Reaching Global AIDS Targets Through Harm Reduction and Reform of Restrictive Drug Policy Frameworks

Co-sponsored by the Mission and the Kingdom of Thailand, the Mission of the Republic of Kenya, the World Health Organization, the International Network of People Who Use Drugs, the International Drug Policy Consortium and Harm Reduction International.

Moderator: Matthew Kavanagh, Special Adviser to the Executive Director for Policy, Advocacy and Knowledge at UNAIDS:

Distinguished representatives and member states, community representatives, dear colleagues, on behalf of all of the co-sponsors of this event let me just welcome you. The co-sponsors of this event are the Mission and the Kingdom of Thailand, the Mission of the Republic of Kenya, the World Health Organization, the International Network of People Who Use Drugs, the International Drug Policy Consortium and Harm Reduction International. I would like to welcome you to this side event that is titled Reaching Global AIDS Targets Through Harm Reduction and Reform of Restrictive Drug Policy Frameworks. This side event is organized in the framework of the 65th Commission on Narcotic Drugs which is an important global platform at which we are able to discuss along with other human rights issues, the topic of ending AIDS for people who use drugs. Friend, we have made remarkable progress in the last few years in regards to the target of ending AIDS. We had believed that this would be impossible in a pandemic for which we have no vaccine and no cure but we are not on track, we missed our Global targets in 2020, and this remains a crisis for many communities. Which is why we are so heartened to have the colleagues we have here today to talk about what is working and to focus on those areas where we can move. Last June, UN member states at the general assembly adopted a remarkable political declaration pledging to end AIDS and inequalities. It sets out bold targets to get us back on track and among the most important and the hardest are the targets on harm reduction and decriminalization. I want to be very clear that these are evidence based commitments and they are very bold commitments for member states to have made. Under our last 5-year strategy, countries that took a punitive approach made less progress. At a population level fewer people living with HIV knew their status, fewer were virally suppressed with effective treatment. That is why UNAIDS is a strong supporter of HR and decriminalization of drug possession for personal use. Scientific evidence clearly shows that these are two major enablers in ending aids and ending inequalities that are driving the pandemic. The question we are going to discuss is the pathway to achieving those bold targets, how can we as the joint UN programme support countries on their journey to 90% coverage of HR and the removal of harsh penalties for the personal use of drugs. We know orc Legal reform is challenging, as we move to try to decriminalization drugs it requires long term and consistent advocacy and requires strong partnerships between communities with public health officials that are driven by science and government officials that are driven by bold politics. We also know that quality and accessible harm reduction programmes take time, they require strong community systems and leadership from people who use drugs. We also know that we face a massive funding shortfall when it comes to scaling these up directly in low and middle income countries. There are challenges created by global crisis as well, we are living it seems in an era of crisis so i want to note that the war in Ukraine has not only put the lives of millions of people in danger but it could destroy the truly remarkable, world leading in many ways health and community infrastructure in Ukraine, so we must stand in support of the heroic efforts of communities and health systems and leaders to prevent the interruption of HR services. So let me with that move into introducing our speakers. Our speakers today are champions of drug policy reform and of harm reduction throughout the world. We have with us today, Doctor Apisak who represents the Government of Thailand, a country that over the past 20 years has really seen a shift in a law enforcement oriented approach to a public health drug policy. We have speakers from diverse communities of PWUD including communities of young people, women, and indigenous people. So I will introduce each when they come to speak. So let me start with Dr. Apisak the Assistant Director of the Narcotic Control and Management Centre at the Ministry of Public Health in Thailand, medical doctor by profession, Dr. Apisak specializes in addiction treatment and clinical epidemiology, he is the co-author of the Thailand guidelines for HIV prevention and care for people who inject drugs and he’s developed a chapter on methadone maintenance therapy. Dr. Apisak is welcome and you have the floor.

