CND Intersessional Meeting – 10 October: Operational recommendations on Demand reduction and related measures, including prevention and treatment, as well as other health-related issues

Charanjit Sharma (India HIV/AIDS Alliance) speaking at the thematic discussion on health-related issues.
Charanjit Sharma (India HIV/AIDS Alliance) speaking at the thematic discussion on health-related issues.

CND Chair: I propose that we tackle the more logistical agenda items 2 and 3 first, before moving onto the thematic discussions (agenda item 1).

Agenda item 2 – plans for the reconvened 59th CND (December) and the 60th CND (March). New nominees have been put forward for 2nd Vice-Chair (Brazil) and 3rd Vice-Chair (Nigeria). Elections will take place at reconvened session, as well as for the Bureau for the 60th CND: Chair – the Norwegian Ambassador Bente has been nominated from WEOG; 1st Vice Chair = Latin America and Caribbean; 2nd Vice Chair = Africa; 3rd Vice Chair = Asia Pacific; Rapporteur = Eastern Europe and Central Asia.

ECOSOC resolution 2016/246 approved the draft agenda for the 60th CND. We still need to decide on the duration of the meeting (proposed for 13-17 March with option of up to two more days). Also we need to agree the structure and theme for agenda item 4.

Agenda item 3 – any other business: letter received from the President of ECOSOC calling for contributions to HLPF on poverty. No other business.

I am now handing over to the Facilitator of the Post-UNGASS Discussions, the Portuguese Ambassador.

Post-UNGASS Chair. All delegations are encouraged to limit interventions to 5-7 minutes max, sharing experiences, lessons learned and information on concrete measures that help implement the UNGASS outcome document. If you wish to share more, we can make targeted presentations available on the UNGASS 2016 website. In line with best practice, UN entities and specialised agencies, regional agencies are also invited to share their perspectives. A representative of WHO and OHCHR will join us. I also welcome NGOs, including the VNGOC. To enhance the interactive nature, delegations wishing to make an intervention should raise their badge. I will use my discretion to grant speaking slots according to the flow of the discussion. UNODC will start by giving introductory remarks on each thematic chapter.

Aldo Lale Demoz, UNODC. We believe that by strongly focusing on the drugs and health nexus, the UNGASS has achieved a lot by granting prevention, treatment and care at the same level as other drug control imperatives. This is also prominent within the SDGs. The UNGASS document provides a sound roadmap to address the needs of all and those of vulnerable populations including women, youth and ethnic communities. It addresses the need to provide alternatives to incarceration, to provide human rights interventions, HIV prevention and care for PWUD, including in prison settings. UNODC is already working closely with member states and co-sponsors to end AIDS by 2030. We also work with WHO to develop a science-based practice for treatment of drug dependence and ensure access to essential medicines.

Gilberto Gerra, UNODC. It’s a great opportunity for us to address this session. It’s important for WHO to speak first in this discussion. We have 3 colleagues from WHO in Geneva here: department of mental health, of AIDS and of essential medicines. I want to start congratulating member states for what you wrote in the UNGASS outcome document – it is a compassionate, science-based document. We can now focus on what we can do in practice to reach people in need. I remind you of what you have written – dependence is a chronic and multifactorial health disorder. This is recognised by high level UN body now. You also focus on a science-based approach here. In the same period you have written two resolutions invoking dialogue with the scientific community. For people who have doubts about the complexity of this health disorder, look at the slide on the board. An article in 2013 showed that addiction was developing in response to stress, which was changing gene expression. This is also linked to vulnerability, abuse, self-medication. Practitioners working with drug addiction, politicians and public opinion still think it is due to weakness. What can we do then? We need to disseminate reliable information and engage public institutions that have not yet been fully engaged with this health disorder. We also need to engage scientists and prepare a new generation of policy makers with a different vision.

With regards to prevention, you mention the important evidence-based intervention of life skills, family skills interventions. This is becoming ridiculous if this is not being included in a broad health policy. Children and social protection, fighting school drop-out are the main prevention activities here. These are applied in less than 1/3 of member states. UNODC is preparing an updated version of the minimum quality standards in drug prevention. Look into this impressive data – looking into authoritative parenting. It is strong interest, care for children, and supervision. We obtain more than 30% of reduction in nicotine use. We have achieved the same for other drugs. We got the support of France and Sweden for the campaign ‘Listen First’. This article is supporting the idea that users should not just be targets, they should be partners. What can we do in practice? We must reduce school drop-out, work with the Ministry of Education, we need to focus on rural areas, work with parents, focus on 2-3 schools at first to experiment in a new way.

Now moving towards treatment – no stigmatising attitude, no discriminatory access (for now, 1/6 access treatment), focus on women (1/5 receives treatment). Ministry of Health should focus on treatment for drug dependence, allocate resources for treatment (we cannot wait for funds from outside), primary care doctors should be engaged. We start to create experience in each country on detox and relapse prevention. You don’t need 30 experts. You can start with a nurse, a doctor, a social worker and a few volunteers. You are in line with science saying how much the outcome is improving when psychosocial support is provided too in the field of medication treatment. This is the right formula. In my article from 2011, methadone treatment should be used properly, you need to fight prejudice. It should be used in a take-home way, under medical supervision. Drug-free weeks are much higher with naltrexone free release. We should continue research to identify tools for drug dependence. But don’t forget the co-occurring mental health disorders. We cannot treat only addiction, we need to treat co-occurring mental health disorders also.

We cannot ignore overdose deaths. We need to use naloxone, it can be used everywhere by medical professionals. A group at university can work on this issue. We need strong contribution of the health department and distribute naloxone to everyone, everywhere.

Participation in treatment should not be compulsory. It should be voluntary. It is not necessary to force people in treatment when you promote good treatment and good social support. You also need to provide alternatives to prison, this is included in the drug control conventions. Often punishment increases their addiction. Programmes in prison should also be provided and of good quality as it is in the community. Diversion of people should be done from criminal justice to healthcare. Most of the time, the criminal justice is unable to divert people, there is no possibility. For each prison we need outpatient services that are as cheap as possible. We prepared, with your support before the UNGASS and CND 2016, the international standards for the treatment of drug use and drug use disorders. We are now doing field testing in some developed and developing countries for adaptation of this tool on the ground. You can pick what you can do in your country based on your reality and what is doable with available resources.

Now turning to treatment for women – we must fight the double stigma of being a woman and a drug addict – we must facilitate access to women with opening hours and taking care of children. I start with a call to reach out to these women.

We cannot do anything without civil society organisations. We need an integrated model with government and CSOs working in an integrated manner.

