Side event: A call for leadership: HIV, human rights and harm reduction

Organised by Germany, Harm Reduction International, UNAIDS, UNODC, WHO, the International HIV/AIDS Alliance, Open Society Foundations, IDPC, the International AIDS Society and AIDS Fonds

Maria Phelan, HRI. We all know now that harm reduction works, but significant barriers remain today. We have a powerful panel today to explore the political positions on harm reduction and how the UNGASS process has reflected these positions.

Dr. Ingo Michels, Head of Unit, Office of the Federal Drug Commissioner, Government of Germany. Our government strongly supports harm reduction. In February this year we organised an Expert Group Meeting to discuss the harm reduction response. Participants highlighted the different aspects of the harm reduction response. Unfortunately, in the negotiation of the UNGASS outcome document we didn’t succeed in including this term. Some countries such as China and Iran which support harm reduction back home do not support it for the UNGASS. Harm reduction contents are part of the document, including reference to the WHO, UNODC, UNAIDS technical guidelines. Harm reduction is effective at reducing HIV infections. In Germany we have a large experience in effective harm reduction measures. We introduced OST with methadone, buprenorphine, morphine and diamorphine. We have 10,000 people in drug-free treatment facilities, NSPs, vending machines for providing needles, safe injection rooms. But the concept is broadening to stimulant use, but also to address social and economic harms as well as stigma and discrimination. On the outcome document – the incarceration of low level drug offenders is a concern for us as drugs are present in closed settings and harm reduction services are limited in prison. We also need a gender perspective as women are vulnerable to HIV, Hep C, stigma, discrimination, gender violence. NGOs should be included in any interventions on drugs. They should play a key role in providing services. Despite the scale up of harm reduction in many countries, local coverage remains inadequate. A significant upscale in harm reduction funding is essential in addressing existing coverage gaps. We hope this will be promoted in the UNGASS process.

Simon Beddoe, India HIV AIDS Alliance. Could you reflect on the EU position on the UNGASS and how these are reflected in the outcome document?

H.E. Ambassador Marco Hennis, Government of the Netherlands. We are not fully satisfied with the UNGASS outcome document, the phrase harm reduction is not mentioned. This is an important topic as we have some experiences also in the Netherlands. We need a recognition of the full range of health integrations – prevention, treatment, rehabilitation, but also harm reduction. We know it is a controversial element but it is common practice in many countries and regions. We encourage these countries to share information and practices in the global fora. Risk and harm reduction have proven their effectiveness in improving public health and reducing drug-related deaths. Dependent drug users should be considered as people in need of attention, care and treatment, social integration, tackling stigmatisation. The EU consistently expressed its concern on gender equality. During the UNGASS negotiations, the EU pushed for recognition on best practices in demand reduction and harm reduction. But in 2016, we should incorporate harm reduction in all documents. This is only the first step. We must also invest. The Netherlands is one of the few countries funding harm reduction in the framework of our international projects on HIV and call on other donors to do so. We intend to keep issues of HIV high on the agenda. We work closely together with UNAIDS, CSOs and governments to broaden support for harm reduction. In 2018, Amsterdam will be the host of the international AIDS conference, focusing mostly on key populations. We must focus on the humane approach to users. The right of the drug user to give an informed consent is paramount to effective drug dependence treatment programmes. Exceptions should be envisaged only in exceptional circumstances, following human rights and ethnics standards. Both for the Netherlands and the EU, evidence is critical. Drug policy should be constantly assessed and evaluated, we should rely on scientific evidence but also best practice from the field. The role of NGOs is critical here. We need them to build a reliable base of evidence. A meaningful and participatory role should be recognised for civil society.

H.E. Ambassador Maiyegun, Director of Social Affairs, African Union Commission. I am not as disappointed as you are since you just need to see how far we have come. I cannot count how many CNDs I have attended and the argument has changed. China and Iran but also others have come a long way. It is a matter of time. Within the AU, are we terribly disappointed? No. We have had 3 different plans of action, they used to be completely focused on supply reduction. Now it is a reflection of the way member states perceived an approach to drug control. In the last revision, there was a careful move to restore the balance in drug control. And it was amazing to hear various AU states. Quite a few countries have experiences on harm reduction. There are only few treatment services in Africa, most in psychiatric hospitals. Stigma drives you away from treatment. When you look at our common position before the UNGASS, harm reduction is mentioned. Was it acceptable to all? No, and it is not mentioned in the outcome document. But elements where we need assistance are reflected. There are a number of countries that cannot put money into treatment and harm reduction. You need to be able to separate treatment, harm reduction and harms caused to individuals and/or the whole society. We must set standards, we can encourage member states, but don’t have as much power as the EU in this regard. I hope that the outcome document will inform that revision when the time comes.