Speaker: Doctor Apisak, Assistant Director of the Narcotic Control and Management Centre, Ministry of Public Health, Thailand:

Good afternoon everyone, thank you Dr. Matthew for introducing me and honour the speakers and audience. I am assigned to share about the policy in Thailand that changed all the time since the opium era until now the policy changed into the human centred policy. So first of all i like to begin about the background of policy, as you know before, in 1990 major drug problem in Thailand and indo-China was opium and heroin as the region of good quality plantation, government at that time deal with the crisis with the concept of abstinence based treatment and state prohibition with intensive penalties. That is very hard for people and for society to see what happened about the withdrawal from opium. The opioid problems after intensive penalization, went underground and became less popular. But as many of you know, around the year 2000, NPS and methamphetamine time stimulants were rising instead of opioids in Thailand. At that time Thailand faced a lot of problems socially from stimulant use disorder and stimulant related violence. The government at that time declared the war on drugs and declared and launched the drug rehabilitation laws. Since 2003, after the rehab laws were run effectively, next year in 2003 and 2004, 400,000 seeking treatment due to the fear of extreme penalties phenomenon but unfortunately all healthcare facilities and non-health care detention units by probation cannot provide enough drug treatment and care. Again, abstinence based concepts still remain the main concept in Thailand that made unfavourable outcomes and expectations for providers and society. The vicious cycle of relapse, dropping out, made more social stigmatization. There’s a lot of ambition to write down many support or orders under the drug umbrella or drug rehabilitation acts. harm reduction and activities such as MMT along with increasing our protection against blood borne diseases, HIV, Hep B and C, the government tried to introduce and acknowledge to the society but the drug related harm and violence still exists and NSP and new purposes of misuse for example chemsex within MSM, LGBTQ and sex workers seems to be more stigmatized in society.

So that is why Thailand need to have a new way to cope with the drug problems along with the UNGASS 2016 in SDG 3 since the years 2017 the government and NGO sector put the effort to remove all out of date drug acts until this last December the new narcotic act was launched. The main concept of the new act is to approach the problem through a public health driven. Drug use disorder is the chronic brain relapsing disease and needs community participation. In detail, we the committee try to put a lot of recovery based in the law because abstinence based seems to be not effective anymore and has stigma attached, so we put recovery based instead, voluntary and motivational enhancing harm reduction approach and community based treatment in the new act last December. So that is the first time that Thailand mentioned a breakdown about community based treatment, harm reduction and recovery based treatment in the acts at the highest hierarchy in the drug policy. This law aims to reduce the criminalization of the drug, but after the act was introduced, there are a lot of activities for policy makers to support and create a way of good implementation and communication to all stakeholders and society because this is a big shift from abstinence based to recovery based and harm reduction. On behalf of the ministry of public health which decides to implement and organise the first ever comprehensive recovery centre. The purpose of the new drug law is to decriminalise and treat drug use as a disease and allow for more harm reduction and community based treatment. So finally, from our side we the committee wish this new act to impact society’s attitude and create a better environment for people. It is quite a big challenge for Thailand, but the key message is to shift from the abstinence based goal to recovery based, and it’s quite hard for people to understand that to detox poisoning from your body is our challenge. Thank you.

Moderator: Matthew Kavanagh, Special Adviser to the Executive Director for Policy, Advocacy and Knowledge at UNAIDS:

Thank you Dr. Apisak we are thrilled as UNAIDS to have Thailand Chairing the Programme Coordinating Board this year, because the work that you all have been doing to move as a government towards approaches that are really evidence based is remarkable and really an example for the region but also the world. So thank you for this and we look forward to a dialogue at the end of this with the rest of the participants so thank you Dr. Apisak. We are now going to move to our second speaker, who is called Skylar Nibi Mshkiki who is an activist working in HIV and drug policy in Canada. Skylar has done advocacy and field work in the area of two spirits and LGBTQAI+, human rights, indigenous rights, HIV and health education, substance use and counselling and more at the front lines. He holds an indigenous social services diploma and has experience working directly with the first nation communities across Canada.

