Injecting drug use IDU

Most people in the capital city of Belarus become infected with HIV from injecting drugs. As a result, a nongovernmental organization in Minsk and the government have responded with HIV mobile testing clinics, drop-in centres and peer counselling to establish trust with people who often shy away from official health services.

Last year, more than 10 000 people visited the three mobile clinics positioned around the city of Minsk offering HIV testing, care and support services. Of 4000 people tested who inject drugs, more than 500 tested positive for HIV.

Word-of-mouth lets people know the mobile clinics are parked up. Positive Movement, the Minsk-based nongovernmental organization that operates the clinics, also lists their locations on its website. In the van-sized clinics you can get an HIV test, talk to a doctor or simply drink tea and chat with peer counsellors.

Positive Movement staff members have first-hand knowledge of issues affecting their clients. Of the 200 employees working there, more than three quarters have been affected by drug use and/or HIV.

“At first, employees were clients, now they are board members,” says Irina Statkevich, the head of Positive Movement’s board. “We believe that harm reduction works and that we can defeat HIV infection,” she says. "If we decide that this service is needed by our customers, we will do everything to get it!”

Above, Positive Movement’s office

Eight years ago, when she started working at the organization, she explains that it was impossible to utter the words needle and syringe exchange programme. “We had to do things incognito.”

Now they have drop-in centres open all day that not only provide clean needles and syringes but also food, HIV testing and a place to wash as well as legal and medical counselling.  Peer-to-peer consultant Julia Stoke likens the centres to safe-havens.

Above, Julia Stoke, peer consultant in Drop-in centre

“This is an island of security,” she says. “A person who uses drugs has a need for safety first, then trust, and then a range of services."

Vyacheslav Samarin agrees. As a social worker at one of the drop-in centres, he explains that people who use drugs often face difficult situations like a loss of housing, a lack of documents, poor health and sometimes nothing to eat and nowhere to sleep. “In many cases,” Mr. Samarin says, “One problem often leads to another.”

Above, Vyacheslav Samarin, a social worker at a drop-in centre in Minsk

“Many are in denial about their health,” he continues. Many clients fear stigma and have different priorities. He says it’s key to support people and not let them feel defeated and abandoned.

“At the very beginning, people do not want to believe their diagnosis, so we are careful to talk to them about starting treatment,” says the red-haired social worker.

Over the years he has noticed changes. "Today there are more treatment methods and the staff listen much more to people living with HIV.” He says that relationships between patients and doctors are much improved.

Also, the government of Belarus has been much more supportive of the work.

Tatiana Migal from the ministry of health confirms this. “By working on HIV prevention among people who use drugs and supporting people living with HIV for nine years, Positive Movement has not only gained considerable experience in this field but has also contributed significantly to reducing HIV infection among people who inject drugs.”

Ms Migal stresses the importance of peer counselling, social support centres and syringe exchange programmes as well as methadone substitution therapy.

“According to estimates by the World Health Organization and UNAIDS harm reduction programmes will help overcome the HIV epidemic in Belarus,” she says.

This story was first published by WHO

Getting life-saving harm reduction services to people who use drugs in Burundi was the aim of a recent learning trip to Kenya supported by the World Health Organization (WHO). This saw a team of Burundian physicians and health advocates travel to Mombasa County, Kenya, to learn about good practice from one of the pioneers of harm reduction on the African continent.

Led by Burundian non-profit, Jeunesse au Clair Medical (JCM), the team will push for a comprehensive package of harm reduction interventions in Burundi. Like many other countries in Africa, injecting drug use is not often acknowledged, and a public health response therefore not implemented.

Drug use is widely criminalised and stigmatised and its complexities misunderstood. WHO defines harm reduction as an evidence-based public health response that includes the provision of needle and syringe programmes (NSP), opioid substitution therapy (OST) and access to testing and treatment of HIV, tuberculosis (TB) and viral hepatitis B and C.

Keen to gain insight into the Kenyan experience and inform the development of a programme in Burundi, the Burundian team of doctors, a counsellor and a national coordinator of a network of people who used drugs, visited the Reach Out Center Trust in Mombasa. They observed the delivery of OST programmes and learnt about advocacy with local influencers – in an excellent example of south-to-south learning.

Kenya’s response to minimising the adverse effects of drug use, although not without its own challenges, has succeeded largely through grassroots advocacy and on-boarding key influencers – making it easier for harm reduction to be accepted. This multi-level approach includes collaboration between government and civil society, involving both law enforcement and networks of people who use drugs.

At a visit to the Mombasa Inspectorate in charge of drug-related offences, the team learnt first-hand from the Chief Inspector the importance of police engagement, highlighting the negative impact drug use can have on young lives and the need for strategies that work. Today, some 100 police officers in Mombasa are trained on harm reduction with their work focusing on supporting, not punishing.

In addition to police buy-in, identifying other key influencers such as spiritual and village leaders, other government officials, and people who use drugs themselves, can ensure that harm reduction programmes are effective and sustainable.

Advocacy wasn’t the only thing on the agenda, the team from Burundi also saw in practice how the Kenyan clinics functioned, how methadone is dispensed, they spoke with peer educators and outreach officers, and were trained on data collection for programme monitoring. An important learning if they want to show evidence to get government and donors on their side.

While Kenya is several years ahead in its harm reduction journey, with local input, their learnings can be adapted to other contexts.

“The burden caused by drugs requires interventions at grassroots and education must be provided by trained people to avoid misinformation,” said Dr Egide Haragirimana, clinical officer at JCM.

JCM are putting into action their learnings and will next be involving networks of people who use drugs to better understand what their needs are, to inform future harm reduction initiatives.

Drug use is more common among men, with women accounting for just one in three people who use drugs and one in five people who inject drugs. However, women who use drugs face special health risks.

Although few countries report sex-disaggregated data to UNAIDS on people who inject drugs, the majority of publicly available data suggest that women who inject drugs have a greater vulnerability than men to HIV, hepatitis C and other blood-borne infections. In 16 of the 21 countries that reported such data since 2013, women who inject drugs were more likely to be living with HIV than their male peers. In Germany, Uganda and Uzbekistan, HIV prevalence among women who inject drugs was almost twice as high as among their male peers.

GENEVA, 22 May 2019—The West Africa Commission on Drugs, UNAIDS and the Global Commission on Drug Policy today presented the Model Drug Law for West Africa to ministers of health of the Economic Community of West African States.

Drug laws in western Africa are not having the intended effect. Neither drug use nor drug trafficking have been effectively reduced. Drug trafficking in western Africa has reached such an extent that the drug trade threatens stability in the region. Data from the United Nations Office on Drugs and Crime from 2014 show that the use of cannabis in western Africa is much higher than globally―12.4% of people in the region had used cannabis in 2014, whereas only 3.9% of the global population had done so―and the problematic use of prescription and synthetic drugs is increasing. The rise in prison populations owing to pre-trial detention and drug-related offences has led to serious prison overcrowding in most countries.

“People who use drugs need help and care, not punishment. Stigmatizing them and locking them up in ever-increasing numbers only worsens health issues and puts enormous pressure on the already over-stretched criminal justice systems,” said Olusegun Obasanjo, former President of Nigeria and Chair of the West Africa Commission on Drugs. “It took our region years to adopt evidence-based policies regarding the response to HIV, and we are now enjoying life-saving successes every year. Our view is that drug policy needs the same pragmatic, health-based and people-centred approach as the HIV response.”

The model drug law provides concrete templates that countries can adapt to reform their drug laws—legal provisions and how they relate to international legal obligations—as well as useful commentary that explains different options and reasons for choosing the proposed legal solution. The model drug law offers a measured way for decriminalizing drug use and possession for personal use by introducing thresholds, thereby allowing people who use drugs to access health services and seek support. The model drug law acknowledges that barriers must also be removed so that the millions of people in need of health services, including people living with cancer or with HIV, can access the treatment and care they need.

“Countries need to take a human rights approach to HIV and drug use and to make sure that the health and well-being of people come first,” said Gunilla Carlsson, UNAIDS Executive Director, a.i., while presenting the report to the ministers of health on the margins of the seventy-second session of the World Health Assembly, being held in Geneva, Switzerland. “We know that harm reduction works, we know that decriminalization works―countries cannot continue to disregard the evidence and urgently need to take action.”

The widespread stigma and discrimination, violence and poor health faced by people who inject drugs are compounded by high rates of HIV. While the incidence of HIV infection globally declined by 25% between 2010 and 2017, new HIV infections among people who inject drugs continue to rise. Of the 10.6 million people who injected drugs worldwide in 2016, more than half were living with hepatitis C, and one in eight were living with HIV.

International experience has shown that it is possible to muster the political will to make these wide-ranging changes to drug laws in order to address the spread of infectious diseases and their burden on development. Ruth Dreifuss, former President of Switzerland and Chair of the Global Commission on Drug Policy, said, “This is a defining moment where governments can turn the tide and control health epidemics by providing the right sets of prevention, treatment and harm reduction tools, or fail to do so if they maintain the prohibitionist status quo.” 

Global Commission on Drug Policy  

The purpose of The Global Commission on Drug Policy is to bring to the international level an informed, science-based discussion about humane and effective ways to reduce the harm caused by drugs and drug control policies to people and societies.

