For most drug users and people who work with them, overdose is an urgent issue. Many AIDS, harm reduction, and other drug service organizations have created programs to educate people who use drugs about overdose prevention and response techniques; to distribute naloxone - a safe and highly effective opioid overdose antidote. This document presents arguments that organizations can make to AIDS funders to show that overdose prevention and response matter for HIV programming. Download the document here.

在大多数地方，参与药物服务的人很清楚过量是一个事关重大的问题。从事艾滋病、伤害减低和其他药物服务的许多组织已创建了项目，以便：向吸毒者提供过量预防和应对技巧的教育；发放纳洛酮----这是一种包含在《世界卫生组织基本药品示范清单》中，安全高效的鸦片类药物过量的解药；并且记录过量的普遍程度和应对措施的成效。过量预防对HIV/艾滋病的项目为什么重要，本文作了概括性的评述。在这里下载文件。

At the Vienna conference, thousands took to the streets to call for human rights to be integrated into AIDS policies and programs. They gathered in the Heldenplatz, a historic square in front of the Austrian Parliament building, to cheer the heads of UNAIDS, the Global Fund, and international AIDS activists such as Mark Heywood (马克-西伍德), and to dance and sing with pop singer Annie Lennox.

While thousands marched and cheered, Viennese police stood on the sidelines and watched, calmly. A few officers even danced to the music. Some Chinese NGO colleagues expressed amazement at the sight - but in fact, public protest is part of the venerable tradition of the International AIDS Conference - even of the global AIDS movement.

In the early years of the HIV/AIDS epidemic, when some commentators called it "the gay plague", Western government leaders refused to even mention the epidemic in public. There was no funding for research, and no meeting to bring scientists and experts together at an International AIDS Conference. These things came into existence because AIDS activists in many countries staged protests demanding government funding for AIDS research. Their protests and demands eventually led to the creation of the Global Fund, national AIDS programs, and the International AIDS Conference.

At the AIDS Conference in Durban, South Africa in 2000, AIDS activists staged massive protests to demand funding for treatment. The existence of government and non-profit organizations providing ARVs to 5.2 million people living with HIV/AIDS today is a direct result of the Durban protests.

This year, guidelines for speakers at the AIDS conference informed us that protests are a respected part of the conference, nothing to get upset about. And indeed there were daily protests by activists to demand increased funding for the Global Fund, decriminalization of sex work, and to "zap" (that is, interrupt the presentations of) speakers who represented countries that activists feel have not done enough to address HIV/AIDS. Some protests were carefully planned in advance, while others were more spontaneous. Often the protests crossed national, gender and identity lines to bring diverse activists together. In many cases, the disruption only took place long enough to make a point, and the conference program then continued as planned.

Many aspects of the AIDS movement that we now take for granted (such as the conference itself) came about because of the work of AIDS activists in the past. That's why we were proud to join with colleagues from Asia, Africa, Europe, and Latin America to call for human rights as part of the world's response to HIV/AIDS - now more than ever.

抗议：艾滋病大会上的光荣传统

在维也纳的会议期间，成千上万的人上街集会，要求把人权列入到艾滋病的各项政策和项目中去。集会的地点是位于奥地利国会大楼前的英雄广场，一个具有历史意义的地方。人们相聚一起，为联合国艾滋病规划署署长、全球基金会会长和国际艾滋病活动家如马克·西伍德欢呼，和流行歌手安妮·列克斯一起载歌载舞。

当这数千人在街上游行、欢呼时，维也纳的警方也站在路旁，冷静观望，有些警员甚至和音乐一起起舞，一些中国的非政府成员表达了他们对这一情景的惊奇感。事实上，当众抗议是国际艾滋病大会甚至是全球艾滋病运动优良传统的一部分。