Speaker: Skylar Nibi Mshkiki, Drug Policy and HIV Activist:

Thank you so much. I will introduce myself in the language to start (speaks his language). As an indigenous person i was always taught to introduce ourselves in our language and this is a way for my spirit to be introduced to each and every one of your spirits. To translate what i said “Hello, my name is Skylar, my spirit name means Water Medicine, i am Bear Clan First Nations Cree and identify as two spirit and trans. My family lineage comes from number 9 known as Ottawa first nation which is located in Northern Ontario, Canada. I have lived experience as a young person using drugs and worked front line conducting harm reduction, both in cities and on reserve and worked indigenous men who have been incarcerated. I advocate strongly for two spirit, lesbian, gay, bisexual, trans, queer, questioning, asexual and intersex rights, indigenous rights, harm reduction and HIV and AIDS advocacy. Currently I’m doing my bachelor’s degree in political science and work as a national coordinator. I am grateful to be here today and speak from a youth perspective. I want to first say that I am one youth and will speak from the lived experience in relation to drug policy and decriminalisation as an indigenous person.

So to start i want to touch on the global targets. When it comes to the global AIDS targets, this will not be reached without the consideration and implementation of youth sensitive drug policy. For youth who use drugs, decriminalisation is key to ensuring access to safe supply, which is another form of harm reduction, decriminalization would allow for more effective working of youth-led responses in providing harm reduction to prevent new HIV acquisitions. Drug decriminalisation that is sensitive to reflect indigenous people would not only address drug related topics but would acknowledge the history and impact of colonialism. It is important to acknowledge that many youths to use drugs, and the last thing we need is continued stigma and discrimination. Stigma and decriminalization against YPWUD creates barriers to accessing HIV services, contributing to the worsening burden of HIV acquisitions that young people bare. For example, in 2020, young people made up about 60% of the world population but 28% of new HIV acquisitions.

Now I am going to talk about how drug policy homogenized youth who use drugs and also black indigenous people of colour. Drug policies tend to homogenize people who use drugs, an acronym known as PWUD, as they don’t acknowledge that each individual youth has their own lived experience, history and forced placement in society due to the intersectional aspects of their identity, for instance, race, gender and sexuality. Not only do they not take a human rights based approach, but also an intersectional approach which acknowledges the complex experiences of black indigenous people of colour who use drugs facing multifaceted forms of oppression, racism, marginalization, stigma, and discrimination. The current drug policies target youth who are black indigenous people of colour which is evidently seen through the overrepresentation of these youth in the prison system. To add the Canadian Drug Policy coalition, shared in the reform for drug policy that police maintain that enforcement is directed at stopping high level production and selling of criminalized drugs, but statistics show that it is actually the youth and poor marginalized people that are subject to arrest. Not to mention that it also dehumanizes the rights of indigenous youth who have disproportionately higher rates of using drugs, from experiences of colonialism to racial trauma and the impacts of these historical implications of genocide. It is imperative to acknowledge that trauma is not always a cause of drug use, drug use is uniquely different for each individual person. Thus fundamentally, drug use is a human rights issue and no one should have to justify their drug use to be treated with dignity.

I’ll now discuss chemsex, we cannot forget to acknowledge chemsex. For those that do not know what it is, it’s the pairing of drugs and sex together. of course it can look different for each individual person, and is commonly seen with two-spirit, gay, bisexual, trans men who have sex with men, chemsex is often completely under addressed and ignored and the issue of chemsex in relation to drug policy is not represented currently, thus creating a major gap. Youth do engage in chemsex, but restrictive and punitive drug policies do create barriers in implementing and accessing harm reduction services. This is on top of the discrimination that YWPUD already face in mainstream services. which creates an environment that severely impacts young people’s rights to their health. Decriminalization of drugs creates opportunities for youth-led harm reduction services that have the ability to address the specific needs of young people engaging in chemsex which are key to reaching the targets set out in the 2021 political declaration on HIV.

