Side Event: Promoting health, human rights and development through a harm reduction approach

Side event organised by the Netherlands, the International HIV/AIDS Alliance, UNAIDS, the African Union Commission and AIDS Fonds.

Martin van Rijn (Minister of Health, Welfare and Sport for the Netherlands)

In November we established the EU position for 2016, including a broad range of issues such as the abolishment of the death penalty and access to essential medicines. We need to acknowledge the full range of public health interventions – including risk and harm reduction for HIV and other blood borne diseases. It is considered sometimes controversial, but it is applied in all regions and it is important to have this recognised at the UNGASS. Harm reduction has proven its effectiveness. We strongly recommend that states promote these interventions. We emphasise that dependent people who use drugs should be considered, first and foremost, as people in need of attention, social support etc, especially women. We should be able to recognise not just the practice, but also the language ‘harm reduction’. This would be a first step to achieve the global goals on AIDS.

This also needs more funding, and the Netherlands continues to support this and calls upon other donors to do the same. We want to keep the issue of HIV high on the agenda, alongside UNAIDS and civil society. The Netherlands will host the International AIDS Conference in 2018, and will focus on key populations in particular. The EU believes in the right of people who use drugs to give informed consent for treatment. Even where such consent cannot be given in exceptional cases to avoid harm to themselves or others, treatment must follow the agreed standards. We must focus on evidence-based policies that are constantly assessed and evaluated. We invite you to look at the Dutch figures on how harm reduction has worked – this is real evidence, especially for harm reduction. The meaningful participation of civil society is also important. Drug policy is not about ideology, it is about facts.

Hendrietta Ipeleng Bogopane-Zulu (Deputy Minister for Social Development for South Africa)

The Africa Union Common Position for the UNGASS remains the formal position for African member states. It has gone through the various processes of consultation, and is committed to by the representatives of member states. The positions that these delegations take here in Vienna should reflect this. The Africa Union continues to support this and promote this position. The EU position and the AU position reinforce one another, so it is comforting to know we are not far off in supporting what has to be done. For Africa, to deal with drugs, our responsibilities rely heavily on the human rights of people who use drugs, the manner in which they are dealt with by justice systems, and the alternatives and diversion processes available. The issue of women remains a major issue for Africa. When you empower women you go to the core of ensuring that the drug problem can be addressed too.

In the AU position, we look at the relationship of a lot of other aspects: gender-based violence, the impact on young people, the issues around human rights, the harm reduction approach, the family-centred approach for psychosocial support, the interaction of drugs and HIV, the development burden on countries, and the impact of drug trafficking – especially for young girls in jail for drug-related offences, impacting on health outcomes and families. So it is important that the AU, as directed by member states, has a position which recognised human rights, health and social outcomes, gender perspectives, and the opportunity for alternatives programmes. If Africa has to get to zero [with regards to the HIV epidemic], we need to focus on certain key populations, and acknowledge the need to treat humans with dignity. We do not support involuntary and imposed treatment.

Luiz Loures (Deputy Director, UNAIDS): More than ever, we need these kinds of dialogues and we need to bring the evidence to the table. Drug use and HIV are a deadly combination that remains unchecked – when people are dying at the scale of the pre-treatment era, we have a massive problem. We look at the UNGASS and the High Level Meeting on HIV [in New York in June] together, and the High Level Meeting will be an ambitious meeting. We need a declaration from the UNGASS that is clear and explicit on its commitment to a rights-based framework. If not, it will have less impact on the High Level Meeting. When I see what happened in the Netherlands, people are not injecting at the scale they were before. There is a clear connection between the harm reduction policy and looking at the drug user as a person. This can take you very far and actually impact on the levels of injection. This is the evidence we need, and it is essential. There are other examples too – in South Africa, when they applied the evidence for HIV treatment, it made the difference between life and death for many people. They needed policy change, and it worked. There is a clear tendency for rhetorical polarisation, rather than looking at the evidence. For the High Level Meeting we are working closely with member states and the Chairs (Switzerland and Zambia) to avoid the rhetoric debates and focus on actions that save lives.

