Committee of the Whole (Thursday morning). L9: Promoting measures to prevent transmission of HIV for women who use drugs, including by improving access to post-exposure prophylaxis

Chair: We now move to L9. I give the floor to Brazil who has led on the resolution and informal consultations.

Brazil: We had 4 informals on this resolution. This has been quite constructive, we have agreed on a good number of paragraphs, and on many paragraphs we have opened language that was similar to the case of the Norwegian resolution where we could not agree on the use of ‘people who use drugs’, ‘women who use drugs’ and ‘drug users’. I ask for the Chair to use your guidance to use the same wording and language for L4, to allow the resolution to move forward. I will start with PP1. The first five PPs were agreed all together in informals in the spirit of compromise. I bring this to the delegations here to see if we can keep the text as agreed for the first PPs.

Chair: We can move to the preamble paragraphs and then the OP

Brazil: we have agreed and discussed to only approach the title once we have an agreement on the context of the resolution.

PP1

Chair: move to the first preambular paragraph. I see no objection. It is approved.

PP2

Russia: We have a technical question. I do not understand what they mean in the second line. ‘which states in its article 25 that everyone has the right to a standard of living for their health’

Brazil: I am not sure what the concern was of the Russian Federation

Chair: it should be ok if it is the exact text? No objection. It is approved.

PP3

Chair: Any comments on this paragraph? It is approved.

PP4

Chair: This is approved. PP5 – any requests from the floor?

Russia: This is a technical amendment, please add a comma after ‘prevention’.

Chair: Can we approve this paragraph? This is now approved, thank you.

PP6

Chair: We move to PP6. This para is now approved.

PP7

Chair: We move to PP7.

Brazil: To introduce the discussion: this is a PP from resolution 60/11 which includes the mention of the needs and challenges of women who use drugs and those who suffer from the use of others. We have agreed it in informals and I hope I can count on the flexibility of other delegations to move along.

Canada: My apologies, to clarify: are we agreed on the text as noted there or do we agree on the text without the strike out?

Brazil: The original is with the language that is shown as deleted, so please reinsert it, this is agreed language from resolution 61/11.

Chair: Can we agree on this paragraph?

Russia: To be on the safe side, can we ask which para of the resolution is reproduced here?

Brazil: To clarify, this is the last PP of the resolution 61/11.

Chair: Any other comments on this para? This is now agreed. We now move to PP8.

PP8

Russia: To bring this in line with resolution 60/8, we want to add ‘drug’ before ‘demand reduction’, now reading ‘drug demand reduction’.

Germany: I have an editorial question to the secretariat: in PP7, we quoted exact dates of resolutions, but this is done differently in other resolutions – is this common practice or should we strike the dates of the resolutions?

Chair: Thank you, we note this editorial change and this will be done by the Secretariat.

PP9

Chair: We now move to PP9, are there any comments? Can we agree on this? I see no objections, this is now approved.

PP10

Brazil: I suggest that for PP10, the title of the resolution include ‘drug users’ so we agree to change ‘people who use drugs’ to ‘drug users, including women who use drugs’ – that way we mention the title of the resolution, while mentioning also women who use drugs.

Egypt: This para would need to go back to informals, we are not comfortable with mentioning Resolution 61/11 here.

Pakistan: I add my voice to the recommendation from Egypt.

Russia: I agree, we need to send this to informals, we cannot add anything to titles of resolutions. This removes their sense.

Chair: We put this in brackets and move to the next para.

PP11

Chair: Any comment on PP11? This is now approved.

PP12

Chair: We move to PP12.

Brazil: On this para, we bring information from the World Drug Report 2018, that talks about women who use drugs, and uses the expression ‘women who use drugs’, so we wish to keep this mention here when we refer to the Report. There is going to be a footnote to the World Drug Report.