在艾滋病流行早期，一些评论家称该病为"同性恋者的瘟疫"，西方政府首脑甚至拒绝在公共场所提起该疾病。没有任何的资金可以用于研究，也没有一个国际性的会议将科学家和专家聚到一起讨论。正是由于艾滋病活动家在许多国家发起抗议，要求政府提供资金用于艾滋病研究，现在这一切才形成。艾滋病活动家的抗议和要求最终促成了国际基金组织、国家艾滋病项目以及国际艾滋病大会的产生。

2000年在南非德班召开的国际艾滋病大会上，艾滋病活动家发起了大规模的抗议，要求提供资金用于治疗，现在，由政府和非盈利组织向520万艾滋病患者提供抗逆转录治疗就是德班抗议的直接成果。

今年，艾滋病大会发言者告知大众，抗议，是大会一个令人尊重的一部分，我们没有必要为此而感到沮丧。实际上，每天都有活动家发起抗议，要求增加对国际基金会的资金支持，对性工作的除罪化，并且他们会打断那些被认为为艾滋病做得还不够多的发言者的发言。有些抗议是经过事先仔细计划的，其他更多的是自发性的。这些抗议通常跨越国家、性别和身份的界限，将不同的活动家聚集在一起。在许多情况下，打断只持续能够说清一个方面观点的时间，然后大会按计划继续进行。

艾滋病运动的许多方面，如国际艾滋病大会等，我们现在认为理所当然，但他们是过去活动家们的工作成果。这也是我们会和来自亚洲、非洲、欧洲、拉丁美洲的同胞联合起来，一起呼吁将人权列入回应艾滋病的一部分，并为此而感到骄傲的原因，现在更是如此！

For a People's Revolution to be successful, it needs the support of the people.  Nepal's Maoists are learning this lesson the hard way.  Just weeks after calling off an embarrassing week-long strike (locally known as a bandh) that shut down Kathmandu but failed to achieve their demands, the Maoists now face an identity crisis and broad public dismay.  Where they counted on popular support to ensure a successful strike, they instead found increasing frustration and anger among the people whose lives they brought to a screeching halt with blockades of men and women with bamboo sticks. 

For the Maoists, such responses are a new phenomenon.  For years their broad public support meant they could utilize drastic tactics like frequent strikes, kidnappings, and "taxes" from trekkers and merchants with impunity.  Their platform, after all, appeared to conform well to a modern understanding of democratic government.  In 1996, they began a civil war demanding that an elected constituent assembly replace the monarchy as Nepal's governing body.  Ten years later, the monarchy fell and constituent assembly elections soon began.  By 2008, the Unified Communist Party of Nepal-Maoist (UCPN-M) occupied more seats than any other party.[1] 

The Maoists' rise can be attributed to many factors, but chief among them is their popularity with the rural poor.  Either through propaganda, threats, or genuine good works, they succeeded in convincing many people--particularly in the southern Terai--that the monarchy would never serve their best interests, that no matter how hard they worked they would never be allowed to get ahead by the monarchist rulers.  Millions believed the promises and joined the ranks. 

Capitalizing on the rural youth's lack of opportunities and angst, the Maoists established the Young Communist League (YCL) in 2006.  The YCL's exact role is unclear, but many believe it is a para-military organization whose cadets have been trained in unarmed combat but also regularly carry knives, iron bars, and other weapons.[2]  In any case, the potential violent power of an estimated 500,000 motivated young men and women has worried everyone from the Prime Minister and UN Ambassador down.[3] 

The most recent strike, which began with a May Day rally in Kathmandu, drew tens of thousands of Maoists and supporters from outside the valley.[4]  With the May 28 deadline for the new Constitution drawing ever nearer, the Maoists sensed the time was right to exert pressure on the government and the citizenry at large.  They had been attempting to return to power ever since their leader, Pushpa Kamal Dahal (also known as Prachanda), stepped down as Prime Minister over a disagreement with the Army chief over integrating Maoist forces into the Nepali Army.  They believe that since they control the largest number of seats in the CA, the people have granted them a mandate to lead. 

