Comprehensive health services for people who use stimulant drugs.

Monica Beg: 34 million people used NTS and 18 million used cocaine last year. NTS is second in prevalence of use to cannabis. Today the panellists will illustrate country specific responses and community responses.

Rafael Batista (Brazil): it is imperative to promote access to the most vulnerable in Brazils society, this side event creates a great opportunity to introduce the work we have all been doing

Rajiv Kafle (Nepal): stimulants are the main drugs used in Nepal and when we looked into it we had nothing we could give to stimulant users or opioid users, I’ve used drugs for over 30 years and been living with HIV for over 20 years, it’s a significant day for me to able to speak about my personal story and shows just how much the CND is changing. We feel the laws that have been implemented are too old and believe that it hasn’t been taken into consideration that different drugs work differently. I started with benzos then after 10 years moved to heroin, another 10 led me to heroin and now I use stimulants. We everyday discuss stimulant use in my network, and we see most programmes based on opioid use and non for stimulant – I cannot do heroin now due to my age and the pain of coming off of it. I have 25 orphaned children I take care of at my centre in Kathmandu. I am a drug user who has suffered not from the drugs but from a lack of understanding from policy makers and leaders of my country. Concluding, there is no programme for treatment, there is no need to panic we just need someone to talk to who can give accurate evidence of what we are going through. Stories come through users and stories that link stimulants to psychosis are not founded in evidence and is more likely due to lack of sleep. Countries do not fully understand how to tackle it. (…) students, workers, taxi drivers, us etc all use stimulants and that scares governments. We really need some good information we can get disseminate to users globally, but I stress we must not panic – like Duterte.

Nara De Araüjo (Brazil): HIV prevalence is higher amongst women than men (8.17% vs 4.01% respectively) over 50% of the interviewed women got pregnant at least once after starting using crack cocaine. Around 30% reported selling sex for money and are at a much bigger risk than men of facing violence in the crack cocaine market. (…) Brazil has the fourth highest female population in the world from 2000 to 2016 rate of incarcerated women increased 525% globally and 656% un Brazil. Challenges we face: we must develop strategies to provide access to comprehensive and integral support when these women are sexually assaulted. And strengthen structural interventions such as job creations and income housing and legal frameworks. Brazil has implemented combination prevention initiatives combining (…) we have a working group on PEP and there is a proposal to scale up availability of PEP at the health urgency care and emergency services in the country.

Gilberto Gerra (UNODC): if you put together amphetamines, cocaine and methamphetamines you have around 80 million people globally affected. I reiterate do not wait for the patient in the office and move to the patients in their office – start with food, clothing and dignity, a drop-in centre and improve housing, Medicines must be offered to those affected by stimulant use. (struggled to transcribe – no translator or speaker used) we need something to attract the people to the services – even if that is the drug itself.

Monica Ciupagea: Stimulant drugs and HIV are issues with many facets, not all stimulant drug use is linked with higher transmission of HIV and hep, only some are at risk, we know there are recent epidemics, Hungary, Romania and Greece for instant – also chem-sex has played a role. We have developed paper that. Our guide recommends 8 interventions 1. condoms and lubes, 2. needle and syringe programmes, 3. HIV testing services, 4. Antiretroviral therapy, 5. Evidence based psychosocial interventions and drug dependence treatments, 6. Treatment of STI’s hepatitis and Tuberculosis, 7. Targeted information education and communication (IEC) for people who use stimulant drugs and their sexual partners and 8. Prevention and management of overdose. The first training sessions will take place in Vietnam in about a month and are for community-based organisations and health personnel. Each module includes training objectives and outcome expectations, exercise and roleplay activities, case studies and additional resources.

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