Oanh Thi Hai Khuat (SCDI Viet Nam): We work with the community directly, so I want to share this grassroots experience. Over the last 15 years, I have seen with my own eyes the change in my country – first with the harm reduction programme. Since 2006, when the programme started, the HIV prevalence dropped from 30% to 10%, and deaths are also reduced. We did a cohort study and found that people don’t get infected any more – we are close to ending HIV transmission in my country. We seem to be almost, almost there: among the drug user population that we work with, zero-conversion is rare, thanks to harm reduction. So I am disappointed when I look at the draft outcome document for the UNGASS and see that harm reduction is not there. How can this happen when it works so well?

It is also not only about health, but the people who are on substitution therapy in my country do not commit crime any more, they don’t violate the law any more. So what is the world waiting for? It is really important that we unite on this issue, share experiences, and state the right things in the UNGASS outcome document. My country has benefited from harm reduction, and I hope other countries will too. The other aspect is human rights. In my country, drug use is decriminalised since 2009. So only about 30% of our prison population is drug-related, compared to 70% plus in other countries. We did have some problems – we had compulsory rehabilitation for up to four years, mandated by law. Because of the support of the international community, our government is changing this policy and are looking to phase out these centres. Living through this, I have learned that policy change on paper is not enough. To sustain this, we need the real programmes on the ground to be evidence based and effective treatment programmes, and we need the experiences and support from countries that have gone through that. Donors were scared to be associated with compulsory detention, so they ran away. We are lucky that, through the Asia Action on Harm Reduction project, we were able to work with the government to establish the alternatives. With support from the Dutch government, we have some positive results to share. There were 123 compulsory centres with 110,000 people in one year. Now there are only around 8,000 people in these centres. Our government is making good progress, and we should acknowledge that. We need sustainable progress and support from the international community. This is why we need these elements in the outcome document, so the international community can help each other to promote this work. That is my hope, and I hope I will not be disappointed.

Kenyan MP comment from the floor: Thank you to the panellists for their encouragement. Kenya has 18% HIV among people who use drugs, and we need a clear understanding on how to formulate a programme that reaches people. No-one must be left behind, in line with the Sustainable Development Goals and the new UNAIDS targets. Member states must endorse the effectiveness and cost-effectiveness of harm reduction in the outcome document, which should also include alternative measures for minor and non-violent offences, and evidence-based drug treatment. Civil society must be involved, including people who use drugs, in decision making. A panel also needs to be established to evaluate current drug policies within the UN system. We want to get out of this mess. I also thank Kenyan government for the steps they have taken. They have put very clear measures in place. Any vessel on our coast carrying drugs will be blown up. So we must deal with this menace. We cannot finish AIDS until we have harm reduction. The UNGASS outcome document must show the political will from all governments on the issue of drugs to make sure that the world is free.

Zimbabwe comment from the floor: We officially support the AU position with the three pillars that they have for harm reduction, supply reduction and demand reduction. We in Zimbabwe have a big problem, and we know we will soon have a problem with injecting too. We must fight for these three pillars, and I agree that those who use drugs should be considered as people, not as criminals.

Chair: It is great to hear that African countries are supporting the AU position, and I hope that those not represented here in Vienna can also have their voices heard.

Question from journalist from VICE: If the UNGASS outcome document does not mention harm reduction, will the panellists consider it to be a failure?

  • Hendrietta: We want to see harm reduction in the outcome document, but I don’t think any African state would be hardcore enough to call it a failure. But for us, the core programmes need to be acknowledged – if not, the document will be a failure. It is not about semantics – we can negotiate what these programmes are called.
  • Luiz: I see the potential impact of the High Level Meeting in June to change how we deal with HIV. I agree that you can call these interventions what you want, but if they are not in the document – we will be killing people. The evidence is clear. Denying access is killing people. I welcome the voices from Africa, Africa is showing that they can change the global context. This is a change maker. The limit of negotiations is when people are starting to die. No member states want people to die.
  • Oanh: I see as a failure if the consensus among the UN family cannot agree harm reduction. This is not a new idea, so why do we have to avoid it? What politics are at play, and why are we accepting this ambiguity?

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