Finally, I want to remind you of our programme with WHO which started in 2009 – practical cooperation for the treatment of dependence and care. This is a historical perspective where governments have recognised the suffering of people due to drugs. Thank you for your attention.

Slovakia on behalf of the European Union. The world drug problem poses a serious challenge for EU Member States as well as for many other countries in the world. For the last twenty years the EU and its Member States have invested substantially in developing responses to this challenge through effective, targeted, multidisciplinary and evidence-based drug demand policies. The Member States have laid down their agreement on this response in EU Drugs Strategies and Action Plans on Drugs, most recently the EU Drugs Strategy 2013-2020. Developing drug policies based on evidence and best practice, supported by objective monitoring and evaluation systems is at the heart of the EU and its Member States priorities to tackle the drug phenomenon. The EU Drugs Strategy is the only regional strategy which names the principle of evidence-base as one of its founding principles.

The EU and its Member States constantly invest in different projects aiming to improve the knowledge on the phenomenon of addiction. A 5 year research project ALICE RAP, dealing with addiction and lifestyles in Europe and bringing together around 200 scientists from more than 25 countries and 29 different disciplines, is just one example for the research efforts in the EU to pull together available evidence and generate new knowledge and insights that feed into the policy making process. The EU and its Member States also emphasise the need for a longer-term research agenda ERANID project focusing on strengthening cross-border research in various aspects of the world drug problem. The project unites researchers from different EU Member States and is a good example of overcoming the current fragmentation in drug research and developing a common strategic research agenda. The European Monitoring Centre for Drugs and Drugs Addiction  based in Lisbon plays a crucial role in producing and collecting available evidence and best practice and feeding it into the decision making process. Its online ”Best practice” portal, accessible to anyone interested, serves as an important database for sharing the existing knowledge on prevention, treatment, risk and harm reduction, social reintegration and some emerging topics, such as new psychoactive substances. We would encourage everyone interested in making evidence-informed decisions to use this valuable resource.

In the EU and its Member States drug addiction is addressed as a public health priority and there is a strong commitment in developing targeted, evidence-based and cost-effective interventions. In the framework of the balanced approach, the EU and its Member States are paying great attention to the full range of measures from prevention, early intervention, risk and harm reduction, to treatment, social reintegration, rehabilitation and recovery measures. Seeking to improve the quality of the above-mentioned interventions, the EU and its Member States have recently developed minimum quality standards in drug demand reduction. This innovative initiative lists 16 standards that represent a minimum benchmark of quality for interventions in: drug use prevention, risk and harm reduction, treatment, social integration and rehabilitation that Member States are encouraged integrate and implement in their drug policies.

The prevention of drug use and the delay of the onset of drug use are central in the response developed by the EU. Unplugged is one of the many projects funded in the EU to help young people to reduce risk behaviours related to substances. This school-based prevention programme, involved 143 schools and 7.079 pupils of 7 Member States in training activities and the strengthening of social and coping skills with the objective to reduce the consumption of drugs, alcohol and tobacco among youth.

As you know, the EU and its Member States attach great importance to risk and harm reduction measures and welcome the reference made to some of these crucial measures in the UNGASS outcome document. We would encourage other Member States to consider this recommendation as a priority recommendation when implementing the UNGASS outcome document. As regards the situation in the EU, some Member States have a long tradition of harm and risk reduction activities, even in prisons, and most recent data indicates that over the last years most EU countries took specific action to ensure the availability of and access to evidence-based risk and harm reduction measures. The current available evidence strongly supports that opioid substitution treatment, including support by psychosocial interventions, keeps patients in treatment and reduces illicit opioid use and mortality. All EU countries have implemented opioid substitution treatment and needle and syringe programmes which have proven to be effective measures to prevent and control infections among people who inject drugs, and the coverage of the two programmes increased considerably in the recent years. The World Health Organization estimates that every year failure to provide opioid substitution treatment leads to 130,000 new HIV infections. In Europe we have a long established evidence of using controlled substances to effectively reduce morbidity and mortality caused by the consumption of drugs, in particular heroin. We have developed best practice in the prevention of infectious diseases and reduction of drug related deaths. As a result of these measures taken in many EU Member States there was and still is a significant decrease of infectious diseases.

An estimated 1.2 million people received treatment for illicit drug use in European Union Member States during 2014 – among them an estimated 644 000 opioid users received substitution treatment. Methadone is the most commonly prescribed opioid substitution drug, received by 61% of substitution clients. A further 37 % of clients are treated with buprenorphine-based medications, which is the principal substitution drug in seven EU Member States. Other substances, such as slow-release morphine or diacetylmorphine (heroin), are more rarely prescribed, being received by an estimated 2 % of substitution clients in Europe. Opioid substitution treatment is estimated to cover more than 50 % of Europe’s problem opioid users. In many countries a majority of opioid users are, or have been, in contact with treatment services.

Let me take this opportunity to emphasise once again that there is a vast amount of evidence and best practices developed in many countries across the world that demonstrate the effectiveness of opioid substitution treatment. Today, evidence suggests clearly that these measures do not only improve the health of our people but also save lives. And we are all aware that the WHO Constitution enshrines that “…the highest attainable standard of health as a fundamental right of every human being.” Opioid substitution treatment is in place in all EU Member States and we will be working hard to further increase its coverage. We would be pleased to share our experience with all Member States which see the availability and expansion of opioid substitution treatment as a necessity and priority. At the same time, we are also aware that the misuse of opioids and the diversion from medical practice can bring negative consequences. Thus, to-date, the European discussion on the misuse of prescribed opioids has focused on the need to reduce the unintended consequences of substitution provision through appropriate prescribing practices. Increasingly, attention is also being given to restricting the illicit production and trafficking in synthetic opioids.

allow me to say a few words about other risk and harm reduction measures applied across EU Member States. Data from 23 Member States representing together more than 250 million EU citizens show that around 36 million syringes were distributed to people who inject drugs in 2014. However, the real figure is higher, as a number of large EU countries do not have centralised syringe monitoring and therefore do not submit estimates. Among other risk and harm reduction measures used in EU Member States are low threshold testing, outreach street work, counselling, distribution of condoms and kits with sterile material, monitoring and treatment of blood born infectious diseases, set up of mobile harm reduction teams, HIV testing, antiretroviral treatment. As part of a comprehensive system of harm reduction responses and to address specific harms, six EU Member States provide highly targeted services such as supervised drug consumption facilities and eight EU Member States provide take-home naloxone programmes. The EU and its Member States are determined to further increase the availability of and access to evidence-based risk and harm reduction measures, as foreseen in the current EU Drugs Strategy. We would like to take this opportunity to encourage other countries to follow the same path and stand ready to share our experience.

