The facts speak for themselves: so why is no-one listening?

By Susie Mclean

SusieThe facts speak for themselves.

  • Globally, around 12.7 million people inject drugs and approximately 1.7 million of them are living with HIV.
  • On average, one in ten new HIV infections are caused by the sharing of injecting equipment.
  • We won’t meet the target to end AIDS by 2030 unless states implement harm reduction programmes and reform drug policies.
  • The case for the effectiveness of harm reduction interventions, like needle and syringe programmes and opioid substitution therapies (OST), is irrefutable according to UNAIDS. And all the relevant UN agencies agree and endorse a harm reduction approach to HIV and drug use, and support decriminalisation.  
  • Harm reduction programmes have averted or reduced HIV transmission amongst people who inject drugs in many countries around the world.

<p>Taking methadone at a mosque in Malaysia.</p>

So, how did the UN’s Commission on Narcotic Drugs, a strange  corner of the UN system, manage to ignore calls to explicitly endorse  harm reduction at its 59th meeting in Vienna last month? Why is this UN process aiming for ‘a world free of drug abuse’ when we know that this is a folly and will lead to further failures? Where is the critique of the harms caused by a system built on prohibition and repression?

It’s nearly 20 years since the last UN General Assembly Special Session (UNGASS) on Drugs committed to the fantasy concept of ‘a drug free world’. In 2009 a Political Declaration and Action Plan followed which was built on a similar paradigm of prohibition. The 2009 Declaration will end in 2019.

But these commitments are not being met.  UNODC’s own data demonstrates that drug use continues to increase, and is predicted to rise a further 25 per cent by 2050.  And worse, the harms that arise from the aspirations of the current Declaration have been toxic – mass incarceration, the death penalty for drug offences, brutal and enforced ‘treatment’ in detention centres and the criminalisation of millions of poor people for minor and non-violent drug offences. Today most countries continue to take a punitive approach to drugs, using arrests, incarceration, criminal penalties and compulsory detention to punish drug users. 

How can we ‘end AIDS’ amongst people who use drugs when so many of them are incarcerated, detained, harassed and criminalised?

This month another UNGASS on drugs takes place in New York.  We had hoped that the CND preparatory meeting would agree a change of direction  in which the rhetoric of a ‘drug free world’ was dropped in favour of more progressive approaches to global drug policy. The draft Outcome Document that emerged was far from perfect, as this commentary from our colleagues at the International Drug Policy Consortium so clearly shows. Some progress was made on language – with reference to HIV goals and support for key interventions such as needle and syringe programmes and opiate substitution treatment . However there are no explicit mentions of harm reduction and certainly no references to decriminalisation, to alternatives to incarceration, and no attention to the harms created by current drug policy.

At the International HIV/AIDS Alliance we know of epidemics being averted, or reduced, in settings as diverse as Australia, Viet Nam, Ukraine, Malaysia, China, Portugal, Mauritius and Switzerland.

All these countries have harm reduction programmes such as needle and syringe programmes and opiate substitution therapy (OST) in common. Even in countries with very harsh drug laws, such as Indonesia, community groups we work with such as Rumah Cemera have found ways of proving the case for harm reduction services.

110,000 injecting drug users were newly diagnosed with HIV in 2014 alone. The need for evidence-based approaches to deal with this public health emergency has never been more important.

If just 7.5% of the estimated $100 billion spent annually on the war on drugs was instead directed to spending on harm reduction, we could practically end HIV among injecting drug users. That’s the conclusion of research by Harm Reduction International published in the Lancet recently.

So why does commitment to the concept of harm reduction keep being contested in global drug policy?

Russia is rumoured to have been active behind the scenes at the CND in Vienna blocking all attempts at putting harm reduction on the agenda.

Russia is one of the few countries in the world where the HIV epidemic continues to grow quickly. It has the highest number of newly diagnosed HIV cases among Council of Europe members. And more than 93,000 new HIV infections were diagnosed in Russia in 2015, 53.6% of which  were attributable to unsafe drug injection, according to the Moscow-based Andrey Rylkov Foundation for Health and Social Justice.

By contrast, neighbouring Ukraine managed to halve HIV prevalence among injecting drug users between 2008 and 2014, in large part because of harm reduction programmes. Yet, today, OST is under threat in areas of east Ukraine annexed by separatists.

Alliance for Public Health, the Alliance’s Linking Organisation in Ukraine, recorded an additional 495 cases of HIV last year in areas where harm reduction programmes are now effectively banned.

There are an increasing number of governments and organisations speaking out about the horrors of the drug war. But for me, sitting in Vienna and watching events unfold was an eye opener. It is hard to accept that UN member states will re-commit to another Outcome Document that’s not fit for purpose when it is put before them in New York this month.  The challenges that we face in trying to get services to people who use drugs, in trying to end AIDS amongst people who use drugs, are not addressed in this process.

This needs to change. Alliance representatives will be out in force at UNGASS.  We will continue to push our five key recommendations for ending HIV and hepatitis C amongst people who use drugs.  We are hoping that this UN process rises to the challenge.

Download the Alliance's position paper on HIV, drugs and drug policy in the lead up to the UN General Assembly Special Session on the World Drug Problem, 2016

A version of this article first  appeared in The Guardian on 21 March 2016. It has been updated to reflect the draft Outcome Document following the CND meeting.