Australia: Brazil has given enormous effort to ensure that we can accommodate language reflected in individual reports. This will come in front of the chair time and time again. I support Brazil in ensuring that we keep the original language in the texts cited. Thank you.

China: China has the reservation on the use of ‘women who use drugs’.

Chair: Last time we agreed to use the text in resolutions and other documents, I call on your flexibility.

USA: I want to recognise the productivity we built last night when we agreed to align with the source document in terms of language. We appreciate your leadership in guiding us with this resolution.

UK: Likewise, I echo your comments and the USA’s. With respect to China, we have precedent on previous resolutions, and distinguished delegates agreed previously today to keep with original text in the spirit of cooperation.

Germany: Maybe it could help, similarly to L4, to say that we ‘express deep concern, according to the World Drug Report’, adding the date of ‘2018’. This might alleviate concerns from colleagues from China.

Russia: We also believe that if we agreed to stick to language of the reports, it should be fully reproduced. We need more time to explore this para. But this para includes different compositions and elements. We need to stick to the language of the report and avoid improvisations here.

Egypt: We are also a bit confused. The message to convey here is in line 4, and the last 2 lines. In line 4, we say that gender-based violence against women who use drugs is 2 to 5 times higher than for women who don’t. In the last line, we say that these factors increase the risk of acquiring HIV, creating the link to what we are looking for – links between violence, HIV and drug use. We can go along with the Russian proposal to have the full text from the World Drug Report, or just say we express concerns that gender-based violence against women who use drugs is higher and this contributes to the risk of acquiring HIV and hepatitis C as compared to men. Maybe our idea would be better conveyed here.

PP13

Chair: Comments?

Brazil: As we are collecting information from the World Drug Report, we would rather the expression be “people who use drugs”.

Chair: Approved.

PP14

Chair: Comments?

Brazil: Just to clarify. This information comes from the UNODC Practical Guide for Service Providers on the Response to HIV. There was a request to add “drug treatment”, which we would be willing to accept. IN line with the information in the guide, we would keep “gender-based and stigmatising attitudes”.

Egypt: As we always mention with “stigmatising attitudes”, the language agreed last year is “promoting non-stigmatising attitudes”; that’s the only formulation my delegation can work with. Maybe we can come back to this in informals? So, we ask for this to be bracketed.

Brazil: I wanted to hear if the United States would be ready to make the comment or if they can accept the language, so that I can offer consensus language.

Canada: Just a very technical point. Not sure it will help my colleague from Egypt. PP7 from resolution 59/11 recognised “marginalisation, stigmatising attitudes, and fear of legal repercussions…”. So, just to clarify, it’s not quite accurate that this language is new. The nuance here is “gender-based”.

United States: We believed that the sentence was “accessing drug treatment services as well as services for HIV and other health needs”.

Chair: We will keep this paragraph in brackets.

PP15

Brazil: Here, we refer to the content of the Practical Guide, which refers to women who use drugs who have shared injecting equipment. So, we would like to keep the mention to the Guide. With regard to the provision of emergency contraception, this is also from the Guide. We are reflecting the wording in the Guide.

Pakistan: I’d like to put on record some observations. I clearly remember this part when we discussed language on abusers, users, etc. We agreed to stick to language in similar contexts. We are willing to accept this perspective if it’s captured in a balanced manner. There are references to one particular perspective now; but not to the other perspective. We’re willing to continue to offer space, but other perspectives need to be reflected. This is not just about this paragraph but a general comment.

Egypt: We had an extensive discussion yesterday about emergency contraception. We have shown a lot of flexibility with regard to other ideas that were presented, such as pre-exposure prophylaxis in exchange that some other ideas, such as emergency contraception, would not fit in this resolution. Thus, we kindly ask other delegations to respect that flexibility and keep the part in brackets, [emergency contraception], stricken out.