I will now discuss age-disaggregated data. When it comes to data being collected for research to inform drug policy, age-disaggregated data whether it be done through qualitative or quantitative research must reflect on the experiences and challenges of YPWUD, in order to mobilize and improve access to services that are tailored for and led by YPWUD. The current absence of data continually keeps YPWUD hidden and homogenized young people, for instance the need for adolescents who use drugs will be very different to YPWUD who are in their 20’s. The continued absence of age-disaggregated data makes it difficult for you to feel represented when this is not bolstered, and also leads to policies being created that are not sensitive to the YPWUD. Thus age-disaggregated data will allow for policies and services that are sensitive to YPWUD in all of our diversity. It is also imperative that when it comes to indigenous PWUD that research is done through indigenous approaches and methodologies in order to capture specific data for indigenous PWUD. It also needs to take into consideration isolated communities where access to being involved in input for drug policies is not of equal opportunity. So for instance, the reserve that I come from and my family lineage is from, is a fly-in community only so we need to find ways to ensure that the voices of YPWUD in smaller communities are actually being reflected in this process as well.

I will now move on to parental consent and age of consent. Parental consent and age of consent policies need to be repealed as they create barriers and obstacles to youth when accessing support and harm reduction services and eliminating these barriers will be key to reaching the 10-10-10 targets on societal enablers set in the Global AIDS strategy. So for instance if a youth wants to access HIV support but doesn’t want to disclose to their parents that they use drugs, the barrier to this of parental consent creates an obstacle. Not to mention, many indigenous youths have been displaced into the child welfare system or flee from foster homes due to abuse and violence, leading them to forced homelessness, therefore they may not have parental support to consent in the first place. Parental consent is a real obstacle for YPWUD and any laws, policies or practices that restrict access to HIV and harm reduction services need to be repealed as a matter of urgency.

I will now talk about service provisions. It is of urgency that service provisions be reconsidered and changed to ensure services are accessible, acceptable, affordable and available to YPWUD that are friendly and human rights based. changes to drug policy must also be accompanied with commitments to funding harm reduction services that are community led, in line with the targets in the community led services delivery in the 2021 PD on HIV/AIDS.

I’m drawing near the end here for my last part on youth leadership and engagement. So when it comes to youth leadership I often turn to the notion of nothing about us without us, as this is substantive for getting the involvement and leadership of youth for implementation of policy. Youth must have a direct involvement in drug policy reform and there must be avenues that are designed by and for YPWUD when it comes to addressing youth specific needs surrounding drug use. To speak from an indigenous perspective, in the culture we often talk about the next 7 generations and how the youth are the future. If we do not engage and empower the leadership of youth who use drugs in the processes of policy and decriminalization that impact them directly we are ultimately ignoring their knowledge, autonomy, experiences and leadership to create a better future for those to come. Having done frontline harm reduction work there have been far too many lives that have been lost and continue to be lost today, particularly indigenous youth who use drugs. It is of utmost importance that we look inward to our spirit, feel and listen with our hearts, and take accountability, responsibility and genuine compassion in order to create support for YPWUD. Thank you for your time today, I am very happy to be here. I hope we can continue to have meaningful conversations about the need to reform and the need for decriminalization.

Moderator: Matthew Kavanagh, Special Adviser to the Executive Director for Policy, Advocacy and Knowledge at UNAIDS:

Thank you so much Skylar for your attention here, your presence here, and your really clear and passionate call. One of the core pieces that UNAIDS are working on is this idea of understanding and approaching intersecting inequalities, and as we think about this, as we think about young people and key populations, and as we think about indigenous experiences, we have to move towards an approach that is effective, and I really thank you for your presentation. I also want to highlight this key point, that we both have a programming piece, but we also have a law and policy piece that needs to move, we often think about young people as people to be programmed for instead of people to be programmed with and we think of young people as not affected by laws and policies, and yet you’ve highlighted a number of examples. Thank you for your presence here.