The EU provides support to third countries in the area of drug demand reduction. One of the four priorities of the Cooperation Programme between Latin American and Caribbean countries and the European Union on drugs policies (COPOLAD) since 2011 provides for capacity-building in the reduction of demand (prevention, treatment, rehabilitation and harm reduction related to drug consumption).

To conclude, I would like to recall that the EU and its Member States have continuously stressed the importance of recognizing the role of civil society and the scientific community in the formulation, implementation, monitoring and evaluation of drug policies at local, national and international level and enhancing their contribution to the decision making process. In the EU an important mechanism for achieving this is the Civil Society Forum on Drugs – a platform of 45 non-governmental organisations, representing a wide spectrum of approaches to drugs policy, specifically created for feeding the voice of civil society into the EU decision making process.

China. On demand reduction, we must continue to stick to the 3 drug conventions. We need to stick to the reduction of supply and demand. In demand reduction, we must pay high attention to health cooperation and law enforcement agencies, focus on abstinence treatment, recovery and reintegration into society, preventing drugs at all levels of society and communities. We want to present our good practices.

First, prevention. We must pay high attention to the importance of prevention as a strategy to make people realise the harms of drugs and stop use from the source. Prevention first should prevail. We need to take all forms to conduct prevention programmes to raise awareness for people to have a resistance from drugs. We must have a system from all government levels and sectors, with a nationwide prevention network. Prevention is an important component of education across the country, to cultivate a culture of cherishing life and staying away from drugs. Youth should be the target of prevention. In China, 66% of addicts are young people 18-25. To prevent use, we have developed preventive and educational interventions at school. At the present, China has established 36 prevention education agencies at provincial level. 90% of schools in china have a prevention curriculum. We have also established prevention mechanisms to link schools and society with community programmes. We also target high risk people who work in this area to tailor programmes for them. We must be innovative in prevention measures. We must expand coverage and increase the quality of prevention interventions. In 2015, we developed diversified outreach activities. We also took advantage of the website and internet to conduct prevention interventions. The website receives 3 million visits per day. We have a weekly messaging of mobile phone newsletters. Public awareness has really increased on the issue.

On the treatment aspect – we must establish comprehensive treatment services to put people first, combined with the involvement of the scientific community. China has adopted anti-drug laws and regulations to treat patients. We have a good network of all elements of detox, rehab and reintegration to society. Voluntary detox, community based detox, will be applied together to ensure a strong network. The results achieved are very good. We also actively explore effective methods for treatment and rehab with a network system for treatment, rehab and care. We also emphasize education on treatment. Supporting the patient and addict to seek employment and security, as well as preventing HIV among these addicts. China has already established about 27,000 community-based treatment services. We registered millions of addicts who have not relapsed for 3 years. Combination of voluntary and compulsory treatment and detox – we encourage users to register voluntarily and we then cover the patient’s needs. Compulsory measures also help addicts. In our law, community-based treatment is prominent, but for those who refuse to go voluntarily or violate the agreement of detox, or go into relapse, we adopt compulsory measures for them to stop using drugs. For these people, we also adopt isolation and work in these facilities. We strive to save and educate patients, promoting measures of treatment in an integrated manner. Fourthly, in safeguarding human rights – we believe that addicts have the right to treatment. Our law protects the dignity and make sure that they are not discriminated against in schools or employment. But there must be balance and a comprehensive understanding of safeguarding the human rights of the addicts, but we are opposed to the use of harm reduction measures as a pretext of facilitating drug use or legalising drugs.

Brazil. The UNGASS and its outcome document represent an important milestone. We consider that to build a meaningful path towards 2019, we must work on implementation. We reiterate the importance of a demand reduction policy. I underline the role of civil society. We remain committed to the implementation of evidence based demand reduction policies based on prevention, treatment, care and reintegration. I want to thank Mr. Gerra for his presentation and the importance for an integrated and engaged approach. When recognising the importance of prevention, we should not focus on fear and stigmatisation strategies. We focus on ethical practices, focusing on youth and children trained by expert professionals focusing on violence, crime and drug use prevention. We highlight our commitment to focus on treatment through the public health system. We also focus on the harmful consequences of use such as HIV and hep C, providing free ART and free hep C treatment regardless of whether the person uses drugs or not. Facing the world drug problem will not be full unless we promote risk and harm reduction, including for stimulants and cocaine. We need to focus on the social and economic circumstances as well in this regard.

Argentina. We trust that your efforts in the next 4 intersessional meetings, we will be able to share a rich discussion on the implementation of the outcome document. As you know, chairman, following the establishment of the new government in Argentina in 2015, demand reduction has been a new pillar of our administration for a balanced approach on demand, supply, putting the individual at the centre. Competence has been shared by SEDRONAR, the Ministry of Security and the Ministry of Health. The policy has been implemented through the Plan for Argentina for Combatting Drug Trafficking. The aim of the programme was to eradicate drug trafficking and reduce drug use. I want to share how this has been implemented nationally.

The compilation of evidence and data has been done by the Argentinian drugs observatory. We have made efforts to strengthen national drugs observatories, through geo-referencing, epidemiological centres, national surveys on prevalence and use to systematically collect data on drug use at national, provincial and local levels. We have also established three projects with Colombia, Mexico and Uruguay to strengthen community based treatment. The programme also seeks to exchange information, certification for treatment programmes, as well as for early warning mechanisms.

I also want to touch upon the prevention interventions in Argentina to prevent addiction in primary schools, as well as for ongoing education of youth, including through sports. We also started launching interventions through football associations. Now turning to programmes of Municipalities in Action bringing together all departments at local level, this programme ensures cooperation among government agencies to address the use of NPS. This phenomenon requires special features at the local setting.

Now turning to the federal drugs council – this brings together national and provincial government agencies to coordinate policies, plans and programmes geared towards drug prevention. To date, four meetings were held in various parts of the country. Post-UNGASS, we have developed cooperation with other ministries, including drug courts with the Ministries for Justice and Human Rights, as well as treatment of problematic drug use. Finally, we developed guidance for drug addiction in the community. The centre provides addiction and care units, a helpline providing guidance. All of these are examples which are correlated with the recommendations contained in the outcome document of the UNGASS. It is noteworthy that the local and national authorities are aware of the contents of the UNGASS and work in parallel to implement its contents.

Canada. We are grateful to brief you on our comprehensive, collaborative, compassionate and evidence based approach to demand reduction – prevention, treatment and harm reduction. Prevention is an essential component of our approach at all levels of government and relies on the expertise and cooperation of NGOs in many instances. Many of our approaches are focused on vulnerable communities.