Yet the people may well have revoked any such mandate given the behavior they witnessed during the strike.  Although the strike was not particularly violent, its level of disruption was extreme.  Transportation was blocked, forcing people to walk anywhere in the five square kilometer valley they needed to go.  Schools were closed, leaving millions of children without educational instruction.  Businesses were shuttered by their proprietors for fear of vandalism and physical beatings.  A severe shortage of food and medicine arose when the Maoists prevented supplies from being trucked into the valley, causing prices to soar.   

On the sixth day, tens of thousands of anti-Maoist protestors from all walks of life converged on the capital to seek an end to the strike and return to their daily lives and livelihoods.  The "peace protestors" took numerous digs at the Maoists in their speeches, even declaring that the Maoists were keeping 28 million Nepalese people hostage.[5]  The widespread disgust and disgruntlement must have resonated with the Maoists, who ended the bandh within 48 hours.  Realizing so many individuals were against them was a sobering experience.  Since then, despite continued threats of more disruption, the Maoists have not acted and instead have attempted to play by the rules and follow the parliamentary process. 

Today, mentioning the Maoists to a Nepalese is unlikely to earn you a favorable response.  Business owners will recount lost profits from the numerous strikes and being solicited for "taxes" by party leaders.  Parents will express anger at the loss of education for their children and the unsafe environment of the protests and strikes.  Soldiers will recount the long Civil War and the losses they faced.  Intellectuals will lament the negative way the Maoists cause Nepal to be viewed by the rest of the world. 

When a group breaks the trust of so many so quickly, failing to deliver its promises and in fact making life worse for its citizenry, no more favorable reception should be expected.  Having lost the clout to flout the laws as they had done for years, they may now be faced to permanently play by the rules.  Nepal waits to see if that is for better or for worse. 

人民革命若要成功需要人民的支持。尼泊尔的毛派正艰难地吸取这一教训。他们刚刚停止了一场尴尬的罢工活动。这次罢工持续一周，让加德满都陷入停滞，但是却没有达到他们的目的。现在，仅仅几个星期后，毛派正面临一场身份危机和广泛的公众质疑。在那些他们赖以获得公众支持以确保罢工胜利的地方，他们看到的却的是一群充满失望和愤怒的人。这些人的生活因为他们嘎然而止，现在正拿着竹棍面朝着他们。

对毛派来说，这种反应前所未有。多年来，他们获得了大众的广泛支持，意味着他们能够使用极端的手段，如频繁罢工、绑架和肆意向徒步者和商人"收税"。毕竟，他们的纲领与人们对民主政府的理解非常一致。1996年，他们发动内战，要求选举成立制宪国会，取代君主制成为尼泊尔的执政体。10年后，君主制崩塌，制宪国会选举很快启动。到2008年，尼泊尔联合共产党（毛派）占据的席位比其他任何政党都多。

毛派的成功可以归功于许多因素，但是其中主要是他们受到贫困农民的欢迎。他们通过宣传、威胁，或者确确实实做好事等方式成功地说服了许多人----特别是南部的特莱人（Terai）----即，君主制永远不会让他们获得最大利益，无论他们如何努力工作，君主制统治者们永远不会让他们走在前面。上百万人相信了这些话，加入了他们的行列。

利用农村年轻人缺乏机会和他们的焦虑，毛派于2006年成立了共青团（YCL）。共青团的确切角色并不清楚，但是很多人认为这是一个半军事化组织。团员们进行非武装冲突训练，经常携带刀具、铁棒和其他武器。无论如何，有50万受到激励的年轻人加入暴力冲突的可能性还是让从总理到联合国大使等所有人感到担忧。

最近的这次罢工，是起始于五一劳动节在加德满都的一次游行，数万毛派分子和支持者从峡谷外来到这里。随着新宪法5月28日的截止日期逐渐临近，毛派意识到这是对政府和所有公民施加压力的好时机。他们的领袖普士巴·卡马尔·达哈尔（被称呼为普拉禅达）曾经试图让毛派力量进入尼泊尔军队，但遭到军方高层拒绝，此后他从首相职位离开，而现在他们试图重新掌权。他们相信，一旦他们能够掌握制宪国会大多数席位，人民会授予他们领导的权力。

