HaRdCOREhARMREdUCER: People Who Drugs Living With and Affected by HIV; Key Policy and Service Advocacy Issues

World Aids Conference 2008

People Who Drugs - Living with and Affected by HIV

Key Advocacy Statements

The key advocacy messages were drafted by a group of DU-Activists during the HIV+ DU affiliated event on Saturday August 2, 2008.

A core group of DU-Activists (Erin O'Mara (UK), Prem Limbu (Nepal), Jason Farrell (USA) and Stijn Goossens (Belgium) edited the draft statements and wrote accompanying background paragraphs per key advocacy issue.

Policy

Allocation of resources proportionate to incidence of drug use, prevalence and vulnerability to HIV

Removal of legal and policy barriers that limit access to quality harm reduction and HIV treatment, prevention and care services

Greater involvement of people who use drugs at all levels and stages of HIV and drug policy design and implementation

Services

Universal review of national practices and the implementation of standards in the field of substance use and HIV related services

To prioritize the needs of HIV+ women who use drugs

The need to broaden and develop comprehensive and inclusive services that consider the changes in modalities in current drug using behaviors and drug culture

To make accessible best practice health and harm reduction services within prisons and detention facilities including HIV prevention and treatment

People Who Drugs - Living with and Affected by HIV

World Aids Conference 2008

Key Statements

On Policy:

“Allocation of resources must be proportionate to incidence of drug use, prevalence and vulnerability to HIV ”

There is a serious misallocation of resources: according to UNAIDS, less than 0.5% of the USD 8.1 billion earmarked for the global AIDS response in 2006 was invested in harm reduction. Considering that 30% of new HIV cases are detected among injecting drug users outside Sub-Sahara Africa, there is a clear imbalance in resource allocation that must be urgently addressed in order to curb HIV transmission. In addition, overwhelming evidence indicates that harm reduction programmes are effective, safe and cost-effective and yet those programmes are underfunded, under-supported and often marginalized among the donor community. Ignoring people who use drugs and denying them services will lead to negative consequences and Universal Access goals and the Millennium Development Goals are unlikely to be met.

Removal of legal and policy barriers that limit access to quality harm reduction and HIV treatment, prevention and care services

We understand that the UN Secretary General has already noted in his addresses this year a need for the removal of policy barriers to effective prevention, treatment and care for people who use drugs and we are extremely grateful for this support. Yet more must be done. Policy harmonization within national governments must be a priority – too often drug control policies are in direct conflict with both harm reduction and HIV policies and commitments made on HIV are not taken into consideration when drug control legislation and policies are developed. Law enforcement continues to be a major barrier to the implementation of services in almost all nation states.

3) Greater involvement of people who use drugs at all levels and stages of HIV and drug policy design and implementation

Today, people who use drugs now represent a significant proportion of the people who contract HIV/HCV yet their involvement in public health campaigns and substance related services are minimal. Just like the GIPA principles tell us, the global response to HIV and drugs must include people who use drugs and provide safe spaces for their meaningful involvement and participation. Yet drug users are generally left out of discussions and are not consulted on the policies that directly affect their lives and livelihoods. Furthermore, governments and community based HIV/AIDS organizations CANNOT claim they involve HIV positive people in their work on HIV/AIDS without actively and meaningfully involving drug users living with HIV in all levels of policy making and service design. This includes service development, provision, implementation, monitoring and the evaluation of a nation’s drug and HIV services. We urge nations to abide by the UN AIDS publications which note that the participation of people living with, and vulnerable to, HIV – which includes drug users – in programme and decision making is a matter not just for human rights and ethics but of ‘best practice’ for effective programmes.It is therefore essential that UN agencies and all stakeholders demonstrate leadership in terms of involving people who use drugs and acknowledge their role as key stakeholders in the global fight against HIV/AIDSs

On Services

Universal review of national practices and the implementation of standards in the field of drug treatment.

Too many governments have not taken drug treatment obligations seriously as a matter of a right to health. There are an alarming number of abuses and human rights violations occurring in the name of drug treatment, often affecting the most vulnerable, in particular those who are doubly stigmatized through drug use and HIV\HCV infection.