Guatemala: We had extensive discussions yesterday and my delegation was one of the delegations expressing concern because of these expressions and phrases. Yesterday, I brought the good news that we had instructions to accept the language we had discussed except the part on “emergency contraception”. We need to insert “in accordance to national legislation”. We would have no problem as long as we add that conditional.

Brazil: Following the speakers, I agree that Thursday’s the day of flexibility and we have to move forward. As the sponsors, we would be willing to stop this sentence at “clinical follow-up” if we’re able to agree the text.

France: This is a very important topic. In particular, if we want to act in a right and effective manner. I would point out to delegation, having indicating they were uncomfortable with access to emergency contraception, that in this paragraph we’re taking note of a UNODC Guide. There’s nothing binding about this paragraph. We’re taking note of a Guide with recommendations. It’s regrettable to not be able to find agreement on this text initially proposed by Brazil.

Russia: If we provide the reference to the technical Guide, we do not need to mention each intervention. People can read the Guide. We echo our Pakistani colleagues. When we discuss terminology, we have shown much flexibility and our concerns should be taken into consideration when we draft the title of the resolution. When we talk about “women who use drugs”, which women? Women for nonmedical purposes? Or do you mean abusers? Misusers of medical drugs? “Women who use drugs” creates confusion. Which category? Maybe a footnote on the scope of the resolution?

El Salvador:I was going to propose the proposal of Guatemala but can go with Brazil.

Germany: As France said, we take note of a practical Guide here. Whether you like it or not, this is in the Guide. It’s a pity we don’t want to mention it. In the spirit of consensus, we can go with Brazil’s. “In accordance to national law” makes no sense here because we take note…so this is nonbinding.

Canada: I support my colleagues from France and Germany, acknowledging the excellent work Brazil has done to seek consensus. We access the deletion as suggested. I think we’re missing the letter “E” in “especially”.

Egypt: I agree with Germany that the word is there whether we like it or note. Which is why we show flexibility by “taking note”. We are willing to go along with Brazil’s suggestion.

Brazil: We thank all delegations for their flexibility. I’d like to request you if you could propose the acceptance of the paragraph with this flexibility shown by everyone. As a follow up to the Russian Federation, I request the Secretariat, from UNODC, when they’re prepared, to explain to us what they mean “for women who use drugs”. We have a hard difficulty when it’s challenged here. This is not a new term, so I ask UNODC to provide an explanation.

UNODC: When we use the term, we refer to women who use narcotic drugs, in many countries illicit drugs. Not people who use medicines.

Chair: Considering views and comments by several delegations. Despite 4 requests of the floor. Can we agree on this paragraph as is?

United States: We would like to remove the word “of” before “clinical”.

Chair: Can we agree on this text?

Russia: We agree and thank the Secretariat for this clarity. I would like to add “for nonmedical purposes” to “women who use drugs”. It would help my delegation to work on this draft.

United Kingdom: Prior to Russia’s amendment we were happy to go along with the paragraph as it was suggested. The idea of emergency contraception is very important to us. And given we’re “taking note”, it shouldn’t be problematic. Going back to Russia’s comments. We strongly support the use of “women who use drugs”. We’re grateful for the clarification. With regards to “women who abuse drugs”, not all women who have suffered sexual violence have been using drugs.

Belgium: We support “women who use drugs” as it has been used before. We thank the Secretariat’s explanation of the scope. It’s sufficient. We cannot agree with adding “for nonmedical purposes”.

Guatemala: We thank the extreme flexibility of Brazil. We have listened to delegations’ red lines and not expressed objectives to comments. But the phrase “in accordance with according legislation” was not a proposal by Guatemala but other countries. At that moment, I said I would consult with capital. 20 minutes later, capital said yes. We heard the flexibility of the main sponsor, so we have no objection to delete everything after “follow up”. That was our proposal. As far as to the explanation by UNODC of “women who use drugs”, this is the language for resolutions, guides and guidance. So, if we’ve used this before, I don’t see why we cannot use it here. We would have to change all the paragraphs. Thursday noon is not the time to do that. In a spirit of mutual understanding and trust, we should accept the explanation and use the terminology by UNODC. At this point, using a new expression and add explanations to the term will add complications. Many delegations would revert to their original positions.