但是，在目击他们在罢工中的表现后，人民很有可能取消这种授权。虽然罢工并不是特别暴力，但分裂瓦解的程度非常高。交通运输被中断，在这个面积达5平方公里的峡谷中，任何人要外出都只能步行。学校被关闭，上百万儿童无法接受教育。商业活动陷于停顿，店主们害怕自己的财物受到损失，自己受到殴打。食品和药品依靠卡车运输进入峡谷，但毛派阻碍了补给，造成食品和药品极度短缺，导致价格飙升。

在罢工的第六天，来自各行各业的数万反对毛派的抗议者在首都聚集，要求中止罢工并回归正常的生活。这些"和平抗议者"在他们的演讲中百般挖苦毛派，甚至声称毛派把2800万尼泊尔人民当成了人质。大范围的反感和不满引起了毛派的反应，他们在48小时内结束了罢工。认识到很多人反对他们的这一事实能够让他们清醒一些。在此之后，尽管毛派继续威胁要进一步分裂，但是他们没有行动，反而试图按照规则来操作并且遵循议会程序。

现在，如果对一个尼泊尔人提到毛派，你很难获得正面的评价。企业主将计算他们在不计其数的罢工中损失的利润，以及被党领袖征收的"税"。家长们对孩子失去教育表示愤怒，并且担忧抗议和罢工造成了不安全的环境。军人将计算他们面临的内战将造成的损失。知识分子会对毛派在国际上造成的负面影响表示悲伤。

当一个群体快速且大量了破坏了别人对自己的信任，未能实现自己的承诺，并且事实上使公民的生活变得更糟糕时，他们将不会再获得预期中的友好接待。毛派失去了他们在过去几年中得以藐视法律的势力，现在可能面临长期按规矩办事的局面。这是一件好事还是坏事，尼泊尔拭目以待。

Research for Sex Work is seeking contributors for its next issue, which will be on the topic of violence against sex workers. This edition will be bilingual: English/Russian. It will be distributed around the International Day to End Violence Against Sex Workers (17 December 2010). Research for Sex Work is published by the Global Network of Sex Work Projects (NSWP).

Theme: Addressing violence against sex workers
Deadline for submissions: 1 August 2010
Deadline for abstracts/ideas: 25 June 2010
Word limit: 1200
Submission languages: English, French, Spanish, Russian and Chinese

Research for Sex Work especially welcomes contributions from sex workers (groups) from all over the world. Please be so kind to circulate the attached call for papers widely in your network. You can also download it from the NSWP website: www.nswp.org.

Human Rights Watch

This month, nearly 600 addicts broke out of a rehabilitation center in the northern Vietnamese city of Haiphong. The addicts overpowered guards at the state-run treatment facility and made a break for it. "We were complete overwhelmed," a security guard told the Associated Press. "Forty of us were not able to prevent them, many with canes and bricks, from escaping."

Why were hundreds of patients fleeing treatment? Because in Vietnam, "treatment" looks a lot more like forced labor, complete with beatings and years of involuntary detention. Like neighboring Cambodia, China, Laos, Malaysia, and Thailand, the government of Vietnam has adopted a "get-tough" approach to drug treatment rather than evidence-based treatment. In Vietnam, more than 100 government-run facilities detain between 35,000 to 45,000 people for extrajudicial sentences of up to four years.

Vietnamese in these treatment centers are engaged in what the government calls "therapeutic labor": long hours at menial jobs for below-market wages -- whatever's left, that is, after the centers deduct for the cost of their meager food and Spartan lodging. Those who fail to meet work quotas are beaten. Patients who violate center rules can be locked in solitary confinement. "[T]hey beat people up, kicked the face, kicked the chest," a former resident of a rehab center near Hanoi told the BBC in 2008. "Later, people were made to work very hard. They said work to forget the addiction, work is therapeutic."

