Organized by the International Network of People who Use Drugs with the support of Czechia, the Kingdom of the Netherlands, Norway, Paraguay, Portugal, Switzerland, Uruguay, the Office of the High Commissioner for Human Rights, the World Health Organization, the Joint United Nations Programme on HIV/AIDS, the United Nations Development Programme, the African Network of People who Use Drugs, AIDSFONDS, the Elton John AIDS Foundation, the European Network of People who Use Drugs, Harm Reduction International, the International Drug Policy Consortium, the Latin American Network of People who Use Drugs the Middle East and North African Network of People who Use Drugs, the Network of Asian People who Use Drugs, the Open Society Foundations, the South African Network of People who Use Drugs, the Women and Harm Reduction International Network and Youth RISE

 

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Fariba Soltani, UNODC, HIV/AIDS Section: … major deficit in prison populations … also there are cultural differences from one country to another. We also aim to provide all the support we can to member states to increase access.

 

We examine not just people using opioids but also stimulants, given the high prevalence of HIV/communicable diseases among stimulant users. We made a recommendation package for this group. We also tried to to learn lessons from the covid lockdowns, for those on Opioid Agonist Therapy, there was a scale up with take-home OAT therapy. Unsurprisingly, these services were implemented very well, with variation between 2 weeks to 3 month take-home prescriptions. 

 

The next effort is on women who use drugs and women in prisons, and thereafter scaling up our efforts with those working in prisons and improving prison conditions. 

 

Judy Chang, International Network of People Who Use Drugs (INPUD): Thank you for highlighting these issues, we’ll turn to our first panelist, Angela McBridge. What are the primary reasons we are so behind on treatment and harm reduction?

 

Angela McBride , South African Network of People Who Use Drugs (SANPUD): In SA our biggest challenge is (a recurring issue) the lack of funding; or at least in SA, the supply is not meeting the demand. The community is frustrated that there’s not enough access to OAT, needles and syringes, etc., and service providers are often the ones blamed–but it’s deeper than that. Budget and insufficient government funding/buying/subsidized, our movement forward is impacted. 

 

Also, there’s a lack of proper wage for peer educators. We need more harm-reduction measures and materials, yes, but peer educators are the ones doing the testing, the hardest work, etc., and these people are paid basically nothing–no public housing, no subsidy, no money for methadone, and this is an issue; there are orgs receiving so much funding and not bringing their own peer workers into the space, to evaluate the budgets, etc., those doing the most real, hardest work are not being paid a livable wage.

 

But it can be amended–tell your management, tell your donors and funders–ask them, have you consulted with those people?

 

So, it’s not just about people holding each other accountable–it’s about ensuring a livable wage. If the salary does not accurately reflect something reducing harm–unable to afford their treatment, the meals, etc.–how can we actually call that harm reduction? 

 

Long story short–yes, there is a need for more harm reduction materials, but there also needs to be proper consultation with harm reduction educators and ensuring that there is a livable wage. If not? Then we need proper subsidies (housing, medication); but we cannot be making those doing the real work suffer–otherwise we contradict the whole point of harm reduction. 

 

Judy Chang, INPUD: Thank you for highlighting this essential need. Next is Jindrich Voboril, National Drug Coordinator of Czhechia. Can you highlight the upcoming plans and what made this initiative possible?

 

Jindrich Voboril, National Drug Coordinator, Czech Republic: I was seriously asked recently, ‘who are these Czechs to be teaching us about human rights?’, after centering human rights in our new strategy. To which we responded: “No, we don’t want to teach, we only want to put human rights in the center”. 

 

Long ago, behind the Iron Curtain, I was often interrogated by the Czech branch of the KGB, as drug users were seen as infected by the West, and drugs were placed there by the CIA. Funny now, but then it was not funny and very real; everyday helping street users, fearing prison.

 

Upon the revolution, we simply wanted human rights and we wanted freedom. So, when through our drug policy or otherwise, when we get a sense of authoritarian feeling, we return to our principles: human rights at the center of the discussion. 

 

We also decriminalized small amounts of drugs in 2013 … Even as a country with a small amount of HIV presence amongst drug users, less than 1%, we believe we can still do better. How? We need to start with decriminalization–to start early, and not be afraid of being in trouble!