We also regard harm reduction as essential including through the prevention of infectious diseases, and bringing people into contact with health support. We include naloxone, safe injection sites, and heroin assisted therapy. We are particularly concerned by the ongoing opioid overdose crisis. We are working to support better treatment access and improving decision making. We have introduced regulatory measures for low dose dexamorphine. A significant body of evidence supports the use of this substance for patients with serious, life-threatening situations where other forms of treatment have failed. We also focus on naloxone nasal spray, without a prescription, to be accessible by police and families. We will look at the next summit on opioid overdose prevention. We will continue to work with all stakeholders to implement our action plan on this matter. We are also committed to improve the participation of NGOs and the scientific community. We remain committed to sharing more.

Guatemala. Once information has been compiled on these intersessionals, we will need to decide how to use this information. In Guatemala, we have initiated a dialogue on how to reform our national policies based on the UNGASS outcome document. We are strengthening our institutions where there is a need for technical assistance and international cooperation.

My government is in the process of implementing these measures through an institution in charge of prevention, treatment, rehab and social reintegration of former drug users. As part of a vision of shared responsibility. It also provides provisions for the Ministry of Health and Interior to prevent unnecessary stigma, punishment of people who use drugs. When it comes to demand reduction, this entity is focusing on prevention, information sharing, awareness of the negative impacts of drug use, and the need to promote healthy lifestyles. The National prevention and education programme also works to prevent the negative impacts of drug use among families and communities.

Another programme was developed in collaboration with Panama to focus on the negative consequences of drug use including preventing HIV. Another programme focuses on helping build capacity in prevention programmes among youth. We work with youth leaders to prevent the negative impacts of drug use. We also create awareness on the impacts of the use of drugs among the community with radio broadcast services. We provide psychosocial assistance and care as part of social reintegration in the labour market by providing workshops for skills training. We also have non-residential care centres for men and women focusing on new psychoactive substances. Guatemala is allocating part of its national budget towards these actions. We feel that a balance must be struck in budgeting between demand and supply measures.

France. France fully subscribes to the EU statement. I want to also focus on the prevention of drug use. It was during the special session that France, together with UNODC and Sweden, on prevention. Our approach as we have developed to prevention is based on a combination of universal and selective prevention targeted at youth and vulnerable populations. We also have prevention targeted at vulnerable people. Our plan is based on scientific evidence around the dangers of drugs and improve the ability of adults to reach out to young people to identify drug use at an early age, and focus on early intervention as soon as we identify the first signs of drug use or risks of drug use. We have set up structures to support drug users and their families, we have centres that deal with addictology for young consumers. These centres also provide trainings for parents. In April 2016, we also created an internet portal: Addict AID, Le Village des Addictions, which gathers information resources and exchange of opinions to provide solutions. The aim is to facilitate information search and provide a knowledge sharing tool.

Post-UNGASS Chair. So far, all interventions have been to the point – providing information on the UNGASS recommendations. We now have a further 28 delegations wishing to take the floor – but I will now give the floor to the first NGO delegate and a UNODC speaker. Governments can also provide more information which will be put on the website of the UNGASS. But please do follow the guidelines of the 7-8 minutes.

Forut-Campaign for Solidarity and Development. Thank you for giving us the opportunity to contribute from the NGO side. The UNGASS outcome document provides us with a comprehensive and balanced strategy. The most obvious weakness is the lack of strategy to mobilise people and local communities. Primary prevention is by far the most powerful and cheap way to reduce drug related harm. As we have heard from Mr. Gerra, international standards are important. They are reiterated in the outcome document. The most effective of all is when programmes are combined with community based multicomponent initiatives. We need to mobilise 1 million communities in the range of prevention. We need to sketch a model to mobilise communities – Community Cooperation in Drug and Crime Prevention.

Let me describe the model – element 1: mapping of the ground situation in a specific area to create a baseline and identify challenges; element 2: identify risk and protective factors, local particularities; element 3: identify strategies to address these risk and protective factors (classroom management, spare time activities, involvement of parents and peer leaders, etc.; element 4: establish a cooperative structure involving all actors in the community like schools, social services, police, CSOs and networks; element 5: monitoring of results and drug use prevalence; element 6: establish a national structure and umbrella. So many people are already on board. If established information and campaign is correct, it is easier to establish good attitudes than to change them. We need local action, mobilise citizens and communities in the next 3 years.

Monica Beg, HIV prevention, treatment and care section, UNODC. The UNGASS outcome document represents a unique opportunity to address human rights and public health. Under SDG 3, and the UNGASS outcome document, member states have committed to end aids by 2030. What does this mean in concrete terms? This means that the world needs to achieve a 90% reduction in HIV infections by 2030, reduce 75% of new HIV infections from here. Sadly, according to new estimates, the number of new HIV infections has become stable so far. We have missed the UNGASS on AIDS target of 2015. We must embark on a fast track response. This map shows 36 countries with ongoing HIV epidemics among PWUD (in some countries it’s not injecting, like in Brazil, it’s among stimulant users).

This map shows countries where UNODC is providing technical assistance. You notice a big gap between UNODC technical assistance and those countries with ongoing HIV epidemics, and this gap might become worse in the next year with funding issues. UNODC is the co-sponsor of UNAIDS on HIV. To strengthen cooperation between UN and non-UN actors, we work with many entities including OHCHR on matters of common interest.

We facilitate CBOs and NGOs, we build the capacity of the police to focus on human rights approaches for PWUD. Convictions for drug use are massive impediments to HIV prevention. We focus on promotion of alternatives to conviction and punishment of drug use and possession for personal use.

We also promote a harm reduction comprehensive package. But the coverage remains too low. Only 10% access OST. We must actively expand these services. We are also developing guides and trainings for women who use drugs, PWID, and HIV among stimulant users. Over the years, technical support we provided has yielded results in Afghanistan, Nepal, Pakistan, etc. We also provide services in prison, we expanded ART in Africa and Latin America.

To improve NGO involvement, in 2013 we established an HIV CSO group with a joint annual work plan with UNODC. It is consulted in the area of drugs and HIV. We partner with CSOs on alternatives to conviction and incarceration. They are also our main implementing partners. Improving data collection is also critical, we do this via the UNODC World Drug Report.

We have made significant strides in implementing the outcome document. Much remains to be done to fulfil if we want to end AIDS – we have the tools and arguments. We must invest time and commitments wisely.

