At the UN General Assembly Special Session on drugs (UNGASS) this week, two very different approaches to the 'world drug problem' will have to be thrashed out by UN member states.
At the UN General Assembly Special Session on drugs (UNGASS) this week, two very different approaches to the ‘world drug problem’ will have to be thrashed out by UN member states.
As governments come together in New York on 19-21 April, there are those who seek to strengthen a zero tolerance approach, and those who believe decriminalising drug users and taking a ‘harm reduction’ approach must be the way forward.
For the latter group, reducing the transmission of HIV and hepatitis C would be one of the main benefits of such an approach, because sharing injecting drug equipment has a high risk of transmitting these viruses. According to the Global Commission on Drug Policy report, the global war on drugs is driving the HIV pandemic among people who use drugs and their sexual partners. And a UNAIDS report states that in 2014 alone, an estimated 110,000 people who inject drugs were newly infected with HIV.
This is a particularly big issue in Asia, in countries like Indonesia and India, where people who use drugs are criminalised. In these contexts there are few ‘harm reduction’ programmes, such as providing clean needles and syringes or opiate substitution therapy, which help avoid the transmission of HIV from sharing injecting drug equipment.
Drugs and HIV in Indonesia
Indonesia has some of the harshest drug laws in the world. At last month’s 59th Session of the Commission on Narcotic Drugs (CND) in Vienna, Austria, Indonesia asked other countries to respect its territorial integrity and sovereignty in its efforts to fight drug-related crimes.
Yet according to UNAIDS’ Gap Report it is the country which has the highest prevalence of HIV among injecting drug users (around 35 per cent) compared to the general population (less than 1 per cent). Within this hostile environment for people who use drugs, Rumah Cemara, a linking organisation of the International HIV/AIDS Alliance, is working with grassroots groups to provide needle and syringe programmes to people who use drugs.
Many drug users in Indonesia are incarcerated, and in order to reach them, Rumah Cemara provides HIV prevention and support programmes in prison. The organisation also advocates for people who are convicted of drug offences to be directed to evidence-based drug treatment services as an alternative to prison. It is part of the Community Action on Harm Reduction project, a five-country programme to provide HIV prevention and care services to people who use drugs.
Ardhany Suryadarma, policy manager for Rumah Cemara, said: “Indonesia’s view on the global drug policy debate is outdated and narrow. The drug policy is murderous even more than the drugs itself. After the Indonesian President Joko Widodo declared Indonesia in an emergency situation for drugs, the National Narcotics Board responded by conducting massive raids to reach the target of 100,000 people who use drugs for rehabilitation. In reality many of them remain inside prisons, killing their careers and social life.”
India’s hope for UNGASS
Policies around drug use are also an issue in India, which has one of the largest injecting drug user populations in the world, and where injecting drug use is also a principal driver of the HIV epidemic. Alliance India works with people who inject drugs across India to help increase the uptake of services and improve the health of this vulnerable population. Investment in harm reduction is a crucial foundation of an efficient drugs policy that not only saves lives but is also cost-effective.
As regional and national stakeholder consultations take place leading up to UNGASS, participants are calling for governments to embrace dignity, humanity, science, medicine and evidence-based treatment in dealing with drug use. The president of the Indian Drug User’s Forum, Abou Mere, said: “UNGASS must ensure that all state members respect the fundamental right to health.”
Decriminalisation of drug users
There is also a call on member states to abolish criminalisation of drug users and provide alternatives to sending people who use drugs to prison. Tripti Tandon, head of advocacy for Lawyers Collective, India, said: “As a minimum the UNGASS outcome document must reflect a commitment to the abolition of the death penalty for drugs. This will not weaken our control over drugs but only elevate our humanity.”
But advocates recognise that achieving this outcome will be a huge challenge. Simon Beddoe, senior advocacy officer at Alliance India, and South Asia regional representative for the UN Office on Drugs and Crime Civil Society Task Force, said: “While radical changes like decriminalisation of drug use and abolition of the death penalty may not be realised, there is hope for a small shift from the largely punitive approach to a more public health centred and rights approach where health care, treatment and alternatives to imprisonment for drug users will be prioritised.”
Although global consensus on this approach may be an unlikely outcome, the evidence of the global health benefits of this approach are undeniable. The UNAIDS paper Public Health and Rights Approach to Drugs highlights experiences from China, Malaysia, Ukraine and Vietnam, where they have taken steps to increase harm reduction services. China’s expansion of opiate substitution therapy has been associated with a sharp reduction of newly diagnosed HIV cases resulting from injecting drug use, from 43.9 per cent in 2003 to 7.7 per cent in 2013.
Ultimately, drug policy reform is a crucial step to ending AIDS. The decision makers at UNGASS must commit to reform legislation, redirect investment and strengthen policies towards health and human rights, if they are serious about their other commitments to end AIDS by 2030.
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Read the International HIV/AIDS Alliance’s position paper on HIV, drugs and drug policy