West Africa Commission on Drugs

Convened by Kofi Annan, the West Africa Commission (WACD) on Drugs comprises a group of distinguished West Africans from the worlds of politics, civil society, health, security and the judiciary. The Commission, chaired by former President Olusegun Obasanjo of Nigeria, is an independent body and can therefore speak with impartiality and directness.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Progress has been made towards achieving the 90–90–90 targets whereby United Nations Member States committed to ensuring that, by 2020, 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads.

However, people who inject drugs and other key populations are often being left behind. Among 13 countries that recently reported data to UNAIDS on treatment coverage among people living with HIV who inject drugs, eight stated that treatment coverage was lower among people who inject drugs than it was among the wider population of adults living with HIV.

While the incidence of HIV infection globally for all ages declined by 22% between 2011 and 2017, HIV infections among people who inject drugs appear to be rising. HIV incidence—the number of new HIV infections among a susceptible population during a certain time—among people who inject drugs rose from an estimated 1.2% in 2011 to 1.4% in 2017.

There is compelling and comprehensive evidence that harm reduction—including opioid substitution therapy and needle–syringe programmes—prevents HIV infections among people who inject drugs. However, criminalization of drug use and possession for personal use and the widespread stigma, discrimination and violence faced by people who use drugs hampers access to health and harm reduction services.

In its new report, Health, rights and drugs: harm reduction, decriminalization and zero discrimination for people who use drugs, UNAIDS has outlined a set of recommendations for countries to adopt for a public health and human rights response to drug use.

VIENNA/GENEVA, 15 March 2019—A coalition of United Nations Member States, United Nations entities and leading human rights experts meeting at the Commission on Narcotic Drugs in Vienna, Austria, today launched a landmark set of international legal standards to transform and reshape global responses to the world drug problem.

The International Guidelines on Human Rights and Drug Policy introduce a comprehensive catalogue of human rights standards. Grounded in decades of evidence, they are a guide for governments to develop human rights compliant drug policies, covering the spectrum from cultivation to consumption. Harnessing the universal nature of human rights, the document covers a range of policy areas, from development to criminal justice to public health.  

The guidelines come at an important moment, when high-level government representatives are convening at the Commission on Narcotic Drugs to shape a new global strategy on drugs. Under the mounting weight of evidence that shows the systemic failures of the dominant punitive paradigm, including widespread human rights violations, governments are facing growing calls to shift course.

“Drug control policies intersect with much of the 2030 Agenda for Sustainable Development and the pledge by Member States to leave no one behind. Approaches that violate human rights and fail to curb the illicit drug trade are leaving a trail of human suffering,” said Mandeep Dhaliwal, Director of the United Nations Development Programme’s HIV, Health and Development Group. “For countries who are ready to place human dignity and sustainable development at the heart of their drug control policy, these guidelines offer valuable guidance to promote more effective and humane drug control policy.”

Seeking to promote the rule of law, the guidelines feature recommendations across the administration of justice—including discriminatory policing practices, arbitrary arrest and detention and decriminalization of drugs for personal use—and articulate the global state of human rights law in relation to drug policy, which includes ending the death penalty for drug-related offences.

At least 25 national governments—from Argentina to South Africa—have scrapped criminal penalties for the possession of drugs for personal non-medical use, either in law or in practice, setting an example for others to follow. The United Nations system has jointly called for decriminalization as an alternative to conviction and punishment in appropriate cases.

“Punishment and exclusion have been instrumental to the war on drugs,” said Judy Chang, Executive Director of the International Network of People who Use Drugs. “The time has come to privilege human dignity over social isolation and champion human rights, putting an end to the shameful legacy of mass incarceration.”

Beyond moving away from a punitive approach to drugs, the guidelines make clear that a human rights approach is critical in improving people’s enjoyment of the right to health, to live free from torture and to an adequate standard of living. In accordance with their right to health obligations, countries should ensure the availability and accessibility of harm reduction services, which should be adequately funded, appropriate for the needs of vulnerable groups and respectful of human dignity.

“Ninety-nine per cent of people who inject drugs do not have adequate access to harm reduction services and are left behind in the progress against HIV,” said Michel Sidibé, Executive Director of UNAIDS. “More than 12% of people who inject drugs are living with HIV and over half have hepatitis C. The only way to advance progress is to put people at the centre, not drugs.”

The guidelines highlight the importance of protecting the rights of farming communities—especially women—to arable land. Consistent with international standards, they suggest that governments temporarily permit the cultivation of illicit drug crops when necessary to allow for smooth transitions to more sustainable livelihoods. Thailand’s success in supporting opium famers to transition to alternative livelihoods is one such example.