Therefore we urge UNAIDs/WHO to commission a global review of national practices and standards in the field of addiction treatment and drug\alcohol services, with an additional focus on the HIV positive drug using population. This must be part of a process to develop a universal human rights based set of standards and requirements for drug services and treatment programmes - as well as the establishment of mechanisms for monitoring the compliance of nation states. In addition, we would urge UN/WHO/ UNDOC when developing these standards to identify what is NOT considered acceptable or ethical as drug treatment

We support the evidence which states that the most effective substance related services are-

Non discriminatory, esp accessible to the most vulnerable, accounting for gender based needs
Of good quality ‘scientifically and medically appropriate’
Culturally acceptable and ethically sound
Physically accessible to all
Affordable and reachable by those who are geographically, legally or socially marginalized.
Employing and training former and current drug users as peer/social educators and professionals and accepted as an essential component to delivering quality drug services in recognition of their experience and specialist insight into drug issues.
User friendly: Physicians and health care professionals are appropriately trained to treat and care for drug users and prescribe and monitor ARTs.

The needs of HIV positive women who use drugs are effectively prioritized

Not enough has been done to address the poverty, subordination, violence and human rights abuses that drive the HIV epidemic among women who use drugs and compound its impact upon them. Today with the rates of HIV increasing faster for women, ignorance within societal attitudes has ensured that positive women who use drugs often become vessels for a great deal of society’s fears and judgments. The stigma that surrounds women drug users and HIV often has its roots in old ideas of promiscuity, used women, diseased, sick women, and infectious mothers. This is often closely associated with drug treatment services being denied outright to women in some countries while many other nations maintain legal or cultural barriers to women accessing the care, support and treatment they need.

We demand that the needs of HIV positive women who use drugs be given the urgent political attention it requires and is prioritized as an issue due to the alarming human rights violations and vast global inequalities in health and social care faced by positive women who use drugs or need access to drug/alcohol services. We call for the design, development, implementation and expansion of women specific drug services – run by women for women. Such services must take into account a woman’s role in her community and family, and appropriate consideration given to a safe and supportive environment for both herself and her children when necessary.

The need to broaden and develop comprehensive and inclusive services that consider the changes in modalities in current drug using behaviors and drug culture.

The unanimous 2001 UN General assembly Declaration on HIV/AIDs recognizes the right of people who use drugs to a broad range of HIV/AIDs prevention and treatment services. In 2005 buprenorphine and methadone were added to the list of essential medicines as defined under the WHO Action Programme on Essential Medicines (Geneva 2007 Section 24.5). While clearly a positive step, the field of drug treatment and prevention has been slow to broaden and develop drug services that engage and reflect the diverse and changing modalities of drug use. The current narrow focus on injection drug users is preventing millions of other people who use drugs from accessing HIV prevention, treatment and/or testing and further harm reduction messages. The exclusion of the drug using community in developing and strengthening more innovative and responsive drug services and HR messages that accurately reflect the rapidly changing face of drug use across the globe is neglecting the health and human rights of a large majority of the illicit drug using population.

We urge the UN and its nation states to act now and design, upscale and broaden drug services to include and address the needs of stimulant users and the smokers of illicit drugs (such as crack, methamphetamine, heroin) who are still vulnerable to blood-borne virus infections and those who may be considered ‘recreational drug users’, yet whose drug use can escalate. More often than not such individuals are not exposed to the usual harm reduction messages or knowledge of drug services and support until the harm has occurred.

To make accessible best practice health and harm reduction services within prisons and detention facilities including HIV prevention and treatment

The criminalization of drug use and thus drug users has meant millions of people who use drugs are being incarcerated and detained in prisons and juvenile facilities around the world, often without due process. The levels of people with drug problems constitute in some cases, between 30-70% of prison populations – many with extremely high rates of HIV and Hepatitis C infection. However, most prison systems have no drug treatment facilities, harm reduction information, or services, adequate detox or methadone maintenance treatment. HIV positive drug users are at particular risk of illness, infection and death due to exposure to stigma, violence (sexual or otherwise) unsanitary conditions and lack of access to ARVs and medicines to treat OI’s.

While the use of harm reduction strategies such as condoms and access to sterile injecting equipment is endorsed by WHO (WHO Policy Brief: Reduction of HIV Transmission in Prisons, May 2004), the reality is that the vast majority of world prisons specifically prohibit such measures, preferring to ignore the reality of drug use, sexual behavior and sexual violence. We recommend the urgent adoption of a minimum set of standards and requirements for prisons and detention facilities to support the implementation best practice, quality health and harm reduction procedures for drug users and those infected and affected by HIV and HCV.