Now let me introduce our next speaker, Alla Bessonova is one of the key leaders of the Narco Feminist Movement she is head of the Women’s Key Populations Network of Kyrgyzstan, and is member of the Eurasian Women’s Network of AIDS, and a well-known human rights activist, Alla, over to you now.

Speaker: Alla Bessonova, Head of the Women’s Key Populations Network of Kyrgyzstan:

Thank you so much, dear colleagues, my name is Alla Bessonova. I want to share my vision as a community activist, advocating for women’s rights with a history of substance use. Drug use in Kyrgyzstan is decriminalization, buying, selling, possessing, transportation, and shipment of drugs is prohibited by law in every sense. The first changes that led to the decriminalization of drugs legislation dates back to 2007, it was a significant success resulting from the lengthy debate among law enforcement, medical, social workers, prosecutors and the community. Legislative reform adopted in 2019 contained double punishment for drug users that included huge fines and restrictions of liberty. In 2021 a new process of making amendments in the law was introduced. This process and in particular that the provisional version of the amendments is not open for community feedback, cost a lot of concerns among the community and the experts. However, in one of the quotes there is an improvement in people who use drugs in terms of fines and choosing community service instead of incarceration which is much more humane than the restriction of freedom. There is almost no publicly available data on the situation with drug use and drug related criminalization in Kyrgyzstan, the number of criminal cases increased in 2020 by 43% compared to 2019. In 2021 the number of crimes related to drug trafficking increased by 23%. We cannot make a conclusion that drug use increased because there was an overall increase in the number of criminal cases. The demand for drugs remains high in Kyrgyzstan, we continue to register facts of abuse of power and violations of rights by law enforcement agencies including in connection with the implementation of COVID-19 measures. The practice of policing Methadone therapy clients and PWUD continues. the main part of violations that we have documented occur on behalf of the police against PWUD, threats of physical violence, extortion of bribe, arbitrary arrests and detention, direct physical violence by police, violation of privacy, abuse of power by police, drug planting by the police, torture and ill treatment during detention, confiscation of a passport, coercion to become a police informant. We suggest that the increase in cases of police violence could have resulted from the new agreement between the ministry of internal efforts of the Kyrgyzstan republic and the ministry of internal efforts of the Russian Federation. I am talking about the provision of financial, logistical and organizational assistance in the fight against drug trafficking for 2020 to 2022. this agreement includes the following targets, indicators, the engagement of PWUD as police confidence, the number of persons against which criminal cases either failed of drug trafficking are started, the number of detected violence of drug laws and misdemeanours decided by the court, the number of the cases of police operational violence of PWUD among others.

So while in Kyrgyzstan the direction of the removal of crime among others. So while in Kyrgyzstan, the overall trend of drug policy is the direction of the removal of crime sensation for drug use and possession for personal use the burden of criminalization and policing onto the community of PWUD is increasing, one fo the reasons for this is the absence of anti-discrimination legislation, state supported human rights monitoring mechanism or gender sensitive integrated support services for PWUD. Moreover, the state continues to encourage stigmatization and discrimination for PWUD through criminalization, zero tolerance policies, and repressive gender blade drug policy in general. Limited support for PWUD is provided minorly by community led orgs, which also faced various political and legal barriers. The women that work with key communities is a national community organization and is hugely concerned about the situation with drug policy in Kyrgyzstan, we need to fully abolish administrative and criminal penalties for possession of drugs and replace the narcotic drugs according to harm to society. We need to ensure voluntary drug treatment instead of punishment for people arrested with a large amount of drugs. Thank you.

Moderator: Matthew Kavanagh, Special Adviser to the Executive Director for Policy, Advocacy and Knowledge at UNAIDS:

Thank you very much for your clear insights. We’ll come back to you and have a deeper conversation but the key pieces you have raised about the intersection of the state and communities and how that is the place that we are going to make the most progress in the near future is incredibly important so thank you.

I want to introduce our next speaker, Halyna Korniienko, is the Advocacy Specialist for the Ukrainian Network of Women Using Drugs. Halyna I want to thank you for being here at such a difficult time, she is a specialist in gender sensitive programmes offering several participatory training programmes on health services and the provision of services for women who use drugs and experience gender based violence.

