SUPPORT. DON’T PUNISH.

A CAMPAIGN TO STOP HIV BY CALLING FOR REFORM OF GOVERNMENT ACTIONS ON DRUGS

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The HIV epidemic is fuelled by the criminalisation of people who use drugs. Governments must reform drug laws and policies that impose harsh penalties and law enforcement measures on people who use drugs, and hamper access to essential HIV prevention and health services. The heightened HIV risks faced by people who inject drugs can no longer be ignored. The SUPPORT. DON’T PUNISH. campaign calls upon governments to put an end to drug policies that lead to poor health, social, economic and human rights outcomes.

An estimated 11-21 million people inject drugs worldwide, with HIV infection rates amongst this group as high as 37% in Russia, and 43% in Indonesia [1]. People who inject drugs account for 30% of HIV infections outside of sub-Saharan Africa, and up to 80% of infections in Eastern Europe and Central Asia [2].

The HIV epidemic is being driven by laws, policies and practices that impose harsh penalties and law enforcement measures on people who use drugs. Initially based on the belief that tough enforcement would stifle drug markets, this punitive approach has failed to reduce levels of drug use [3]. It has also led to the discrimination and stigmatisation of people who use drugs, impeding their access to HIV prevention, treatment and care services that are essential to saving lives and curbing the spread of HIV.

The criminalisation of drug use creates an environment that condones imprisonment for minor offences along with a range of human rights violations by law enforcement agencies, including torture, executions, extrajudicial killings, bribery, imprisonment as a form of treatment, and other abuses that result from overcrowded prisons [4]. The imprisonment of people who use drugs increases their HIV vulnerability because of unsafe injecting and sexual practices, and worsens HIV treatment outcomes because of inadequate treatment access [5].

Evidence-based interventions that are effective at halting or reversing the HIV epidemic among people who inject drugs are already endorsed by international agencies such as the WHO, UNAIDS and UNODC [6]. But their full implementation is blocked by policy and legislative barriers, inadequate resources, lack of capacity and political or ideological objections. Eminent groups of experts and policy makers, such as the Global Commission on HIV and the Law and the Global Commission on Drug Policy, have recently published reports [7] calling for reform of drug polices based on available evidence and human rights in order to prevent HIV amongst people who inject drugs. The body of evidence and the momentum for change is growing.

As part of this momentum, the SUPPORT. DON’T PUNISH. campaign calls on governments to confront these political, legislative and ideological barriers, and ensure the health and human rights of people who use drugs, their families and the wider community.

SUPPORT

Invest in effective HIV responses for people who use drugs.

  • We call on countries to scale up evidence-based HIV prevention measures for people who inject drugs, including programmes that prevent the sharing of injecting equipment (needle and syringe programmes), and effective programmes for those with drug dependency problems (opioid substitution therapy).
  • We call on donors, UN agencies and governments to direct resources to close the gap between the scale of need, and current levels of investment, for targeted harm reduction and HIV programmes for people who use drugs.
  • We call on international donors to fully fund the Global Fund to Fight AIDS, Tuberculosis and Malaria, so that programmes essential for tackling HIV transmission amongst people who use drugs can achieve the required scale.

DON’T PUNISH

Improve policies and reform laws that undermine effective HIV responses for people who use drugs.

  • We call on governments to bring an end to the criminalisation and punishment of people who use drugs, and to the prohibition of needle and syringe programmes and opioid substitution therapy.
  • We call on governments to ensure the provision of voluntary, evidence-based and human rights compliant drug treatment programmes and put an end to imprisonment as a form of treatment.
  • We call on governments to work with civil society and most-at-risk populations to gain a better understanding of the harmful impacts of drug laws and policies, and to develop programmes that are proven to be effective at stopping HIV transmission.

IT IS TIME TO LEAVE BEHIND HARMFUL POLITICS, IDEOLOGY AND PREJUDICE. IT IS TIME TO PRIORITISE THE HEALTH AND WELFARE OF PEOPLE WHO USE DRUGS, AND THEIR FAMILIES AND COMMUNITIES.

[1] Mathers et al (2008) The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet, 372(9651): 1733-1745; Federal Service on Customers’ Rights and Human Well-being Surveillance of the Russian Federation (2010) Country Progress Report on the progress of implementing the Declaration of Commitment on HIV/AIDS adopted at the 26th United Nations General Assembly Special Session on HIV/AIDS. Reporting period: January 2008 – December 2009; United Nations Office on Drugs and Crime (2012) HIV and AIDS.

[2] Mathers et al (2010) HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet, 375(9719): 1014-1028; Mathers et al (2008) The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet, 372(9651): 1733-1745; Horton & Das (2010) Rescuing people with HIV who use drugs. Lancet, 376(9737): 207-208.

[3] Degenhardt et al (2008) Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys. PLOS Medicine, 5: 1053-67; Jurgens et al (2009) Interventions to reduce HIV transmission related to injecting drug use in prison. Lancet Infectious Disease, 9: 57-66; The National Centre on Addiction and Substance Abuse at Columbia University (2009) Shoveling up II: the impact of substance abuse on State budgets. New York: Columbia University; Reuter (2009) Ten years after the United Nations General Assembly Special Session (UNGASS): assessing drug problems, policies and reform proposals. Addiction, 104: 510-517.

[4] Room & Reuter (2012) How well do international drug conventions protect human health? Lancet, 379(9810): 84-91.

[5] Carrieri et al (2012) Reconceptualising research on HIV treatment outcomes among criminalized groups. JAIDS, 59(4): 329-330; Mathers et al (2010) HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet, 375(9719): 1014-1028.

[6] World Health Organisation, United Nations Office on Drugs and Crime and the Joint United Nations Programme on HIV/AIDS (2012) Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users.

[7] Global Commission on HIV and the Law (2012) HIV and the law: risks, rights and health; Global Commission on Drug Policy (2012) The war on drugs and HIV/AIDS: how the criminalization of drug use fuels the global pandemic.