Organized by INPUD Limited with the support of the UNODC HIV/AIDS Section, the European Network of People who Use Drugs, the African Network of People who Use Drugs, the South African Network of People who Use Drugs, the Eurasian Network of People who Use Drugs, the Middle East and North Africa Network of People who Use Drugs, the Network of Asian People who Use Drugs, the Drug Harm Reduction Advocacy Network Nigeria, Women in Response to HIV/AIDS and Drug Addiction, and Youth RISE

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

Welcome to all those here and joining us online. This is a hybrid event and translation is available in 5 languages. This is the first time a drug user group has led a side event at the CND. It took many years for INPUD to be accredited by ECOSOC. This morning we are launching our new report “Side Event Pandemic Preparedness and Response. Voices of People Who Use Drugs” (link). The reason we focused on this theme is that the pandemic has had a disastrous effect on our community. The pandemic intersected with criminalization, stigmatization and other harms and while devastating for everyone, it was particularly devastating for marginalized peoples, such as people who use drugs. Criminalization has pushed us away from traditional health services. The pandemic also showed how resilient and resourceful our community is in the face of twin pandemics.

Dr. Annie Madden: International Network of People Who Use Drugs (INPUD):

We conducted this research and I’m one of the lead researchers. I’d like to acknowledge Sara L.M. Davis and Kaitlin Large (both – Geneva Graduate Institute) and CRB Members: Angela McBride, Anton Basenko, Danielle Russell, Ernesto Cortes, Yatie Jonet and all the study participants.

INPUD had done research in the early stages of the pandemic (2020) and since then we’ve done more research into the twin epidemics of HIV and Covid. We had four research questions as we wanted to understand some of harms that impact people that use drugs. The survey reports are available in 6 languages on the INPUD website: INPUD.net In 2021 INPUD received community research funding to address the dual epidemics of of HIV and Covid-19. INPUD saw our research as an opportunity to shape INPUD’s future advocacy in relation to PPPR and wider health governance matters.

Methodology was conducted as follows: desk review, key informants, focus groups / webinars, and online platform with ethics approval.

There were 43 study participants, 8 key informant interviews, 35 FGD participants across 3 webinars and 4 of 6 WHO Regions were covered.

Research questions:

• What caused the harms and challenges faced by PWUD during the pandemic?
• What are the continuing impacts of living with multiple pandemics?
• How prepared were governments, civil society and international organizations to address the needs of PWUD (criminalized / marginalized communities)
• What can we learn from Covid-19 to enable better pandemic preparedness and response in the future?

8 Key themes:

• Police violence and gender-based violence
• Economic impact of covid-19
• Challenges accessing health services
• Essential role peer-led services
• Harm reduction flexibility and other positive innovations
• Digital advocacy and digital divides
• Pandemic Treaty, to engage or not?

Key conclusions:

Illuminated myriad of weakness in the global heath system. Ability to prepare for, respond to, and mitigate a global pandemic.Social and economic and health impacts have been devastating for all, but disproportionate impact on those already marginalized. Gendered impact on women who use drugs. PWUD were experiencing multiple pandemics HCV, HIV, covid-19. PWUD drugs as a marginalized and criminalized population were exposed to some of the worse harms of the pandemic. These included harms to their ecumenic means of survival, loss of employment and loss of housing. Also exposure to punitive enforcement of restrictions and increased police surveillance and loss of access to essential health services.

Policy flexibility was one benefit such as regulatory flexibility for take home OAT doses, decarceration efforts (including for drug offenses) and the conversion of hotels into shelters.

Our research shows still much to be done. The gains from covid cannot be lost. During pandemic we saw more funds and resources allocated to marginalized communities. PWUD want more meaningful engagement in policy decisions. Putting the last mile first is a concept that a health system that works for the most marginalized (such as PWUD) works for all. This should be our guiding principal moving forward with global health governance.