Russia. I want to extend my congratulations to you and to the new UNSG. I want to underscore our efforts based on international law, first and foremost the 3 UN drug conventions. They are our guiding star in all our efforts to countering drug abuse. In terms of our internal policy, we have seen a reduction in the number of teenagers and an increase in the number of people above the age of 45 who are using drugs. Consumers are looking for assistance at an older age. This change is due to the fact that people are using later, and drugs are less attractive to people. We see this in surveys. There is a move away from cannabinoids towards synthetic drugs. In terms of NPS, we have seen new substances emerging every year. State policy to counter this is effective.

We have an outreach promoting healthy lifestyles, we target certain populations. We focus on prevention and examinations of people for drug abuse. We have around 40 million people who undergo prevention examinations, including children and young people. When we find people who use drugs we send them to treatment. We also have alternatives to incarceration for those who committed minor crimes for the first time. We also have rehabilitation. We have a treatment based approach, with multidisciplinary teams of psychologists, social workers and addictologists. Medical assistance is provided free of charge by the state. We have dispensaries, enabling us to target sub-social groups. It also enables us to achieve long-term remission. We are working extensively to provide follow up to patients too. This approach is effective in terms of reducing the threat to people.

Portugal. The measures adopted in Portugal are part of an integrated approach, favouring treatment and care above punishment. Universal prevention is part of our curriculum provided in civic education studies, awareness raising and education, protecting schools from drug trafficking. Targets are students, school staff and parents. Prevention aimed at university students, in work places and military are also implemented.

On treatment – the move away from punishment has focused on providing referral networks encompassing specialised services, NGOs, experts in the provision of care, free of charge on a voluntary basis. OST is widely available in Portugal in NGOs, pharmacies, hospitals, care centres, etc. In 2014, more than 6,000 people were receiving OST. OST is also available in prison. A network of harm reduction programme structures has been consolidated throughout the country to target social exclusion, HIV, infections, etc. This is included in the national health services and they are free of charge. All 9 UN interventions are available in the country. A decreasing trend in new HIV cases has shown the success of the programme. There was a decrease in injecting drug use and sharing of drug paraphernalia. In 1997, 60% of new cases were among PWUD. Now, only 5% of new cases of HIV were among PWID. The number of PWID has declined also. There was also a drop in overdoses: 380 in 2000 to 33 in 2014. Drug use remained stable below the European average. This is an integrated and comprehensive strategy where each element reinforces the other.

Mexico. I want to echo previous speakers in welcoming your facilitation. For Mexico, the preparatory process has shown that demand reduction measures must address prevention, early intervention, treatment, recovery and reintegration. It should also reduce to a minimum the negative impacts of drug use, curb stigma and discrimination that impede quality healthcare services. There is also a gap between policy and clinical practice. Academia and NGOs should therefore be involved to comprehensively include all social and economic factors that accompany drug use. The WHO should be more involved to support the implementation of the UNGASS outcome document. I also want to raise this question – what does a public health approach really mean and how can it be applied to a demand reduction approach? Can it be possible if we seek to reduce use at all costs? We need prevention, harm reduction and treatment of drug use.

Uruguay. Uruguay welcomes your presence here. We want to commend you for convening this CND intersessional on the follow up to UNGASS 2016. We thank Mr. Gerra for his statement, it is a valuable contribution to the discussions. The UNGASS and its outcome document have established a before and after in tackling the world drug problem. Our demand reduction is based on prevention, treatment, harm reduction and social reintegration. The concept of prevention has been superseded with strategies based on fear. We focus on promoting complementary strategies to delay initiation of drug use and connecting spokespeople from different levels to target the local and community levels with skills building and promoting a healthy life. We provide our population access to healthcare as a fundamental right including prevention, treatment, social reintegration and harm reduction. We also improved monitoring and control mechanisms. We have established a range of actors working together to achieve an open and constructive dialogue to enhance activities such as education and employment for people using drugs, focusing on a sense of citizenship. We also have harm reduction as an ideology, an array of principles. The control of substances is also a way of reducing risks and harms. We reduce social stigmatisation.

Vladimir Posniak, World Health Organisation. At the UNGASS, the Director of WHO emphasized WHO’s preparedness to implement the task given by WHO in the session. We welcome the high attention given to public health in the outcome document. In the report of WHO in May 2016, the cooperation on drugs was described under five pillars: 1- prevention; 2- treatment and care; 3- prevention of harms; 4- access to medicines; 5- monitoring and evaluation. The 69th WHA decided to include drugs on the agenda for January 2017.

On prevention of drug use, WHO continues its work on effective and cost-effective interventions, promoting healthy development of youth and adolescents. See for example the latest Lancet study. We also focus on the development of drug use prevention guidelines, we also continue to disseminate information on the non-medical use of cannabis. We also produced guidelines on road safety and drug use. WHO continues its work on early identification and early intervention in the health sector and training of health professionals. The use of NPS presents new challenges for health professionals and we are developing tools for NPS. Another activity is prevention of drug use and disorders for pregnancy, alongside alcohol and tobacco prevention. We are working on reviewing the classification of substances which will be released in the next months in Japan.

We will promote the inclusion of certain cannabinoids in schedules. We will review a number of substances in November, including on cannabis. We will continue close cooperation with UNODC on the impact of naloxone to prevent naloxone deaths. We are working with UNODC on field testing, international standards for demand reduction, public health oriented interactions between public health and criminal justice.

Today, the WHO mental health and substance abuse department is meeting in Geneva as we are celebrating Mental Health Day, and will discuss management of substance use disorders/mental health issues. WHO stands ready to strengthen technical assistance including training, capacity building and technical know-how.

We work on strategic cooperation in the field of HIV as incidence continues to increase. We focus on the fast-track approach with UNODC and UNAIDS, promoting harm reduction services based on evidence of effectiveness for OST and NSP combined with other harm reduction services. In May 2016, the WHA adopted a new comprehensive strategy aimed at reaching this fast track strategy by 2030 in line with the SDGs.

The main objective is also better coordination and harmonisation to improve epidemiological data on use, health and well-being. We now use data collected from member states, UNODC and mathematical modelling. A new programme was established to improve the global estimates we have.

We are committed to strengthen cooperation with UNODC, UNAIDS, NGOs, etc. to combat the world drug problem and implement the UNGASS outcome document.

Turkey. We welcome the opportunity to implement the outcome document. I want to summarise recent steps taken by Turkey on demand reduction. We adapted a new national anti-drug strategy and action plan in April 2016, integrating a comprehensive strategy that defines drug use as a health matter. It developed as a strategy of cooperation with Health, Security, Transport, Education, Customs and Trade, Justice. Implementation is conducted by the Ministry of Health. We focus on awareness raising of society as a whole. Prevention modules for students were developed, trainings were conducted throughout the country. The Ministry of Education and Turkish Green Crescent Society signed a protocol for drug prevention throughout the country.

