Safeguarding the rights of drug users is essential for an effective HIV response
23 May 2008
Ensuring the human rights of injecting drug users to access life-saving health services and to participate meaningfully in the decisions that affect them is critical for an effective HIV response. This was the message from the Alliance at the 19th International Conference on Reducing Drug-Related Harm that took place in Barcelona, Spain, in May 2008.
At the conference, the Alliance urged the World Health Organization, UNAIDS, and the United Nations Office on Drugs and Crime to add community mobilisation and advocacy to their draft comprehensive package of interventions for injecting drug users as a way of overcoming barriers to access and ensuring the effectiveness of HIV work with drug users.
92% of injecting drug users in middle and low-income countries have no access to HIV prevention services*. Despite increasing availability of antiretroviral treatment, injecting drug users are not benefiting from it. In Eastern Europe and Central Asia, 80% of people living with HIV are injecting drug users, yet make up just 24% of those receiving antiretroviral treatment. In China, 50% of those living with HIV are drug users, yet drug users represent just 2% of those receiving antiretroviral treatment.
Stigma and discrimination present further barriers to HIV services. At the community level, there is limited support for the human rights of drug users to access health services. More than half the countries submitting reports to UNAIDS admitted that their existing policies – such as preventing the use of methadone or needle exchange – interfere with the effectiveness of HIV prevention and care.
The World Health Organization, UNAIDS, and the United Nations Office on Drugs and Crime’s draft comprehensive package for preventing HIV through drug use includes nine interventions:
- Needle and syringe programmes
- Opioid substitution therapy
- Voluntary HIV counselling and testing
- Antiretroviral treatment
- Sexually transmitted Infections prevention
- Condom programming for injecting drug users and partners
- Targeted information, education and communication for injecting drug users and their sexual partners
- Hepatitis diagnosis, treatment (Hepatitis A, B and C) and vaccination (Hepatitis A and B)
- Tuberculosis prevention, diagnosis and treatment
While welcoming the list, the Alliance pointed out that none of the interventions explicitly addresses structural barriers to services and stigma and discrimination. The Alliance is arguing that ‘community mobilisation and drug user empowerment’ and ‘advocacy (for a supportive legal environment)’ be added as additional interventions. Community mobilisation ensures that drug users will have a say in how their needs are met, and will involve their families, partners, healthcare providers and law enforcers in the response. Advocacy for a supportive legal environment will influence local, national and international policies so that they do not undermine the right to health for drug users. Not only are the two interventions in line with human rights imperatives, but they also have the potential to increase the impact of the other nine interventions on the list.
The effectiveness of community mobilisation and advocacy work with drug users is borne out by the Alliance’s experiences. In India, Social Awareness Services Organisation (SASO) directly tackles stigma and discrimination against drug users by working with family members, health care professionals and the wider community. This has led to an increased demand for services, better family support for adherence to antiretroviral treatment and increased acceptance of people who use drugs and people living with HIV. And in Ukraine, sustained advocacy efforts to make the provision of methadone legal on public health and human rights grounds has demonstrated the positive impact of advocacy interventions that include drug users; methadone is now being rolled-out in Ukraine and the government has named harm reduction as a key strategy in its drug policy.
Alliance participation in the conference
The Alliance had a strong presence at the Barcelona conference. Alliance Ukraine delivered a series of poster presentations on subjects such as monitoring and evaluation of harm reduction programmes, working with police to support harm reduction in Ukraine and large-scale peer education programming. Tiken Rajkumar, from Social Awareness Services Organisation (SASO) (an implementing partner of Alliance India), was also at the conference presenting in session sponsored by the United Nations Office on Drugs and Crime and the World Health Organization.
