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Drug Use and HIV Vulnerability: Policies in Seven Asian Countries wider acceptability because of ethical and moral considerations." These comments seem to suggest once again a sense of discomfort and reluctance among professionals working in the HIV prevention area to embrace harm reduction as an approach to drug use and HIV prevention initiatives. Among the objectives of the draft National AIDS Prevention and Control Policy document is one of seeking "To promote better understanding among people art large, to generate awareness about the nature of its transmission and to adopt safer practices to prevent the disease from spreading." This presumably provides a lead for the provision of explicit harm reduction information and education aimed at all people at risk from drug use. Under a section of HIV and injecting drug use, it is further acknowledged that injecting drug use poses a serious problem for HIV transmission in the northeastern parts of India and in cities such as Mumbai, Chennai, Calcutta and Delhi. It is stated that "the government considers drug-related HIV risk as a serious issue and that it is committed to the adoption of appropriate strategies for preventing the risk of transmission through injecting drug use." As such, it is further acknowledged that harm minimisation is the most appropriate strategy to combat the problem of injecting drug use and its serious consequences of HIV transmission. However, the definition that is adopted does not align with that which is accepted internationally. The draft policy document defines harm minimisation as follows: "Harm minimisation aims to reduce the adverse social, economic consequences and health hazards by minimising or reducing the intake of drugs leading to gradual elimination of their use." The draft policy goes on to state: "Harm minimisation in the context of injecting drug use would require not only appropriate health education improvement in treatment services but in most practical terms, providing bleach powder, syringes and needles for the safety of the individual. An appropriate needle and syringe exchange programme with proper supervision by trained medical doctors and counsellors, will be required. Government will encourage nongovernmental organisations working in drug de-addiction to take up harm minimisation programmes as a part of HIV AIDS control strategy in areas, which have a large number of drug addicts. Greater convergence will be brought about between programmes of non-governmental organisations for drug deaddiction and the hospital de-addiction programmes run by the government." Notwithstanding all of the above mentioned concerns, it is important to acknowledge official sanctioning within the National AIDS Prevention and Control Policy of harm reduction as a philosophy and of needle and syringe exchange in particular, as a harm reduction strategy. On the other hand and zyprexa, for example, zocor muscle weakness.

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3. MATTERS ARISING 3 a ; Flow Chart for Sale of Zocor Heart-Pro in Community Pharmacies Andrew informed the sub-group that Naomi had issued the flow chart for sale of Zocor heart-Pro in Community Pharmacies. ACTION: The sub-group accepted the information. 4. BUDGETARY UPDATE Andrew reported on the full revision to the PPRS agreement between the government and the pharmacy industry on how much the NHS will pay. There is a 7% reduction in the price of prescribing from the current financial year, with a large underspend on practice allocations for this current financial year. The projected underspend is now 1.1M and has been earmarked for use by the PCT for Agenda for Change. ACTION: The sub-group accepted the information. 5. RED AMBER GREEN DRUG LIST NOVEMBER VERSION Andrew informed the sub-group that the updated red amber green list has been circulated. ACTION: The sub-group accepted the information. 6. GUIDELINES FOR CRUSHING TABLETS PRIOR TO ADMINISTRATION Andrew informed the sub-group that he has been requested to put together guidelines for nurses who may be required to crush tablets before administering to patients and presented a comprehensive "Drug Administration Protocol for patients with Swallowing Difficulties" for discussion and approval by the sub-group. The sub-group approved the protocol. ACTION: The sub-group approved the protocol. 1. REVISED INTERIM GUIDANCE ON COX-2 INHIBITORS Andrew reminded the sub-group that Bury Medicines Management Sub-Group produced guidance on Cox-2 selective inhibitors in November 2002 and had intended to review this guidance in June 2004, immediately after an expected update from NICE in May 2004. It now appears that revised guidance from NICE will not be produced until May 2005, or at least until after a review of these drugs, currently underway, has been completed by the European Medicines Evaluation Agency. As considerable quantities of new information have come to light since NICE's first appraisal and in view of the worldwide withdrawal of one of these drugs, we consider an update would be useful. Andrew presented "Recommendation for COX-2 selective NSAIDs ANYcoxib, melocicam, and etodoloc ; : interim guidance" for use on cardiovascular risk. The subgroup discussed and accepted the information. ACTION: The sub-group accepted the information. 2. PATIENT GROUP DIRECTION FOR RATIFICATION: CEFOTAXIME FOR BURY WALK-IN-CENTRES FOR CASES OF SUSPECTED MENINGITIS Andrew presented the Patient Group Direction for Cefotaxime Injection 500mg and 1g for ratification by the sub-group. After an in-depth discussion it was agreed to discuss this item with paediatricians, the Meningitis Trust and request information on a meningoccal protocol policy from the Director of Public Health, Dr Peter Elton. Subsidiary Companies: a. Lekar Healthcare Limited ii ; Associated Concerns Trusts a. Mody Trading Company c. Jyotindra Family Trust e. Shirish Family Trust iii ; Key Management Personnel: a. Mr. Jyotindra B. Mody c. Mr. Shirish B. Mody iv ; Relative of Key Management Personnel: 1. Mr. Pranabh D. Mody 3. Mrs. Kumud D. Mody 5. Mrs. Pallavi B. Mehta 7. Mrs. Priti R. Shah 9. Mr. Nirav S. Mody 11.Mrs. N. R. Mehta 13. Shirish B. Mody - HUF 2. Mrs. Ansuya J. Mody 4. Mrs. Bharati S. Mody 6. Mrs. Purvi U.Asher 8. Mrs. Deepali A. Jasani 10. Mrs. K. V. Gosalia 12. Dinesh B. Mody - HUF b. Mr. Dinesh B. Mody b. Mody Brothers d. Dinesh Family Trust b. J. B. Life Science Overseas Limited and accutane. This research has created an excellent foundation for more specific studies by providing a repeatable methodology for targeted data collection and by establishing a set of results from which to design more specific inquiries, for example, zocor medication.