On treatment, an initiative improved the role of primary care actors. The capacity of healthcare professionals engaging in addiction treatment was also increased. We also continue to strengthen institutional capacity in this field. We work on social reintegration in collaboration with NGOs. In the field of data collection, we provide data to UNODC whenever possible, and to the EMCDDA.

Australia. I thank you Mr. Chair and the CND Secretariat. We welcome the opportunity to discuss demand reduction. It is key to addressing the world drug problem as agreed in 2009 and more recently at the UNGASS. Effective measures to minimise causes and consequences of drug abuse are important to addressing demand. Australia’s national approach is consistent with UNAGSS recommendations – we address the health and social consequences of drug abuse with prevention, early intervention, treatment including relapse prevention, and comprehensive harm reduction.

A strong evidence base will be necessary. We need to strengthen this evidence base. Our demand reduction approach is inclusive. Engaging with families, communities and civil society, including government ministries, is important in addressing the world drug problem. We focus on the broad spectrum of prevention, harm reduction and treatment. We recognise the importance of early intervention for youth. We have integrated treatment programmes focusing on abstinence or replacement therapy. We have special programmes for those who are most at risk.

Our harm reduction programmes are also based one evidence including OST, NSPs, a safe injecting place, diversion towards treatment. By decreasing disease, injury, violence and crime, the benefits of harm reduction expand to the individual, families and communities.

Australia encourages broad cooperation and coordination between UN agencies such as UNODC, WHO, INCB and others. The CND is a forum to share experiences and lessons learned in cooperation with all relevant agencies and NGOs.

Philippines. I congratulate you, Mr. Chair, on your position. I reiterate the Philippines’ strong commitment to the UNGASS outcome document. The fight against drugs starts with preventing drug use among young people with awareness raising campaigns. An informed individual is an effective weaponry to combat use, including with law enforcers and teachers. The 2014 survey in the Philippines shows the role of peer pressure among young people. To reach the youth, we implement a programme among youth: ‘Buddies against Drugs’ where youth have information about drug use in school and impacts of drugs. Programmes involving art are also being implemented. Targeted programmes focusing on public awareness and capacity building are being implemented. The national and local government units are also involved. To accommodate drug users who have voluntarily surrendered, we will use current healthcare centres that will be tailored to provide in-patient treatment. We cannot emphasize enough the important role of CSOs, academia, faith based organisations and youth officials in demand reduction. We believe in the value of collaborative efforts. For example, the Philippines and other countries were involved in the Listen First campaign. We believe that the campaign can contribute to protect young people from experimenting with drugs.

United States. I welcome you Mr. Chair, and WHO and CSOs. We welcome the UNGASS outcome document’s affirmation of a balanced approach to drug policy. It should include 4 components: prevention, treatment, recovery and prevention of stigma. We must help countries to move away from programmes that do not have a record of success. We have a prevention curriculum that is based on international prevention standards focusing on families, schools and the international community. It provides comprehensive materials for prevention. In 2016, 60 countries have used this curriculum. The international standards developed by UNODC also provide us with useful materials in this regard. The USA has also worked with international researchers and trainers for the treatment of children’s substance use disorders, going towards also addressing risk and protective factors for vulnerable children. The federal government provides grants to communities for prevention, enabling them to develop local solutions. State and local governments have a responsibility in this regard. In Chicago, there is a programme working with the criminal justice system. Law enforcement is also developing front-end diversion programmes without entering the criminal justice system. To support youth recovery, there are recovery high schools. Lastly. The US government is trying to change the language of dependence to reduce the stigma and encourage more people to seek and receive the care they need. We plan to provide more detail on the UNGASS website.

Colombia. Thank you for your facilitation and the Secretariat for its efforts. On operational recommendations in demand reduction, the national council on narcotic drugs in Colombia has adopted a national plan based on health and human rights, to improve access to and quality of services for drug users. Trainings and capacity building programmes have been developed. As part of the implementation of this plan, we have received support from NGOs. We have undertaken actions for implementation of the outcome document. When it comes to prevention, we are implementing prevention among children, adolescents, and our main programme is oriented at families between the age of 10-14, with support from the World Health Organisation and UNODC. We are evaluating the success of the programme. Other NGOs are evaluating universal prevention programmes in the country. We are implementing capacity building programmes, community based provision at school and university as part of prevention and mitigation measures. We have a national technical committee to combat drug use. On the recommendations to establish national centres for youth, we have involved centres for sport and the Ministry of Education. Turning to improving systematic provision of information, we are conducting surveys on NPS abuse. We are implementing the Inter-American drug control strategy. The national drug use programme recognises the need to consider use as a health issue.

Nationwide, actions are being established for comprehensive health programmes. To ensure inclusiveness of national policies, we are conducting prevention of opioid overdoses. We are working with cities and NGOs providing timely care for overdose with the use of naloxone. We are removing barriers for the provision of naloxone. We also have assistance from other countries to provide NSPs, care, assistance and guidance, HIV prevention and care, ART, etc. We also have a methadone substitution programme free to all citizens. We also have mobile OST units.

To conclude, we want to thank the WHO contributions. We want to build on the UNODC and WHO partnerships to adopt a public health approach to drug use. It is important to identify measures based on evidence to further the comprehensive public health approach to reduce HIV infection and other blood borne diseases. Finally, it is important to share information based on evidence to combat stigma, marginalisation and discrimination. It is important to include people who have been involved in drug use in this regard.

Peru. On Goal 1 for health, we want to highlight the establishment of the national programme for prevention and treatment for people who are in conflict with the law ‘Puedo’. The objective is to help reduce the number of young people falling into crime. The programme is based on a diagnosis to address the risk factors youth are exposed to, explaining why people engage in criminal activities. One factor is the use of drugs and alcohol. We are undertaking steps to train adolescents. We are also building the capacity of staff working in juvenile centres. Emphasis is placed on drug use as a risk factor. As regard to adult, we have the ‘Reto’ programme to build social skills for those who leave prisons. This programme is coherent and seeks to promote the reintegration of individuals undergoing treatment and rehab. This has been used as a preventative tool. It helps people develop social skills to engage effectively with their environment.