 

What also helped is that in 2013 we also decided that policing is no longer the strategy, but harm reduction; but not just servies, but also into the legislation–people simply use drugs! This also includes a wide variety of drugs, a wide variety of behaviors, illegal or legal, and this will simply be so. And it starts with this philosophy.

 

We need to lead with this mentality, or else we’ll be here in 5 years having the same discussion, saying we could’ve eliminated Hep C, etc., some time ago. 

 

Judy Chang, INPUD: Next we have Palani Narayanan of the Malaysia AIDS Foundation.

 

Palani Narayanan, Malaysia AIDS Foundation/Health Equity Matters Malaysia: The policy we are advocating for is decrim of drugs for both use and possession. This has many factors behind it, including on public costs, prison systems, etc.; but due to time restraints we’ll focus our efforts on the treatment only.

 

We had a change in 2005 … 

 

Populations such as gay men and other vulnerable populations continue to be incarcerated.

 

We must ask ourselves: through harm reduction we’ve saved thousands of lives, but is that good enough? If someone is incarcerated over and over again, before the age 50, such as [name], a woman from Kuala Lumpur. We need to ensure that human rights and dignity are at the center. We need to go beyond and think about quality of life.

 

Secondly, thinking about who needs treatment: not everyone who uses drugs needs treatment, and many live prospering and successful lives. A young person experimenting does not need prison sentences; although from those who do develop problems, they need support!

 

But mandated treatment centers and forced treatment is not the answer, especially when centers pop up overnight in response to government efforts. …

 

So to answer your question: how will decriminalization lead to better treatment?

 

First, people who need assistance will come forth for treatment, distinguish why people use, and better identify those who need vs don’t need treatment. We hope that our government will recognize that people are on a spectrum of drug use, different treatment for different people, not all people need treatment (and certainly not rehab!), also not forced, and replicating the harms of criminalization.

 

Drug policies which focus on punishing and incarcerating people who use them are hypocritical and corrupt. 

 

Prof. Alan Miller, National Mission on Drugs: National Collaborative, Scotland: 

 

This is a question of altering our framework approach to drug policy. A brief overview of our plan:

 

We’re moving from what’s been a criminal justice approach towards a public health and human rights approach to drug use. This new charter, developed through the national collaborative, through also a public process, centers on the right to health. Also part of the forthcoming Scottish human rights bill, introduced in the coming months.

 

Further info on  powerpoint which Judy will make available later.

 

A few words: all laws, policies, and procedures regarding drugs must be grounded in human rights. So, how do we replicate this elsewhere? It’s absolutely applicable elsewhere as it’s grounded in int’l human rights laws, and most countries have either ratified these treaties or adopted them into their own national laws. 

 

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This means that individuals also have a right to choose their treatment plan, including harm reduction measures, and also no stigma against people who use drugs. 

 

So, this framework requires that healthcare services are of sufficient quality, and if not, there’s a recourse. And going beyond–towards also the positive determinants of good health, including housing, food, etc., are crucial to this discussion.

 

Later, a presentation regarding this framework will be made available by our friends at INPUD.

 

Boyan Konstantin, UNDP: UNDP actually provides policy advice and technical support to support the processes of law and policy reform. We partner with all stakeholders, including civil society, to ensure understanding why these punitive policies must be removed. It’s disturbing that we have 143 countries which still criminalize HIV around the world; similarly number for criminalizing drug use. So, clearly, to address these issues and deliver on the 2030 pledge to end AIDS as a public health crisis, so UNDP is supporting these processes, to lead this work and cooperate with all other partners and stakeholders to ensure these laws will be reformed.

 

This is a long process; when it comes to some countries, things have barely moved. Looking at criminalization of same-sex sex, drug use, etc., we see similar challenges; and for many which have changed, nothing prevents countries from changing their policies and laws back. 

 

Also through the UN Secretariat, UNDP has delivered 2 reports on what’s still needed to deliver on our pledge to address the 2030 goal of elim HIV. Includes partners with (?#) countries around the world, and includes recommendations on many various laws to improve the situation. Most recently, Cote D’Ivoire reformed its laws regarding drug use.

 

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