Speaker: Halyna Korniienko, Advocacy Specialist for the Ukrainian Network of Women Using Drugs:

Thank you, dear friends and partners, on behalf of the two national networks of PWUD in Ukraine, the Ukrainian Network of PWUD, and the Ukrainian Network of Women who use Drugs. We would like to state the following, but I will speak in Ukrainian and I will have a translation.

We’re told about decriminalization and its priority in politics, but in fact every 11th person who uses drugs is in prison for alleged drug crimes but in fact people in Ukraine are being persecuted and imprisoned for minimal amounts of drugs that they have on them for personal use. We are told about the prioritizing of harm reduction programmes but this is in fact fiction as these programmes are outdated all over the world, services do not match people’s needs and are instead designed to the needs of policy makers and programme managers. Needle and syringe programmes should be accompanied by peer counselling which is currently not covered by the state and is lacking donor funds. There are no overdose prevention programmes and only some projects have access to some naloxone, there are almost no projects that finance the development of drop in centres. we are told that the government and doctors will work with us to reduce the spread of dangerous diseases but we are not being heard, when we talk about the poor quality of drugs and therefore the need for increasing dosages the urgent measures are needed to provide harm reduction and OST during COVID or war or other emergencies we are not always being heard. As a result, there is suffering, lack of medication and much more, this only increases the stigmatization and discrimination of people who use drugs. We note the actual absence of progressive drug policy in Ukraine and the lack of interest by institutions in its development despite the states commitments of state delegations. We remind you that PWUD are not criminals, we need help and guarantees but unfortunately those that are entrusted with providing a dignified life cannot provide it for us. We hope that we will be heard, and in addition to just words and resolutions, for action to be taken to ensure standards in drug policy, where honour, dignity, the right to get help and possibility for PWUD to make decisions will become a reality. PWUD have a right to a dignified life and should not have to hide from prosecution.

Prior to war, high quality medical care was guaranteed in Ukraine, although the implementation of this care raises many questions. Now the War has left 18,000 OST participants with a life or death choice, we do not mean shelling and bombing, but access to treatment with OST and ART programmes. Before the war we were declaring and developing a strategy for drug policy in Ukraine and also really making proposals for the realization of human rights for PWUD. Unfortunately, decriminalization policies have never been implemented in Ukraine and now the country has neither a document or plan to improve drug policy. There is no plan for drug policy at all but there are 343,000 people that according to decision makers should not exist at all. Stop playing with people’s lives, stop making decisions that cannot be implemented or where there is not political will to do so. Recognize our rights as people who use drugs. Thank you dear colleagues.

Moderator: Matthew Kavanagh, Special Adviser to the Executive Director for Policy, Advocacy and Knowledge at UNAIDS:

Thank you so much for being here, please on behalf of UNAIDS extend our well wishes and appreciation for the strength that has been shown by communities of PWUD in Ukraine. You know the remarkable work that’s been done over years by communities has really been the cutting edge of what harm reduction looks like in difficult contexts. Now we are in arguably the most difficult context and we still have communities pushing for harm reduction services in the country. UNAIDS will continue to do anything we can to stand by you and support.

Let me turn finally to our last speaker, Judy change probably needs no intro on this call and is the Executive Director of the International Network of People who use Drugs, as a woman who uses drugs she brings 20 years of experience as a global advocate for decriminalization, harm reduction, and community leadership and a vision of a world that we want. So over to you Judy thank you for being here.

Speaker: Judy Chang, Executive Director of the International Network of People Who Use Drugs (INPUD):

Thanks Matthew. So yes thank you, I just want to express appreciation for organizing this side event and bringing us all together. It was a fantastic line-up of speakers and I think there is a lot of rich knowledge and experience to draw from within the HIV movement as evidenced today and leverage that for drug policy.