Iran. A balanced approach is still working. We are happy that we had the good information for this approach at UNGASS. We need more time than 2019. My country is leading for both demand and supply reduction, but we need time to prepare budget and special laws based on the recommendations of the outcome document. I was given information comparing 2015 and 2016. We have already started good programmes but need more time to implement the UNGASS outcome document. We suggest that the target date be extended to implement the outcome document after 2019. Maybe 2025 as we have the target for HIV being extended. But I can give reports for activities we have. We started focusing on prevention in schools. We have many trainings for parents, in schools and work places. 3 million people were trained. We started having prevention and trainings in urban areas. For the activities so called ‘harm reduction’, we had 400,000 people treated as this policy in about 6 months, in collaboration with NGOs. I appreciate experiences from other governments. I hear the EU has 21 minimum standards – I find this information to be very useful. But this, or Mr. Gerra’s presentation, should not be for diplomats, it should be for people in the field. We’d appreciate for UNODC to share this. I requested this many times, especially for overdose where interventions can save the lives of NGOs.

Post-UNGASS Chair. I want to react to the statement of Iran – we are trying to see what member states have done only a few months after UNGASS. It is difficult but we are trying to keep the momentum. We understand that some countries have difficulties in implementing this, but we didn’t want the document to be placed in a drawer. We are providing countries an opportunity to share and push for interventions.

Harm Reduction International. Harm Reduction International is a non-governmental organisation working to reduce the negative health, social and human rights impacts of drug use and drug policy.  Ahead of this year’s UNGASS on Drugs and High Level Meeting on HIV, we launched a declaration calling for a new approach to drug use rooted in science, public health, human rights and dignity – for a harm reduction decade.  Our call was endorsed by over 1100 organisations and individuals.

The UNGASS did not deliver a harm reduction decade, but it did secure the strongest ever endorsement of harm reduction in a UN document on drug control.  Paragraph 1 specifically mentions “medication assisted therapy”, “injecting equipment programmes”, “antiretroviral therapy” and “opioid receptor antagonists” for the treatment of overdose.  The Political Declaration on HIV and AIDS again commits to scale up these interventions, noting the lack of progress in reducing HIV among people who use drugs and the impact of restrictive laws in hampering access to services.  Both documents urge States to provide harm reduction in prisons.

Now, it is time to turn this language into real progress.  It will not be enough come 2019 to measure what countries say – we need to measure what they do.  We need progress targets which will measure coverage of the four harm reduction interventions which the UNGASS document names, including coverage in prisons; which will examine whether States are removing restrictive laws, including those which criminalise people who use drugs; and vitally, which will look at harm reduction funding.

Research by Harm Reduction International and the Burnet Institute has shown that by redirecting $7.5 billion from drug enforcement to harm reduction – equivalent to just 7.5% of the estimated $100 billion spent each year – we could end AIDS among people who inject drugs.  Harm Reduction International’s 10 by 20 campaign calls on governments to go a little further and redirect 10% – enabling us to pay for prevention and treatment of viral hepatitis, life-saving naloxone and support for networks of people who use drugs to be directly involved in policy-making.  The UNGASS has signaled a more balanced approach to drug policy.  We must now redirect funds accordingly.

Finally, we must also ensure that this brave new approach, and not the now outdated 2009 Political Declaration on Drugs, is the starting point for the next Political Declaration on Drugs.  If now is the time for progress, 2019 must be the moment to go further and to secure a decade of drug policy with harm reduction as a guiding principle.

Uganda Youth Development Link. Addiction needs to be treated, recovery is possible. We have developed drug-free contracts for students. We are promoting drug-free lifestyles. We have established support groups such as alcoholics anonymous. We currently have very few support groups. We have trainings across the country but we lack professionals. With this structure, we want to reach to 1 million addicts. We use religious institutions as it is easier than the state. In Uganda, 98% of people are religious, so we can reach out to a large segment of the population. With your support, a lot can be achieved in Uganda.

Belgium: The EU declaration underscores the importance of acting decisively on harm and risk reduction measures. When it comes to prevention of HIV/AIDS, Hep and other infectious diseases, UNODC important actor. First funder: UNAIDS core fund; and also bilateral funds. UNAIDS Support catalytic efforts from headquarters and in various regions: targeted advocacy, technical assistance, global guidance development, resource mobilisation. Belgium and UNAIDS signed a multi-year agreement 2016-20. It renews Belgium’s contribution (4M/year). Crucial to achieve fast-track targets. The AIDS section of UNODC produces vital contribution for these efforts. Belgium strongly supports UNAIDS and UNODC on HIV/AIDS.

United Kingdom: The EU declaration underscores the importance of acting decisively on harm and risk reduction measures. On treatment, recovery is at the heart of our drugs approach. More people are in recovery than in 2009-2010. Access to treatment in less than 3 days. Number of users of cocaine and heroin are declining. We provide evidence-based treatment, with guidance written by experts. Support for users must move beyond the clinical: housing, social network, support. We include these, including needle exchange, distribution of foil, OST, naloxone distribution, protecting individuals from the risks of drug use. All these tools needed to get people into treatment and toward recovery. Measures recognised by the WHO. The UK welcomes the reference to the WHO guidance in the outcome document to UNGASS. Pursuing SDGs, need to acknowledge HIV/AIDS efforts. Prevention, UK has programmes to provide confidence, resilience and tools to reduce misuse. Ex. Rise Above, for 15-year-olds. FRANK updated to reflect trends. PHE has launched toolkits on specific issues around new psychoactive substances (NPS). School programmes, Alcohol and drug prevention and education information services.

Norway: Nothing much to report in terms of changes. We will focus on this statement on principles. Health is essential for human welfare, and drug policy. UNGASS was meant to review progress and identify challenges. The process attracted enormous attention. Excellent basis for further discussion. The international debate is progressively focused on health and wellbeing, and the role of health and policies as a means to reduce harm of drugs to society and individuals. Long way to go to reach sufficient balance. Need to implement harm reduction services. Harm reduction measures are essential and insufficiently recognised. It’s also a tool for drug users to achieve abstinence. Not sufficient in itself. Access to treatment, rehabilitation and support also needed. Drug use and ill health are interlinked. SDGs provides a good framework to tackle drug problem and public health.

Netherlands: Balanced approach: health related and judicial responses equally important. Prevention, early detention, treatment and harm reduction. Monitoring and evaluation are very important too. Three examples of practices essential for successful demand reduction policy: 1) Unity project, adult users through peer support to share information and risks. App to provide reliable information about health risks of drugs (and warnings when drugs appear to be more dangerous. 3) Invest on support for people who use drugs. Recommendations on GHB detoxification, for instance. 3) Reduce blood borne disease: NSP, rapid testing, OST, counselling. Ex. Bridging the Gaps & CAHR. Success in generating behavioural changes among people who use drugs. Reduce injecting drug use.