“Human rights should not just inform critiques of the response to drugs worldwide, they should also be the main drivers of its reform, underpinning checks and balances to break cycles of abuse,” said Julie Hannah, Director of the International Centre on Human Rights and Drug Policy, University of Essex, United Kingdom of Great Britain and Northern Ireland. “Fighting inequality and injustice is a more effective way of addressing the global drug problem than prisons and police,” she added.

The guidelines will support United Nations Member States, multilateral organizations and civil society to integrate the United Nations Charter and the Universal Declaration of Human Rights into national and global policy-making.

UNDP

UNDP partners with people at all levels of society to help build nations that can withstand crisis, and drive and sustain the kind of growth that improves the quality of life for everyone. On the ground in nearly 170 countries and territories, we offer global perspective and local insight to help empower lives and build resilient nations. www.undp.org.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

New report by UNAIDS highlights the urgent need to implement a human rights and evidence-informed approach to reach people who inject drugs with essential health services

GENEVA, 13 March 2019—A report released today by UNAIDS shows that despite a decline in new HIV infections globally, HIV incidence is not declining among people who inject drugs (1.4% worldwide in 2017). The report also shows that 99% of people who inject drugs live in countries that do not provide adequate harm reduction service coverage.

“UNAIDS is greatly concerned about the lack of progress for people who inject drugs, which is due to the failure of many countries to implement evidence-informed, human rights-based approaches to drug use,” said Michel Sidibé, Executive Director of UNAIDS. “By putting people at the centre and ensuring that they have access to health and social services with dignity and without discrimination or criminalization, lives can be saved and new HIV infections drastically reduced.”

The new UNAIDS report, Health, rights and drugs: harm reduction, decriminalization and zero discrimination for people who use drugs, shows that of the 10.6 million people who inject drugs in 2016, more than half were living with hepatitis C and one in eight were living with HIV. It outlines that ensuring that comprehensive harm reduction services are available—including needle–syringe programmes, drug dependence treatment and HIV testing and treatment—will kick-start progress on stopping new HIV infections among people who use drugs.

However, few United Nations Member States have lived up to the 2016 agreement outlined in the outcome document of the United Nations General Assembly Special Session on the World Drug Problem to establish effective public health measures to improve health outcomes for people who use drugs.

The report outlines that although decriminalization of drug use and possession for personal use increases the provision, access and uptake of health and harm reduction services, criminalization and severe punishments remain commonplace. An estimated one in five people in prison globally are incarcerated for drug-related offences, around 80% of whom are in prison for possession for personal use alone. In addition, the report lists 35 countries that retain the death penalty for drug-related offences.

UNAIDS is also advocating for the full engagement of civil society as an essential source of information and to provide mobilization, advocacy and community-led services, especially in places where repressive policies and practices are the norm. In addition, UNAIDS is calling for sufficient funding for human rights programmes and health services that include harm reduction and HIV services, community-led responses and social enablers and the removal of drug- related and HIV-related stigma and discrimination.

Health, rights and drugs highlights that despite the effectiveness of harm reduction, investments in harm reduction measures are falling far short of what is needed for an effective HIV response. In 31 low- and middle-income countries that reported data to UNAIDS, 71% of spending on HIV services for people who use drugs was financed by external donors.

While some countries have made progress by implementing evidence-informed approaches that are grounded in human rights, most are still lagging far behind. Ahead of the ministerial segment of the Commission on Narcotic Drugs, which starts on 14 March 2019 in Vienna, Austria, UNAIDS is urging governments to revisit and refocus their approaches to drug policy by putting people at the centre and linking human rights to public health.

UNAIDS has outlined a set of recommendations for countries to adopt which include:

• Fully implementing comprehensive harm reduction and HIV services, including needle–syringe programmes, opioid substitution therapy, overdose management with naloxone and safe consumption rooms.
• Ensuring that all people who use drugs have access to prevention, testing and life-saving treatment for HIV, tuberculosis, viral hepatitis and sexually transmitted infections.
• Decriminalizing drug use and possession for personal use. Where drugs remain illegal, countries should adapt and reform laws to ensure that people who use drugs have access to justice, including legal services, and do not face punitive or coercive sanctions for personal use.
• Taking action to eliminate all forms of stigma and discrimination experienced by people who use drugs.
• Supporting the full engagement of civil society as a source of information and to provide community-led services, mobilization and advocacy, especially in places where repressive policies and practices are the norm.
• Investing in human rights programmes and health services, including a comprehensive package of harm reduction and HIV services, community-led responses and social enablers.

Full report: Health, rights and drugs: zero discrimination, harm reduction and decriminalization for people who use drugs.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.