Brazil: I would like to ask UNDOC if they would not use this definition on every single paragraph. We could have a footnote.

UNODC: there is no definition in the guide. We have the World drug Report. We will try to draft a definition to be added into the footnote if it is requested.

Canada: we would have preferred the original text, but we will support Brazils compromise. I would like to make it clear that women who use drugs for medical purposes also have problems. In our country, we have a misuse of drugs that are prescribed. I urge member states not to get caught up in the non-medical purposes.

Chair: this paragraph needs more consultation. It should be put into brackets. Consultations can be considered in the informals.

PP16

Spain: I think in the resolution we dealt with before we said ‘antiretroviral’ so we would have to do that here too.

Russia: the amendment in the Norwegian resolution was focused on viral hepatitis C. We see no merit in changing it.

Germany: we cannot agree with the Russian federation.

Colombia: this is an exact quotation from the UNGASS. It is preferred to take the agreed language.

Chair: Can we agree?

Norway: What do we mean when we use ’antiretro’

Secretariat: Antiretroviral refers to the medication people use when living with HIV, antiviral refers to other viruses.

Germany: do you want to copy mistakes from previous years and arguing that it is agreed language? There must be a point to correct it? I pledge that we delete ‘retro’

Chair: is the room in agreement with the deletion of retro?

Spain: In the same vein as Germany, are we going to take the decision to consolidate agreed language that is technically wrong and make the same mistake over and over again because it’s agreed language? This would be regrettable. We are a commission of experts here. We have to abide by science and what scientific proof tells us.

USA: We are going into technical waters here. The way we read this mention is for the prevention of HIV, not treatment. Antiretroviral is correct for prevention. My suggestion is not to add language into this agreed text. We need to focus on the prevention of HIV here as it is the focus of our resolution.

Australia: I ask we maintain antiretroviral. In L4, we focused on hep C and used antiviral. Hep C here can be covered by ‘other relevant interventions’. The word ‘antiretroviral’ is the correct term in this PP.

Colombia: We agree with what Australia and the USA have pointed at. We are not a commission to just repeat agreed language, but we are referring here to a specific document. We should not reinterpret a document agreed in 2016.

Canada: We can see both sides of the discussion. Antiretroviral is specific to prevent HIV transmission, and antiviral therapy is broader. Considering the time we have spent here to be specific in our language, we’d have a preference for using ‘antiretroviral’ here.

Chair:We have to stick to agreed language.

Spain: For the sake of consensus, we could actually delete the term, and say ‘therapy and other interventions’ that apply to the interventions to follow, without entering into detail of which medication would be administered in this case.

Chair: Can we approve this para as the original? I see no objection, thank you very much.

PP17

Chair: I see no comments.

PP18:

Pakistan: Conceptually, this para is missing something important. When we are discussing the ‘grave concerns’ of barriers, why are we not recognising here the fact that member states have different levels of development? Some states cannot allocate more resources, so why are we ignoring this reality? This is very much captured in the SDGs. We want to keep this para in brackets and get back to it.

OP1

Brazil: I understand all the concerns of the different delegations, but I request that you put forward proposals when you make a request so that we can move forward and find solutions. I want to consult you on the time we have left, and on the paras agreed in informals.

OP4

Chair: There are no comments on this OP, let’s approve it.

OP6

Egypt: We are ready to agree on this para but point out that in informals we agreed to pre-exposure prophylaxis here only if we do not mention ‘emergency contraception’ in the next Ops.

Colombia: As was mentioned in a previous para, we suggest to add ‘in accordance with national legislation’ at the end of this para.   

Chair: This para is now approved.

OP10

Chair: Any comments?

