference in developing other MMT programs. Hong Kong has historically been, and continues to serve as a learning site and hands-on training ground for those countries initiating and implementing MMT in the Asia region.

However, a yawning chasm exists between the progressiveness of the Hong Kong government’s MMT program and its refusal to initiate Needle and Syringe Programs (NSP). NSPs, along with Opiate Substitution Therapy (OST) have long been the mainstay and cornerstone of effective harm reduction practice.  It thus seems a contradiction in practice to run MMT in isolation from NSP services. Moralizing and conservative attitudes that perceive NSPs as condoning or even encouraging drug use prevent the distribution of needles and syringes. There is strong evidence that NSPs reduce HIV and Hep C transmission. According to an Australian government study in 2009, investment in NSP averted 32,000 HIV infections and 100,000 Hep C infections in the country between 2000-2009. Though HIV prevalence remains low amongst IDUs in Hong Kong, Hep C prevalence amongst IDUs is estimated to be at 85% and is presenting a growing threat to public health (Lee 2009). Despite these facts and figures, the Hong Kong government is still not ready to change its stance on NSPs. Like many of the Asian countries, the law in Hong Kong allows one to be prosecuted for supplying or simply for possession of clean needles and syringes.

Though methadone treatment is shown to be effective in reducing risk behaviors and transmission of HIV and other blood borne pathogens, the landscape and trends around drug use is continually shifting. In Hong Kong, there has been an increase of injecting drug use amongst the Nepali diaspora. According to a study by harm reduction researcher Lloyd Belcher, Nepali drug users are often isolated and do not access treatment programs in Hong Kong due to language, cultural and social barriers. Additionally, a growing surge in ketamine use, particularly amongst the youth of Hong Kong, and a number of associated overdoses, as reported in the local media present new challenges. In order to not lose ground on its past successes, and to sustain momentum, there is a need for all stakeholders to start devising ways and strategies to reach these populations.

There is a need to move away from rigid approaches that are based on ideology and ‘morality’, and instead move towards flexible and sensible policies and approaches that are appropriate to changing contexts. It is indeed time for Hong Kong to prove itself again as a leader in responding to the needs of drug users. Contradictory approaches to harm reduction can counteract the overall impact of the successful and renowned Hong Kong Methadone Maintenance Program, whilst streamlined and integrated harm reduction approaches could immensely enhance the current and overall response to drugs, drug use, and HIV in Hong Kong and beyond.

Article on the AHRN website can be viewed here: http://new.ahrn.net/hong-kong-harm-reduction-a-learning-site-with-contradictions

AHRN Secretariat Team

References:

AVERT 2011 Needle Exchange and Harm Reduction’ 

Belcher, L. (2011)  Hepatitis C: Hong Kong 2011’

Belcher, L. (2011)  Mind the Gap: Nepali Drug Users in HK’

Belcher, L. (2012)  ‘Ketamine Use and Societal Reaction’

KH Wong, RLM Ho, STK Yeung, KSW Chan, T Mok, KKW Kwong (2010) ‘The success of methadone treatment programme in protecting Hong Kong from an HIV epidemic among drug users.’ Public Health Epidemiology Bulletin. Apr 2010, pp 10-14.

Lee, SS (2009) ‘Prevalence of Hepatitis C infection in injecting drug users in Hong Kong’ Hong Kong Medical Journal Vol 15, Issue 8 pp45-46

Lee SS (2007) ‘A humble service that has delivered public health good’ Public Health Issue 121 pp 884-886

Narcotics Division, Security Bureau The Government of the Hong Kong Special Administrative Region (2009) CRDA and Drug Statistics

National Centre in HIV Epidemiology and Clinical Research (2009) ‘Return on Investment 2: Evaluating the cost effectiveness of needle and syringe programs in Australia’

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Categories: Article, HK Spotlight

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