INPUD welcomed the new Global AIDS Strategy 2021-2026, with its very strong and uncompromising focus on equality, and that because as PWUD we really do know first-hand what laws and policies affect what services are available what choices are available and whether we have to risk arrest and harassment for simply seeking healthcare, and also of course impacts the level of shame and judgment we experience in health settings but also of course broader.

We also welcome the World AIDS Day report 2021, which really emphasized the HIV incidents thrives on the fault lines of inequalities within and across societies and think it’s very important to note that these fault lines do not naturally occur but are created by people who create the laws and policies and really do determine the haves and have nots. In this context there’s no surprise that globally 65% of new HIV infections are amongst key populations. As others have mentioned, there is progress and opportunities for change and the targets, the 10-10-10 societal enabler targets that we are all aware of now, i think its real acknowledgement of the primary role that laws and policies have in shaping our lived experiences. As Matthew mentioned before, the 10-10-10 targets were passed by the majority of the states in both the Global AIDS strategy and the 2021 Political Declaration, of course accompanying these targets are the 80-60-30 targets on community led responses so that 30% of treatment services should be led by community led organizations, 80% of prevention services and 60% of advocacy programmes and advocacy efforts in moving towards the 10-10-10. Of course there were also harm reduction targets, that by 2025, 90% coverage of NSP and 50% coverage of OAT programmes. As we mention these targets, what should be at the forefront of all our minds, community, policy makers, programmes, other stakeholders, researchers, how do we move these targets from paper, from commitments to reality.

We know that harm reduction targets are never going to be reached as long as experiences of health care for PWUD remain hostile, too often our experiences within healthcare services are of extreme discrimination and stigma and always shaped by this shame and paternalism, where others get to decide what is good for our bodies and our minds. There are too many reports in hospital and clinic settings where PWUD are turned away based on accusations of drug seeking and given substandard care just for being a PWUD. There’s multiple cases where we are denied treatment unless we quit using drugs, and this is the case of ARVs, hep c treatment, and in some cases mental health treatment. In health settings we are also aware of compulsory drug treatment centres and rehab centres and it has been very frustrating, also as we’ve heard this week, this denial that there are rights violations that occur within these centres in the name of treatment. Also diving into harm reduction settings, so beyond just broader health, we do see problems within some harm reduction programmes and whilst of course harm reduction services and programmes are essential and lifesaving, and we all understand the benefit, for example I have been on OAT for a total of 15 years, I’ve had overdose reversal through Naloxone, so I totally understand the value of harm reduction services, but we also have to point out where they need to be doing better because that is what is ultimately needed. In NSP services we still see stripped one in one exchanges, PWUD shouldn’t have to risk being arrested by law enforcement when accessing these services and funding and scale of harm reduction needs to match need. When we talk about OAT, we only need to look at the humanitarian crisis and conflict in Ukraine to understand how broken the treatment and OAT system is. PWUD are having to make these heart-breaking decisions to flee conflict or stay behind because they’re scared of not being able to access OAT, either moving to another area or country. And beyond conflict settings, these programmes and the rules and regulations on them are still oppressive and the system needs radical reform. With Naloxone, there is barely any access as noted by Halyna in Ukraine but this also is the case beyond and we need to look at lifting funding and regulatory barriers for this.

Health is not a political right, so criminalisation drives people away from seeking health services, it limits funding, and restricts availability. If we look at global mapping there has really been barely any progress. Only 6 countries have fully decriminalized drug use, and that means removal of all criminal laws and sanctions including fines or mandatory treatment. Over the last year, the only changes we are seeing are at the state level, whether that is Oregon in the US or potential change in BC in Canada. When we talk about moving towards 10-10-10 we need to strongly emphasize that PWUD led organizations, including youth led, including women led in all their diversities must be involved in all stages of the reform process.