Recommendations:

• Uphold and enshrining human rights
• Access to safe supply
• Ending criminalization of people who use drugs
• Financing mechanisms that value community and principals of sustainability, transparency and accountability.
• Ending stigma, discrimination and violence against people who use drugs, including gender-based violence
• Fulfilling the right to health for PWUD

Prof. Michel Kazatchkine – Global Commission on Drug Policy

Thanks to INPUD and UNODC HIV Branch. The Global Commission welcomes this report. The pandemic has upended society and it has exacerbated inequalities within countries and between countries. Without change we will not be able to prevent a widening of inequalities and a pandemic responses need equable measures to ensure marginalized people are not left behind. A pandemic treaty needs to be fit for purpose. Outbreaks should not become pandemic and epidemics not become pandemics. This is not just a health issue but a social and economic one

There is a HLM of General Assembly in September (2023) on the pandemic. The response must include equity from end-to-end. The Global Commission advocates for 5 pathways to drug policies that work:

• Put people’s health and safety first
• Ensure access to essential medicines and pain control
• End the criminalization and incarceration of people who use drugs
• Refocus enforcement responses to drug trafficking and organized crime
• Regulate drug markets with the goal of putting governments in control

We advocate for the removal of all sanctions, not just criminal, but also civil. Law enforcement refocused away from users and towards large criminal markets and money laundering. Prohibition is the problem, not the solution and we need to do everything we can to end it. The political resolutions for the pandemic response needs strong to include civil society and community groups.

Angela McBride – South African Network of People Who Use Drugs (SANPUD):

Every was caught off guard when covid hit, but the community that was hit the hardest was the most marginalized. In South Africa shelters were opened and people warmly welcomed, but in others there was violence and sexual abuse. Many community-led organizations were responsible for distribution of PPE. We already have a very shaky aftercare system of shelters. In some, so called ‘safe’ spaces they become site of violence during the pandemic and PWUD were refused access. Women were being sexually harassed and people were suffering withdrawal from drugs and a number humans died in these so called safe spaces.

Our governments did try to address covid, however one of the policies they adopted was prohibition. Alcohol and cigarettes and were banned in South Africa during the pandemic for several weeks at time. This prohibition drove people to seek illicit markets and homemade alcohol and increased the harms. This is highlights the failure of prohibition. People that were not marginalized were fine and continued to use imported alcohol and cigarettes. However, due to the banning of cigarettes, marginalized groups suffered. Multiple people were sharing single cigarettes and putting themselves at risk of contracting covid. This criminalization, isolation and exploitation of our community only created more harms.

The one of the governments other responses was enforcement and control, not health, human rights and support. The pandemic showed the cracks in the system for funding. With emergency funding we could have provided PPE, emergency methadone and needle syringes for our community. Criminalization causes harms and South Africa during covid is perfect example of this.

Fariba Soltanti: Chief, UNODC HIV Branch

Thanks to all the networks involved in this research project. As we’ve seen the pandemic was even worse for the criminalized and marginalized people, such as PWUD. It is really vital to hear from community on the pandemic, particular as they experiencing multiple pandemics.

I like to take this opportunity to share work we did together with INPUD. We did a scientific community consultation. Greater involvement of PWUD in pandemic response and planning is crucial to increase acceptability, access and retention in services. Adequate resources must be allocated to support peer-led interventions. Covid adaption during pandemic was an important lesson. The perfect example is expansion of OAT and removal of restrictions around take home doses. We released two reports on this with WHO and a policy brief with one with Harm Reduction International. These are available on the UNODC and HRI websites. We also worked with the International AIDS Society (IAS). The former head of IAS gave statement in the opening of the CND Plenary in support of people who use drugs and community-led responses. Country-based plans need to incorporate community voices. During the pandemic the community showed how effective they were as first responders.

The international community is finally recognizing the value of community-led response. I’ve learnt this from working in harm reduction for over 20 years: community-led responses are crucial at all stages.

Anton Baesko: European AIDS Treatment Group (EATG):

I wear two hats as I’m also a member of INPUD. I’m Ukrainian and remember when Covid hit. Our government wasn’t prepared at all. PWUD often exist in survival mode and this was evident with both the pandemic and when the war started. In Kiev, where I live, when Covid hit the government shut down all public transport and this was a disaster for people who use drugs and rely on public transit to access essential medicines and services.

Pandemic however brought us a number benefits that can be seen in Annie’s report. The experiences from the pandemic prepared us for the war of aggression / invasion. Similar experiences and difficulties accessing services exist now as did during the pandemic. The impact of the war on PWUD in Ukraine has been terrible. However, in the first days of the war the Minister of Health approved take home doses of OAT for up to 30 days. What is needed is now is very basic services, not just syringes but shelters, food kits and hygiene kits. We are always talking about resources and important to see big donors creating emergency funds to be made available. This started with covid, but continues with the war.

What can we learn from these major emergencies?

Judy Chang – Executive Director, International Network of People Who Use Drugs (INPUD)

Al people are struggle during war, covid and other emergencies. People who use drugs have always been marginalized, but during these emergencies it becomes even more pronounced. Community-led response is crucial to ensure our needs are met during these periods of crisis.