Opium cultivation and smoking are not new phenomena in Vietnam. But with economic liberalization and increased migration since the 1980s has come greater economic polarization and drug abuse. It is estimated that there are more than 100,000 injecting drug users in the country today, and nearly one in three is HIV infected.

Drug treatment hasn't kept pace with increasing abuse, and aside from some small-scale programs, allowed by the government but largely funded by other donors, effective treatment is virtually nonexistent. Instead, the government emphasizes compulsory, institutionalized treatment that isn't just inhumane, but also next to useless. Government reports have said that 70 to 80 percent of those who spend time in a center return to drug use. Other estimates put the rate closer to 90 percent -- and when drug users do relapse, they have no place to go, especially not to a compulsory "treatment" center.

In fact, Haiphong's escapees probably stand a better chance on the outside, if they can stay there: The city is one of three in Vietnam that is piloting the use of methadone to manage opiate addiction, the preferred approach in most developed countries. Indeed, trials of methadone maintenance therapy were already successfully conducted in Hanoi in the mid-1990s. So why not increase the number of slots in the Haiphong methadone clinic and offer the escapees voluntary enrollment? The U.S. government could help ensure that those who escaped can access services by redirecting its funding, which currently goes to HIV-treatment programs inside these abusive centers (though not the centers themselves), to programs based in the community.

Indeed, were Haiphong to expand access to the community-based drug treatment services it already offers and add counseling, employment prospects, and housing assistance, the city could become a model of humane and sustainable treatment. Those who were only occasional drug users -- and who don't need drug addiction treatment in the first place -- are more likely to find meaningful work and social support networks in the community to avoid becoming addicted. Serious addicts and casual users alike are likely to find better HIV prevention programs and services in the community.

Drug rehabilitation should provide drug users with a chance to regain control of their lives, repair broken relationships, and overcome destructive addictions. Rehab in Vietnam ruptures the lives of drug users, severs social support, and pretty much guarantees a return to drug use after years of abuse. No wonder drug users are escaping.

Recently, Indonesia's health services have begun to scale up the implementation of harm reduction in Surabaya. From a positive standpoint, government support for this program is improving, though there are down sides as well.

Broadly speaking, public health services are improving health care provision for injecting drug users. Both service providers and program implementers are increasingly integrating their efforts in HIV prevention programs. At the same time, implementation has not yet included integrating law enforcement agencies and the general community, let alone improving drug policy. As a result, we can expect to see problems emerging in the future that will affect the overall implementation of harm reduction programs. In addition, the lack of active involvement by civil society through the coordination of the National AIDS Commission, and the lack of advocacy clout at relevant agencies, will make it difficult to improve relevant policies.

Other policies will create obstacles for full implementation of the harm reduction program. For one, beneficiaries must pay a fee every time they access these services, including syringe services. Although the nominal cost is pretty small (Rp 2,500, or US25 cents) this still has a big effect, considering that the drug user community has received free harm reduction services from civil society for so long. These fees are also not comparable with HIV programs, which are free of charge.

Meanwhile, there are some logistical problems relating to syringe distribution. The needles being distributed need to be assessed by the government in order to make sure that they actually meet the community's needs. Also, the provincial and city health department has not set a limit or quota for services in each unit that provides Methadone Maintenance Therapy. In order to encourage patients to use public health services, hospitals have continued to accept patients without providing recommendations for referral services to satellite agencies. Some agencies are therefore overrun with patients who could be accessing services in other parts of town, and this will affect the quality of service patients can receive.

MMT services are also not yet complete. For example, during the intake process, until recently health services have not provided urine tests. Urine tests are standard in the provision of MMT, as a way to identify whether or not patients are still injecting drugs. In addition, clinics that offer MMT are not yet providing psychological counseling or consultation rooms. This shortcoming combines with the infrastructure of MMT clinics to make these spaces unfriendly to patients. Some service rooms seem like prisons, heightening the feeling IDU patients have that they are receiving a lower standard of care than are other patients.

