Geneva, 9 April 1999 (RFE/RL) -- Epidemics of the HIV virus associated with intravenous drug use often occur quicker than the time it takes to develop appropriate research and interventions. This has led to an increasing interest in the use of rapid assessment methods as a tool to research and plan best-case response scenarios in the shortest possible time.
Experts at the recent International Conference on the Reduction of Drug-Related Harm held in Geneva, Switzerland, said that rapid assessment and response (RAR) is needed most in Central and Eastern Europe. There, in the wake of the collapse of communism, both the incidence of AIDS [Acquired Immunity Deficiency Syndrome] and the number of drug users are on the rise.
Tim Rhodes of the Center for Research on Drugs and Health at London's Imperial College says there is a long history of rapid assessment and response efforts to develop interventions in a variety of fields, including malaria, cholera and even suicide. From that experience, Rhodes says, experts have learned some valuable lessons:
"First of all, we need to look at risk situations and environments and not just individuals. We need to look at not only behaviors but their meanings and the context in which they occur. Secondly, we need to think about how action-oriented research can involve the community at the outset and see assessment as part of the community response. And thirdly, we need to think about social and environmental change."
Rhodes also said that with the current ability to predict environments conducive to the spread of HIV, for instance, experts should be able to help prevent infection. But he emphasized that it is important to remember that local health problems demand local solutions.
Romania was one of the first of the former communist states to initiate a rapid assessment and response program among its intravenous drug users. A 1998 study was initiated and supported by, among others, UNICEF [the United Nations International Children's Emergency Fund] and the UN's AIDS agency, known as UNAIDS. Gabriela Paleru oversaw the effort. She said it targeted drug users in Bucharest, Constanta, Lasi and Timisoara. It also surveyed prison officials, medical personnel and people working in bars, discos and casinos with whom the users might have come into contact.
Paleru said that little official, reliable data could be found but that headway on the overall nature of the problem in Romania was made by searching the records of treatment centers, emergency rooms and toxicology centers. At the Geneva meeting, she detailed her initial results and assessments before fellow harm-reduction colleagues who are anticipating -- or already carrying out -- similar RAR efforts of their own.
"As conclusions, the main drug used in Bucharest is heroin. The level of treatment demand by injecting drug users is more important in Bucharest than in the other three cities. There is a lot of risk behavior among IV [intravenous] drug users, even though the number of HIV and AIDS cases is not so big yet. But this risk behavior might be a warning and a danger for them. All these results are only the tip of the iceberg." Paleru also said that she hopes policy-makers will take the data to heart when they begin formulating HIV, AIDS and drug policy in Romania. She hopes, too, that Romania's lessons can be applied to neighboring Bulgaria, Moldova and Hungary.
Paleru was joined on the panel by Pavel Bem, who until recently headed the Czech Republic's National Drug Commission for four years. Bem, a newly elected mayor of a large Prague district, was intimately involved in designing a new national drugs policy for the Czech Republic.
As one of the few in the region to have successfully overcome a lack of data in formulating a policy, Bem was able to pinpoint problems with past policy making:
"Policy has been designed without being in any contact with the ground --with reality. It was an air castle and really it didn't work well.... I find something which I see now from the perspective of four or five years of experience -- and I see that in many other countries in Central and Eastern Europe. I find sort of typical problems in policy planning -- the lack of general political support. Drugs are not the issue. There is economics, health, social welfare, but not drugs. There were very emotional attitudes among policy makers. You would hear long speeches about the dangers of drugs but only emotional speeches. At the end, there was just the appeal, 'We have to forbid.' There was limited impact of pressure groups and a minimal role of service users or clients, who were not at all involved in the formulation of drugs policy. And the most important, there was an absolute lack of reliable data."
Bem declared that four years later most of these problems are no longer very important. He said that the Czech Republic now has a drugs policy that is not only pragmatic and effective but affordable.
"Compared to sophisticated general population surveys, it (RAR) costs nothing. It was also quick, and we were under the pressure of time and so we needed a quick response to the situation. It was action-oriented and intervention-oriented and in fact involved many professionals who later on became a part of the intervention. And extremely important is the process of that as they have become involved in data collection and have their own personal interests in planning and even implementing the intervention."
Our correspondent notes that there is a smaller school of thought in the harm-reduction community which argues that RAR efforts can sometimes sacrifice validity. These practitioners argue that the best research is not necessarily the quickest.
Still, whatever the approach, most agree that the problem of HIV, AIDS and drug use is a major one in Central and Eastern Europe --and that there is no time to waste.
(This is the fourth in a series of five features by Lisa McAdams focusing on the global fight against drug-related medical harm. McAdams attended a harm-reduction conference late last month in Geneva. In the fifth and final piece in a series on drug-related harm our correspondent will examine the social implications of drug use.)