UNAIDS. It’s too early to tell the success of the UNGASS. We need to see how it gets translated into action on the ground. We have just published the report First Do No Harm. This takes our earlier position paper to a new depth, offers recommendations and talks about various elements of harm reduction, drug consumption rooms, treatment, etc. It also provides country context. If you look back in 2015, we had the SDG adopted. We put together global agreements. The 2030 Agenda is extremely ambitious. The whole document contains that level of ambition. If we look at the AIDS response, it is an incredible story. If you use the tools at your disposal, you can make remarkable progress, but it is fragile and success is reversible. 246 million people use drugs, 12 million injecting, 1.2 million of them living with HIV. There are 2 million new infections per year. Regarding the outcome document, it’s good to see different perspectives reflected. To see 193 UN member states adopt a common document is already an achievement. It’s not the first. This year we had a resolution on HIV at the Commission on the Status of Women. When we go to the HLM on HIV we will also have an agreement on a document. Regarding harm reduction, it’s unfortunate that it couldn’t be added as such, but there is progress. It is slow but steady and it is definitely not quick enough. We believe that the war on drugs is a war on people and it’s not working for tackling HIV. When you look at the 2011 target, progress we’ve made in 5 years is zero. We cannot say it is successful. We must push further to translate the outcome document into national plans. Only then will we see the new statistics on HIV infections coming down. We will see HIV featured in the UN Security General report and in the declaration of the HLM on HIV in June.

Dr. Cathrine Kyengo Mutisya, Head of Substance Management Unit, Ministry of Health, Kenya. Harm reduction in Kenya is spearheaded by the Ministry of Health in Kenya, alongside NGOs, the Minister of High Court and the police. We started many years later than other panellists. We started OST in 2014. So far, we have 1,087 clients accessing OST. We also have NSPs since 2013. Women have specific programmes. We are reviewing standards of operations to include other groups as well. More than 18% of injecting drug users are living with HIV, as compared to 6% among the general population. We have good strategic plans, we are still streamlining our policies. We have a national technical committee lying in the Ministry of Health, as well as a National Drug Control Authority called NACADA. We are seeing a shift with more drug users being referred to the court instead of being jailed. If we look at the comprehensive package of interventions, we are doing most of it already. Treatment, however, is not free so many people are not able to access it. Around the UNGASS process, we have a high level delegation here. We expect a shift and further support from the head of state. We know that as we move on there will be more emphasis on the public health aspect although we won’t neglect other aspects of drug control.

Germany. I work in Central Asia and we try to support Central Asian states to implement harm reduction. Most programmes, however, are funded by the Global Fund.

Canadian SSDP. What is the relationship between emphasizing harm reduction strategies and emphasizing demand reduction.  

Women’s International Lead for Peace and Freedom. I don’t understand why we should achieve consensus when there is so much disagreement. What were the nations insisting that harm reduction be kept out and what was the position of the USA?

Pat Ohare. People don’t really know what consensus means – it actually means compromise. I started working in harm reduction many years ago, and at the time the Netherlands was a beacon of light at the time. Harm reduction is about justice. Not believing in harm reduction is believing in injustice, stigmatisation. If you don’t believe in harm reduction, what do you not believe in? It’s common sense. The best harm reduction is to stop the drug war.#

H.E. Ambassador Marco Hennis. The USA has been supportive but not very vocal. When we talk about demand reduction, we have prevention, reducing harm, reducing public nuisance related to use and trafficking, fighting trafficking and dealing. You cannot cover the whole field. We have been learning a lot over the past 50 years. And then you know a bit better and can find a way out.  What makes us succeed a bit more than other countries is that we want to involve others and learn from others. We learn how to join forces.

H.E. Ambassador Maiyegun. You cannot have harm reduction without the broader context of demand reduction. We need care. Over time, the area of harm reduction has kept expanding. Where we do not do that, you may be successful initially but you need to fit this within a demand reduction policy.

UNAIDS. I want to discuss the issue of funding. You see from data that most funding is international, very little is national funding. We see from research that harm reduction does not increase demand. We have so much evidence now that these strategies work. We need balance but we must chip that balance towards where it works.

Dr. Cathrine Kyengo Mutisya. We have three centres and four more are getting prepared for disease control supported by UNODC and USAID, as well as civil society.

Monica, UNAIDS. I work with UNAIDS but I am also Dutch supporting key populations. The remark you make in demand reduction and harm reduction is interesting – the results in the Netherlands found that due to harm reduction there is hardly any infection among them, the group of drug users is kept alive, but there is no new group of injecting drug users. Injecting drug use is not popular, it is very cultural. It’s an interesting result of the introduction of harm reduction. I wanted to share this experience.

Georges. The cost of hepatitis C treatment remains extremely high. We need to see where the money goes.

H.E. Ambassador Maiyegun. First we should not forget those who are not injecting drugs. Drug use evolves over time. The negotiation of the outcome document took a year.

H.E. Ambassador Marco Hennis. The process is not easy. I am new in this field. It can sometimes help to be new. We still have 3 months to go in the EU presidency and we have a lot to learn in this process. The political declaration could be made much stronger. What we did in Vienna was not too bad. I doubt it would be shorter if the process had been brought to New York.  

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