Support. Don’t Punish: Human rights, people who use drugs and the end of the HIV epidemic

In the run-up to the Global Fund Replenishment Conference in Lyon this year, civil society organisations committed to fairer drug policies must speak up to ensure the specific vulnerabilities of people who use drugs are addressed with much-needed resources.

By Enzo Poultreniez, AIDES | Translation by Jean Pasteur, AIDES

The “Support. Don’t Punish” Global Day of Action, on 26 June 2019, will take place 3 months before a key event in the fight against HIV/AIDS, tuberculosis and malaria, and for the health and welfare of people who use drugs. An event that will determine whether political leaders can put their money where their mouth is when it comes to putting an end to AIDS worldwide, without leaving people who use drugs behind.

October 10th, 2019: The Global Fund Replenishment Conference in Lyon (France)

Hosted in Lyon by French president Emmanuel Macron, the Global Fund Replenishment Conference will gather heads of state and government from the wealthiest countries to decide on the financial commitment dedicated to the fight against these pandemics for the next 3 years. It is the first time that this Conference will take place in France since the creation of the Global Fund at the beginning of the century.

Today, the Global Fund represents 43% of the total funding dedicated to harm reduction interventions in low- and middle-income countries (two thirds of international funding). Without it, it is impossible to reach an adequate access to needle & syringe programmes and opioid agonist therapy, or to reduce the impact of the epidemics on the lives of people who use drugs.

The Global Fund achievements in tackling the HIV epidemic among people who use drugs

Current drug policies increase the vulnerabilities of people who use and inject drugs. As a result, for people who inject drugs, the likelihood to live with HIV is 22x higher than for the general population. The situation is equally dire when it comes to viral hepatitis. In Russia, for instance, where the so-called “war on drugs” rages with particular cruelty, 1 out of 4 people who inject drugs lives with HIV whereas. Tackling the epidemic necessitates addressing these specific vulnerabilities. The Global Fund understood that well by funding access to harm reduction services, not without difficulty when confronted to certain governments, which would rather sacrifice peopled stigmatised, marginalised, deemed undesirable.

Needle & syringe programmes were hence implemented in Nepal or South Africa to facilitate access to hygienic paraphernalia and therefore prevent the transmission of HIV related to the sharing of syringes, needles and other equipment. As a reminder, the implementation of such programmes in France since 1987 had a tremendous impact on reducing the number of new HIV infections among drug users: From accounting for a substantial proportion of new transmissions, they now represent less than 2%. The Global Fund also funds opioid agonist therapy, viral testing and antiretroviral therapy.

There is still a long way to go, and we are worried

Despite a growing number of new HIV transmissions among people who use drugs worldwide (+33% in five years), the provision of hygienic drug use equipment and other specific health interventions are estimated to be funded at only 7%, and this financial support is constantly at risk.

It is, thus, urgent to redouble global efforts to prevent new transmissions among this vulnerable population. This, however, requires more means and, hence, increased funding. Any reduction to existing funds would be catastrophic for people who use drugs. As one of the most marginalised communities disproportionately affected by HIV, they would certainly be among the most affected by budget cuts.

10 October is, thus, incredibly important. At the moment, the Global Fund counts on US $4 billion per year to fund and implement programmes (for the three pandemics, all populations considered). The Global Fund Advocates Network (GFAN) considers that between 5 and 6 billion dollars per year would be necessary for the Global Fund to hope to put an end to AIDS. The effort is considerable, but not unachievable: it only represents a tiny part of global wealth.

We need to mobilise in the run-up to 10 October!

As civil society members committed to drug policy that is based on knowledge, evidence and the real needs of affected populations, we cannot ignore this opportunity to make our voices heard. This conference should not overlook the specific issues concerning people who use drugs, including harm reduction programmes, opioid agonist therapy and sexual health prevention tools, but also the removal of criminal penalties for people who use drugs, which remain an obstacle to access services and to foster treatment adherence, as well as a source of insecurity, poverty and oppression.

As civil society, we have a responsibility to speak to and with our political leaders. The wealthiest countries should increase their contribution to the Global Fund. Implementing countries should remove the barriers to actual access to harm reduction tools and increase, as much as possible, their dedicated domestic resources. The whole international community should put an end to the war on drugs!

For the people who use drugs too: Get Back on Track!