Indonesia: Demand reduction should be conducted in a comprehensive and integrated manner. Prevention to post-rehabilitation programmes, to achieve drug-free societies. We follow international standards of prevention. Family programmes are currently scaled up. Prevention to cure addiction and provide addicts with means to integrate into society. Government based centres and community/NGO centres for prevention. We include evidence-based treatment, in partnership with civil society too. Need to enhance coordination among authorities. Measures against those involved in drug abuse and trafficking. Successful demand reduction programmes require coherent action of different public authorities and agencies. Important to implement recommendations by outcome document according to national legislation and the international drug conventions.

Venezuela: Many of the recommendations are a part of Venezuelan legislation and practice. Concerning demand reduction and related measures and other health-related matters, one of the pillars of the Venezuelan anti-drugs office is prevention, through various activities targeting in particular children and young people. Promoting healthy lifestyles through sports, cultural activities, etc. As part of the involvement of communities, we could highlight the funding of prevention programmes provided by the Venezuelan anti-drugs fund, which allocates resources to communities to create fora to encourage healthy lifestyles. Achievement of unification of public and private systems of treatment under standardised free and inclusive system.

Ecuador: Outmost importance of prevention, one of the main strands of counterdrug policy. We have fully implemented the recommendations contained in the UNGASS. The main projects: strengthening departments to focus on comprehensive prevention of drug use through workshops to help instruct professionals, updating lists of controlled substances and providing this information, promoting inclusiveness (training and capacity building for teachers), working with the Ministry of Education and the technical antidrug secretariat, projects in schools and communities. Zero-drugs missions brigades led by these institutions. Awareness raising campaigns. Implementation of joint efforts between authorities and teachers. Capacity building and wareness raising among drug users. Joint programmes with UNODC to prevent drug-related crime. Strategic alliances with Red Cross, Scouts, training volunteers. Training under Ministry of Health. Providing intensive mobile care unit nationwide to strengthen 39 mobile care units across the country. Working with an age and gender sensitive approach. Programmes to promote healthy lifestyle and recreational leisure. Clear warning against the use of drugs. Encouraging analysis of drug policy by our universities. Cooperation agreements to promote inter-collegial activities towards healthy lifestyles. Complementarity between UNODC and WHO.

Switzerland: Insufficient coverage of risk and harm reduction programmes in the outcome document. Leaving behind drug users will preclude the achievement of zero HIV infections. Harm reduction, distinguished colleague from China, is not legalisation or being permissive with illicit substances; it doesn’t stand alone, it’s a part of a comprehensive strategy. Overcome consumption phase with the smallest level of harm. Harm reduction interventions also reduce nuisance of consumption to general public (ex. Less misdemeanours, less discarded paraphernalia, less open-air use).

Singapore: Methamphetamine and heroin most abused drugs. Focusing on prevention: first line of defence in the fight against drugs. Comprehensive and targeted approach to drug education. Wide audience in a variety of ways: always say no to drugs. There’s no such thing as a soft drug. One cannot expect to experiment with drugs and not get hooked. Parents, educators and peers play important role in antidrug message, so the country supports them. We educated young people on harms and the need to avoid use. Regularly explore new ways to reach young people: an app “Aversion” with a game to teach not to engage in drug use. Testimonies from ex-abusers with real life stories. Equip parents, teachers how to detect signs and obtain help. New toolkit also in this regard, for teacher and parents. Social and traditional media for general public (apps, anti-drugs apps). Jackie Chan is Singapore’s first celebrity anti-drugs Ambassador. Medical professionals on cannabis to dispel misconceptions. 90% of youth agree drugs are harmful. Some countries have shared specific options that work for them. Before we explore how each option works for each country, we need to contextualise each case. No one size fits all. Full menu to identify what is useful for each situation.

Japan: UNGASS as a vital opportunity to intensify anti-drugs efforts. Prevention of drug abuse is a high priority since 1998. We promote intervention programmes based on CBT, to treat and rehabilitate drug abusers. This and law enforcement, lifetime prevalence of cannabis and meth 1% and 0.3 respectively. Successfully contained the expansion of the drug problem. Demand reduction approaches should be based on human rights and fundamental freedoms. Japan has started new legal measures for rehabilitation period for incarcerated abusers as alternatives to incarceration.

Chile: Unwavering commitment to promote conventions and drug control system, but also ultimate aim of the system is health and wellbeing of humankind. Real balance between demand and supply approaches, and cross cutting issues like human rights, gender and development of inclusive societies. Higher budget for treatment. We review our drug laws and take into account UNGASS. In Gender, as part of 2030 agenda for SDGs, we established National Council to implement Agenda 2030, which coordinates all sectors for the implementation and follow-up of the agenda. It will provide a report on the state of compliance and identify main challenges. Need to have participation of different units.

Nigeria: UNGASS provides a critical opportunity to reassess action. Most of the recommendations are already a part of Nigeria’s plan. Unplugged programme for young people being implemented in schools across the country. Multimedia drug control initiative, including twitter and Instagram campaigns. Phone counselling being trialled. Embraced multifaceted and multi-sectoral approaches. Capacity-building programmes as well as treatment and care. Inclusion of CSOs. New standard operating procedures for healthcare office to ensure quality treatment, rehabilitation, aftercare and social integration. Prison settings upgraded to provide quality service. Rates of HIV transmission is gradually declining within the general population. Concern about rates among PWID. We are committed to ART provision. Key target is to reduce substance abuse.

NGO Alliance India Harm Reduction Initiative | International HIV/AIDS Alliance (Charanjit Sharma): Access and quality to harm reduction services still challenging. Death rates still high. Most interventions function in silos. Overdoses still a threat. Harm reduction interventions when implemented to scale can improve health outcomes. We urge member statres to include sexual and reproductive health services. Multi-sectoral approach requires dedication and commitment. Call upon the government to take lead to end AIDS as a public health threat. End the criminalisation, remove death penalty and ensure proportionate sentencing, close compulsory treatment centres, scale community based treatment centres. Establish community committees at the local and national levels to improve implementation. Encourage non-punitive approach and appreciate those who continue to support evidence based and rights centred approaches to HIV.

Gilberto Gerra, UNODC: 1) Public health means different things in different contexts. Need to increase resources. Discrimination in rich countries against HIV/AIDS patients. 2) Possibility of relapsing is always present in addiction and support is needed, but goal should continue to be abstinence.

Aldo Lale Demoz, UNODC: Happy to provide briefings regarding to our work in prevention to anyone demanding so. The challenge of stimulants must be taken into account and it is very good that Brazil shows leadership on this. Important point by Belgium about funding of work on HIV/AIDS by the joint programme and collaboration with UNODC.

Chair: Grateful to UNODC for their support.

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