Russia: On the third line, we want to add a comma after ‘HIV and drug use’ and we would prefer to use ‘in prison settings’ rather than just ‘prisons’.

Pakistan: Should we add ‘through’ before ‘national investment’?

UK: Just a question to UNODC: is there a distinction between ‘prisons’ and ‘prison settings’? From my understanding, would prison settings include other places of detention?

UNODC: There is a difference. Prison settings include all forms of places where people are held when waiting for trial or during short-term arrest.

OP11

Chair: Can we approve this para? I see no objections. It is approved. I ask Brazil to consider the paras we have not discussed.

Egypt: We are ready to agree to this paragraph we are just noting, we will not agree to the mentioning of emergency contraception, We will not hinder the agreement to this paragraph, but we want this in mind when discussing the incoming paragraphs.

Colombia: The will of any individual, it was handled by the different legislation, add at the end when appropriate and with national legislation.

Russia: After HIV and aids and drugs we would like to put ‘as it was in the preamble part’, and we would prefer in prison settings.

Egypt: Just an editorial, in the last should it not be including through national investment

UK: Just a question to the UNODC, is there a distinction between prisons and prisons settings, could prison settings also discuss detention for example? I would appreciate a clarification from the UNODC.

Brazil: PP.18 was a concerned express by the delegate of Pakistan, I just wanted to provide a piece of information. It is agreed language from resolution 61/4 from, I’d like to see if this would provide the delegate with the flexibility to accept this paragraph.

We added by the request of one delegate, treatment for drug use in line two, so we added that to the agreed language.

Pakistan: I just was reflecting on how we can make some small changes without totally trying to redraft the language. I would like to introduce a slight change. Our concern is that this paragraph should also acknowledge that countries have varying levels of development. Perhaps o the third line after no barriers, whilst also recognising the different levels of national development and capacities.

Russia: This is language we agreed in the preious resolution, my question is which infections do we mean here? Are we talking about HIV and hepatitis?

USA: We were very comfortable with the agreed text being brought forward from last year, had the phrase and paragraph so we could all see ourselves init, and all the issue we all face, specifically women experiencing from poverty. We felt that the pargraph that Pakistan is making and therefore

Brazil: Definitions thank regarding STI. The appropriate expression could be treatment for drug use disorders., is this with the UNODC the confirmed understanding and slightly confusing for my delegation.

UNODC: We prevent drug use, we treat drug use disorders.

Egypt: My delegation still sees in the proposal put forward by Pakistan, we would like to propose a different formulation, instead of lack of sufficient resources, we can say the challenge that faces developing countries in mobilising resources.

Belgium: We are willing to go along with the initial wording as it coding for an existing resolution, now we are in a different situation, is just treatment enough, are harm reduction services are facing multiple barriers, so it is not only treatment, but also aim and reducing social consequences etc. Our proposal would be to have a more broader term, access of woman to … reduction services.

Pakistan: With so many further amendments we would need more time, we believed our delegation was the most neutral one, countries are at different levels of development, then if that is contested then why do we always discuss technicalities? We request small time to capture a different perspective

Brazil: we should add ‘to ending the AIDS epidemic and elimination of’ we can remove ‘combat syphilis’.

Chair: is the room ready to agree on this paragraph as a mandate?

Australia: could the delegation of Brazil clarify? Changing ‘contribute to’ to contributing would change the message. We recommend the leave the wording the way it was. This caveat is important to give the meaning of the paragraph.

Brazil: I have received this request from the delegation of Egypt. We are not trying to restrict the efforts of member states. I do not think this language does this. I request member states to take another look to see if they can agree on the proposal

Egypt: We are happy to go along with the proposal from UNODC. We would prefer to keep the proposal from Brazil; if not we can take it to informals.

Chair: We will resume our work at 15:15 on the resolution L3. We will need to continue after 18:00, but there will be no interpreters after this.

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