We know that we have the commitments to get there thanks to UNAIDS, the Global AIDS Strategy, the UNODC HIV/AIDS section which has committed to align the UNODC strategy with the Global AIDS strategy in its work. In addition to this progress to achieving 10-10-10 we need to also look at what are the other areas We do need ramped up research agendas because we know PWUD are invisibilized, Skylar talked before about the lack of disaggregated data, and that should include community led research. We need to fund peer led advocacy and programmes in line with the 80-60-30 targets. to emphasize, continuing on from the equity focus and lens, true equity means equal status of PWUD and this means that PWUD should not only be seen as peers of each other but as peers and equal partners of policy makers, programme managers and researchers.

So in closing, we’re coming to the end of a long and dramatic CND, of course thinking about global drug policy, I would make a note that I am concerned that global drug policy there seems to be a move away from strong narratives, strong push on human rights and health objectives, we are seeing more focus on demand reduction rather than harm reduction. Drug use has always been a part of human behaviour but it is the global war on drugs that is more recent. The choice to not be vocal about decriminalization and harm reduction and human rights is actually a choice that causes harm for PWUD and the wider community globally.

Moderator: Matthew Kavanagh, Special Adviser to the Executive Director for Policy, Advocacy and Knowledge at UNAIDS:

Thank you for your clear concluding pieces here. Let me thank all the speakers, and their contribution to this very challenging complicated CND process and where we’ve come. I do think there has been a remarkable push that really does set out what evidence and science says, and we won’t reach the 10-10-10 targets, and we certainly won’t reach the ending AIDS targets if we don’t actually take things seriously if we don’t see with law reform, programme reform, and a move to align these things with science. So that is the clear message from UNAIDS. Along with the realization that has been highlighted today, that there are very clear examples of where this is working, so we can build off of it, it is not an impossibility that we can centre people and we can centre science when it comes to drug policy. so we are hopeful and realistic about what is to come. Thank you to all the speakers, let me open it up and turn it to my colleague Daria Matyushina as we take some questions from the audience.

Moderator: Daria Matyushina

Please raise your hand if there are any questions that you wish to have answered. Now I will give the floor to my colleague Marie Engel to sum up the discussion we had today.

Speaker: Marie Engel, UNAIDS Regional Programme Advisor in Dakar:

Thank you Dasha, thank you to all the great panellists. I’ve noted three key messages and related recommendations. The first one is criminalization, stigma and discrimination are key barriers to access to HIV and harm reduction services. All the activist’s testimonies were very clear that we must value the human rights of every person who uses drugs including in countries facing war such as Ukraine. So the recommendation there is that we need to remove punitive and discriminative laws and policies such as those that criminalize drug use and possession and policies related to parental consent. Our work must be based on science, evidence, human rights this is in line with the commitments that member’s states made in the 2021 General Assembly Political Declaration on AIDS. We heard from Dr. Apisak about the golden model approach in Thailand with its 2021 Act that reduces criminalization of drugs. We also heard from Halyna about good national laws that are promoting decriminalization that can be derailed by priorities of donor countries. Second message, particularly was made by Judy and Skylar to invest in disaggregated data and research agendas on PWUD, so including size estimates, qualitative research, lived experience that includes community led research and monitoring. The recommendation there is really a meaningful engagement of PWUD in all the policies and programmes that affect their lives, with the famous line ‘nothing for us without us, that includes young people as Skylar passionately pointed out, we need to push for meaningful youth leadership. Third point is we have an ongoing funding crisis for harm reduction in low and middle income countries. We really need to scale up investment now, and with the focus on funding community led responses. We already know these are the most effective and there are clear targets on these in the Global AIDS Strategy. So to conclude, I will recall Matthew’s first words, we need to remember in the context where we are in the midst of so many other crises, that the HIV pandemic remains a crisis for many groups and in particular for PWID communities. So clearly without continued access to HIV and harm reduction services we will not end AIDS among PWUD and prison inmates, and therefore we will not end AIDS at all. Thank you.

Moderator: Daria Matyushina

Thank you very much Marie for the conclusion, thank you very much Matthew for chairing the session. Thank you to all the speakers. Thank you very much to all of you.


Leave a Reply

Your email address will not be published.