In sum, it is essential that the evaluation of health care for injection drug users in this government program be conducted with full involvement by the beneficiaries, who can help to provide a balanced view. These views should be solicited and collected not only through research, surveys and other metrics that evaluate aid projects, but should involve the stakeholders directly expressing their views at all levels of the program.

The perspectives of program beneficiaries (in this case, injecting drug users) are important to the sustainability of HIV prevention, and important in helping to target those programs effectively. Bringing in the perspectives of program beneficiaries helps to create a fair process - rather than positioning program beneficiaries as commodities or objects of assistance by a government program.

Rudhy Sinyo is General Coordinator of East Java Action, www.eastjavaaction.org. 

印尼的公共卫生部门近日起开始在东爪哇省泗水市普及减害工作。从积极的角度而言，政府支持将有利于减害工作的开展。当然，这项活动还有很多不足之处。

大体看来，公共卫生部门的介入将有利于改善针对注射吸毒人员的保健服务。无论是医疗服务的提供方还是项目的执行者，都致力于将减害项目逐步纳入艾滋病预防项目中。然而，与此同时，项目执行者还未能有效地与执法机关和社会各界合作，也没有从政策层面改善当前的针对吸毒人员的社会政策。因此，未来出现的一些问题很可能影响减害活动的总体实施。另外，减害项目执行方未能与全国艾滋病委员会合作，因此难以调动民间的社会力量的积极参与，也缺乏针对各个相关机构的沟通和宣传，这很可能造成未来其他相关和辅助政策的出台不利于减害项目的实施。

其他政策对于减害项目的实施造成阻碍。比如，吸毒人员每次接受针筒交换等服务时必须支付费用。尽管这些费用只是象征性的小额收费（每次大约2500卢比，约25美分），但是价格杠杆还是会有很大的影响，因为民间社会长久以来通过慈善机构等向吸毒人员提供的减害服务都是免费的。并且，其他艾滋病防治服务也是免费的。

与此同时，在物流方面，注射器的分发过程中也存在着一些问题。所使用的针头必须经过政府检查，以确保这些针头符合吸毒人员的特别需要。此外，省市级公共卫生部门并未对提供美沙酮治疗项目的医疗机构设置配额。很多医院为了鼓励病人使用公共医疗服务，大量接收病人，却又不将他们转到其他分支医疗机构，导致一些病人不能就近就医，在一定程度上影响了病人获得的医疗服务质量。

一些医院提供的美沙酮治疗也很不完善。比如，很多医院直到最近还未能在收治病人的第一时间提供尿液测试。尿液测试是美沙酮治疗的标准项目之一，因为医院需要确定患者是否仍在使用注射毒品。另外，很多提供美沙酮治疗的诊所尚未提供心理辅导或专门的咨询室。这些诊所的疏漏加上基础设施的不完善使得整个医疗环境不够理想。有些诊室看起来更像监狱，这使得注射吸毒人员感觉他们低人一等，因而所获得的医疗服务不如其他患者。

总而言之，在评估政府向注射吸毒人员所提供的医疗服务的过程中，始终邀请吸毒人员全程参与是十分重要的，因为他们是这些项目的受益人，他们能从自身角度出发，为这些项目的完善提供更为全面的参考意见。征求意见的方法除了传统的调研、问卷调查等其他社会项目评估方法之外，还应该直接地请项目受益人对项目的方方面面进行评论、直抒己见。

项目受益人的观点对于艾滋病预防项目的可持续性极其重要，因为他们可以帮助这些项目制定更有效的目标。同时，听取项目受益人的意见使得他们不再被视为商品或者仅仅是政府援助的对象，有益于创造一个公平的项目优化过程。

Rudhy Sinyo是东爪哇行动组（www.eastjavaaction.org）的总协调员。