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Harm Reduction – A Global Response

Organized by the Governments of the Netherlands and Indonesia.

Aldo Lale-Demoz (UNODC)

Thanks to the Governments of the Netherlands and Indonesia, for hosting this event. There are more than 50 side events this week, but this is one of the most interesting. We remain concerned by the lack of coverage for harm reduction, and the need to improve access. We must also keep reminding people of the important role of CSOs in this work. The UNODC HIV/AIDS Section has identified 24 HPCs for their work to try and meet the target or reducing HIV among people who inject drugs.
Fatma Jeneby – Muslim Education and Welfare Association (MEWA)
People who inject drugs have faced serious structural barriers, high risk behaviours, threats of violence (including acts of mob / vigilante justice), stigma and discrimination, etc. But after harm reduction services have been implemented (including OST since December 2014), we have seen a change in attitudes, a raised demand for services, better relationships, and greater political commitment among policy makers and opinion leaders. UNODC have played a key role in this, enabling policy makers to see what is happening on the ground. The community have been engaged in the delivery of needle and syringe programmes and OST.

In Kenya, they have also been able to create a positive enabling environment, changing law enforcement practices towards people who use drugs. There are also programmes on gender-based violence, including a partnership with the Red Cross to help vulnerable children re-enrol into school.
In the future, they will deliver more work with law enforcement agencies (including training for new staff), and aim to further expand and scale-up the harm reduction programmes, which still only reaching around 27% of the target group. There is also a need to support clients with job placements and experience.

Andrey Klepikov – International HIV/AIDS Alliance in Ukraine
HIV and injecting drug use is concentrated in Kiev, Donetsk, Dnipropetrovsk, Odesa and Mykolaiv – with an overall HIV prevalence of 19.7% among this population (up to 40% in some regions). Ukraine has the largest harm reduction programme in Eastern Europe, with nearly 200,000 clients registered – 27% of whom are female (up from 19% five years ago). This programme includes the comprehensive package, but also outreach and other services. There has been a reduction in new cases of HIV among people who inject drugs – although data from Crimea are not included due to the annexation of Crimea by Russia. When compared to Russia, there is a clear difference in HIV outcomes in Ukraine – with stable HIV rates that can be directly associated with the adoption of harm reduction, especially needle and syringe programmes and OST.

Challenges remain, such as the need to increase OST coverage – which is especially threatened by the cutting-off of treatment in Eastern Ukraine due to the annexation (around 600 people have already had their treatment cut-off). They have ambitious plans for the current year, but funding remains a major challenge. The Global Fund allocations for harm reduction are being dramatically reduced (from $10.63m in 2013 to $3.36m in 2017), even after much advocacy. The assumption from the Global Fund and bilateral donors was that domestic funding would increase, as Ukraine is a middle income country. But at the same time, national funding has dropped – in 2014 it was 71% lower than the planned investment, and none of the domestic funding went to targeted prevention / harm reduction.

We need to join forces to ensure that international funding for harm reduction continues until national funding has actually increased – we cannot leave a gap like the Global Fund have done in Ukraine.

Edo Agustian – PKNI (Indonesian drug user network)
Indonesia have had progressive policies on harm reduction since 2003, yet almost all regions of the country still have concentrated epidemics. They started needle and syringe programmes in 1999 (with informal services established in Bali), and this was accepted as a national programme in 2003.

The new Narcotic Law from 2009 decriminalises drug users on paper – yet 45% of prisoners are for drug-related offences and little has changed in practice. In 2011, compulsory registration started – which means that a person can face arrest if they do not report themselves (or a relative) as a drug user! Compulsory detention centres also continue to operate across the country.

Nonetheless, the role of the drug user community in Indonesia has been positive – monitoring the quality of services, providing community-based services, engaging with law enforcement, and providing legal assistance. The change in Global Fund policy has threatened harm reduction, alongside the withdrawal of bilateral support from the UK and others. Harm reduction in Indonesia remains dependent on international funding for harm reduction – and they have major concerns over Australian bilateral funding, given the political fall-out from recent drug-related executions. To make things worse, the government have now relaunched a war on drugs – this stops people from accessing services, and leads to more arrests, bribery and sexual abuse by law enforcement. Now we are seeing the real negative impact of the war on drugs in the country, things are getting worse and worse. There is a need to implement the commitment to decriminalisation in the Narcotics Law.

One comment

  1. Anonymous says:

    Brilliant summation Edo of the contradictions in Indonesia regarding harm reduction versus ‘war on drugs’ policies

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