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Risk-reduction strategies to include in discussions with MSM and WSW, and all sexually active patients, include the following see Primary Care and Sexually Transmitted Infections and Human Immunodeficiency Virus Infections chapters for more information on safer-sex and HIV-specific counselling ; : Avoiding or minimizing unprotected anal, vaginal, oral and anal-oral intercourse; in addition to intercourse, minimize other sexual activities involving exchange of bodily fluids i.e., sharing of sex toys ; , which also carry risk for STI transmission. Ensuring consistent and correct use of condoms for vaginal intercourse and both insertive and receptive anal intercourse. Ensuring use of barrier protection for oral sex. Avoiding or minimizing sexual encounters with multiple and anonymous partners, as well as the use of recreational drugs in conjunction with sex. Regular testing for STIs if engaging in unprotected or risky sexual activity. Negotiating safety in sexual encounters, including disclosure of STI status to partners and learning partners' STI status; it should be noted, however, that serostatus disclosures may or may not be accurate, and that safer-sex practices i.e., condom use or non-penetrative acts ; provide the best protection against STIs in a sexual encounter. Avoiding the use of products containing nonoxynol-9 N-9 ; during intercourse, given the safety and efficacy concerns regarding its use see Primary Care and Sexually Transmitted Infections chapter for more information on N-9 ; . N-9 found on spermicidally lubricated condoms may provide added protection against pregnancy, but it does not effectively protect against infection with HIV or other STIs and may irritate the genital mucosal lining, facilitating their transmission; however, a condom lubricated with N-9 is better than no condom at all. Receiving vaccination for both HBV and HAV; this should be offered to all MSM, given their increased risk of infection67, 68 and poor vaccination coverage; 69 the first dose can be given while waiting for serological test results if performed ; , as immunization is not harmful for previously vaccinated or infected persons see Hepatitis B Virus Infections chapter for more information on HBV vaccination and preimmunization screening ; . * For WSW, undergoing regular cervical screening for dysplasia and or HPV infection. Note: * Preimmunization testing for immunity against HAV should be considered for populations with the potential for higher levels of pre-existing immunity i.e., older Canadians and people from HAV-endemic areas ; . Routine preimmunization serologic screening for HBsAg, anti-HBs or anti-HBc is recommended for people at high risk of having been infected, but is not practical for universal immunization programs.70.
Appendix: Lack of consultation The RIA provides details of consultation it has undertaken for each of the clauses in the Bill it analyses. It notes that the Home Office produced a consultation document on police powers titled `Policing: Modernising Police Powers to meet Community Needs' : homeoffice.gov n story ?item id 1055 ; in August 2004. However, the consultation picture is that emerges is seriously inadequate: Only three elements of the Bill were covered in a Home Office consultancy document, two of which inference from refusal to a search and increased powers to detain drug swallowers ; were relatively uncontroversial, and the other testing on arrest ; presented in brief, missing key details21. A single informal meeting took place at Number 10 between 20 police from ACPO ; and the Prime Minister, Home Secretary and Home Office minister, at which some, but not all, of the more contentious clauses were discussed22. Large sections of the Bill appear to have received no consultation whatsoever. On the ASBOs clause 20 ; the RIA notes that: `No external consultation has been carried out.' p.13 ; . Other clauses do not give any information on any consultation. No details are given as to what the response to this consultation was and no responses are published on the Home Office website. It is also unclear to whom this consultation was sent soliciting replies. Transform believe that these shortcomings breach the cabinet office code of practice on consultation available here: : cabinetoffice.gov regulation docs consultation pdf code and actonel and zocor, for example, zocor danger.
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