Among the UNAIDS Strategy goals to achieve by 2015, one is to prevent all new HIV infections among people who use drugs.
Globally, there are an estimated three million people who inject drugs also living with HIV—with nearly 13 million more at risk of HIV infection. Access to HIV prevention services, including harm-reduction programmes has increased but not at the required levels. In 2009 the median coverage of HIV prevention services was 32%.
It is estimated that on average globally fewer than two clean needles are provided per month per person who injects drugs, there are about eight people in opioid substitution treatment for every 100 people who inject drugs. According to WHO, UNODC and UNAIDS target-setting guidelines, the availability of fewer than 100 syringes per person who injects drugs per year is considered low.
Few countries have data on HIV treatment coverage for people living with HIV who inject drugs, 14 countries treat 5% or fewer and in only nine countries does treatment reach more than 10% of people living with HIV who inject drugs.
UNAIDS calls for scaling up comprehensive, evidence informed and human-rights-based programmes accessible to all people who inject drugs (i.e. attending to harm reduction alongside demand reduction), including programmes to reduce hepatitis co-infection, increasing access to HIV treatment, and ensuring legal and policy frameworks serve HIV prevention efforts.
What is harm reduction?
Harm reduction – in some countries called risk reduction or harm minimization – is a strategy to address the potential harm associated with the use of drugs.
Its main goal is to diminish the negative effects resulting from the use of drugs and, as a consequence, to improve the quality of life of drug users.
Harm reduction strategies have not only dealt with individual practices but also with understanding person’s conditions of vulnerability in order to develop appropriate interventions, and establishing specific relations for care and reciprocity among individuals and groups in the context of drug use.
Some programs develop actions to involve others from the territory in which they intervene (neighbours, social activists or public institutions such as schools or health care centres) in the transformation of the suffering situations that affect them.
Origins and tactics
The origin of the harm reduction concept was in Holland in the 70s when identified professional alternatives with a drug user perspective – known as “acceptance model” – appeared. At the end of the 80s they started to be used in the region of Merseyside (England), answering to two key factors:
A harm reduction strategy may involve a broad variety of tactics. It may include the change in the legal sanctions associated to drug use; it may improve the accessibility of drug users to treatment services; it may generate direct services for drug users and their social networks by means of education; it may also be aimed at modifying the social perception about drugs and drug users.
How to reduce harm
The intervention strategies part of a harm reduction policy are characterised by:
These strategies allow for various types of actions that can be implemented jointly or separately, depending on the realities of each community. Among the most common we may find:
Source (in Spanish): www.intercambios.org.ar
THE VIENNA DECLARATION
The criminalisation of illicit drug users is fuelling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences. A full policy reorientation is needed.
In response to the health and social harms of illegal drugs, a large international drug prohibition regime has been developed under the umbrella of the United Nations. Decades of research provide a comprehensive assessment of the impacts of the global “War on Drugs” and, in the wake of the XVIII International AIDS Conference in Vienna, Austria, the international scientific community calls for an acknowledgement of the limits and harms of drug prohibition, and for drug policy reform to remove barriers to effective HIV prevention, treatment and care.
The evidence that law enforcement has failed to prevent the availability of illegal drugs, in communities where there is demand, is now unambiguous. Over the last several decades, national and international drug surveillance systems have demonstrated a general pattern of falling drug prices and increasing drug purity—despite massive investments in drug law enforcement.
Furthermore, there is no evidence that increasing the ferocity of law enforcement meaningfully reduces the prevalence of drug use. The data also clearly demonstrate that the number of countries in which people inject illegal drugs is growing, with women and children becoming increasingly affected. Outside of sub-Saharan Africa, injection drug use accounts for approximately one in three new cases of HIV.(8),(9) In some areas where HIV is spreading most rapidly, such as Eastern Europe and Central Asia, HIV prevalence can be as high as 70% among people who inject drugs, and in some areas more than 80% of all HIV cases are among this group.
In the context of overwhelming evidence that drug law enforcement has failed to achieve its stated objectives, it is important that its harmful consequences be acknowledged and addressed. These consequences include but are not limited to:
HIV epidemics fuelled by the criminalisation of people who use illicit drugs and by prohibitions on the provision of sterile needles and opioid substitution treatment.
HIV outbreaks among incarcerated and institutionalised drug users as a result of punitive laws and policies and a lack of HIV prevention services in these settings.
The undermining of public health systems when law enforcement drives drug users away from prevention and care services and into environments where the risk of infectious disease transmission (e.g., HIV, hepatitis C & B, and tuberculosis) and other harms is increased.
A crisis in criminal justice systems as a result of record incarceration rates in a number of nations.(19),(20) This has negatively affected the social functioning of entire communities. While racial disparities in incarceration rates for drug offences are evident in countries all over the world, the impact has been particularly severe in the US, where approximately one in nine African-American males in the age group 20 to 34 is incarcerated on any given day, primarily as a result of drug law enforcement.
Stigma towards people who use illicit drugs, which reinforces the political popularity of criminalising drug users and undermines HIV prevention and other health promotion efforts.
Severe human rights violations, including torture, forced labour, inhuman and degrading treatment, and execution of drug offenders in a number of countries.
A massive illicit market worth an estimated annual value of US$320 billion. These profits remain entirely outside the control of government. They fuel crime, violence and corruption in countless urban communities and have destabilised entire countries, such as Colombia, Mexico and Afghanistan.
Billions of tax dollars wasted on a “War on Drugs” approach to drug control that does not achieve its stated objectives and, instead, directly or indirectly contributes to the above harms.
Unfortunately, evidence of the failure of drug prohibition to achieve its stated goals, as well as the severe negative consequences of these policies, is often denied by those with vested interests in maintaining the status quo. This has created confusion among the public and has cost countless lives. Governments and international organisations have ethical and legal obligations to respond to this crisis and must seek to enact alternative evidence-based strategies that can effectively reduce the harms of drugs without creating harms of their own. We, the undersigned, call on governments and international organisations, including the United Nations, to:
We also appeal to the Secretary-General of the United Nations, Mr Ban-Ki Moon, so that he urgently implements measures that ensure that the system of United Nations agencies – including the International Narcotics Control Boards (INCB) – unite in one voice supporting the decriminalization of drug users and the implementation of proof-based strategies to control drugs.
Basing drug policies on scientific evidence will not eliminate drug use or the problems stemming from drug injecting. However, reorienting drug policies towards evidence-based approaches that respect, protect and fulfil human rights has the potential to reduce harms deriving from current policies and would allow for the redirection of the vast financial resources towards where they are needed most: implementing and evaluating evidence-based prevention, regulatory, treatment and harm reduction interventions.
ICW Global has signed the DECLARATION. If you are interested, you can do it here: