1

People who use drugs, HIV,and human rights

The Lancet: HIV in people who use drugsVienna, 20 July 2010

Ralf JürgensJoanne Csete, Joe Amon

Steven Baral, Chris Beyrer

2

Acknowledgements

Nick Crofts, David StephensJonathan Cohen, Daniel Wolfe

Damon Barrett, Rick Lines, Richard Elliott

people who use drugswho participated in the research

3

Key questions

1. Do drug laws, policies, or practices:a. violate the human rights of people who use

drugs?b. increase vulnerability to HIV or HIV-related

risk behaviours?c. otherwise compromise the health of people

who use drugs or the communities in which they live?

4

Key questions

2. What works?

Which initiatives support the effectiveness of services for people who use drugs and reduce abuses of their human rights?

Background

1. Until mid-1990s, human rights were rarely mentioned or accounted for in drug policy and research.

2. Drug use was rarely mentioned in the human rights world. 3. This is changing: reports & studies document

1. human rights violations2. their negative outcomes for health & other human

rights of people who use drugs3. programmes & interventions & policy changes.

Results of the review: human rights abuses

• denial of harm reduction services & effective treatment• discrimination in access to ART• police harassment, arbitrary detention, ill-treatment and

torture• Thai “war on drugs”• police presence at NSPs; enforcement of drug

paraphernalia laws

Results of the review: human rights abuses

– Death penalty for drug offences– Incarceration and lack of prevention & treatment in

prisons and other places of detention– Coercive and abusive treatment in drug detention

centers– Denial of information & services to youth & women– Denial of adequate pain relief

Results of the review: what works?

• Practical programs or initiatives to support the effectiveness of services and reduce human rights abuses include:– harm reduction training for police officers, judges &

prosecutors– partnerships between law enforcement & public health– legal services– meaningful participation of people who use drugs

A public health & human rights imperative

• There are situations in which some rights might be restricted.

• But reported measures are entirely disproportionate, ineffective and cannot be justified.

• Governments have good public health reasons to ensure laws, policies & practices do not contribute to spread of HIV.

A public health & human rights imperative

• Governments also have legal obligations to act.• The right to health requires all countries to have an

effective, national, comprehensive harm-reduction policy and plan.

• Providing NSPs, OST, ART is not enough: importance of supportive environment, including protective laws.

Increasing the evidence base

• Reports on HIV infection risks rarely include consideration of human rights and related barriers to services.

• Increasing the amount of evidence of non-medical HIV risk factors should be priority for medical researchers.

• “Risk is not limited to the moment of injection with contaminated needle but can begin minutes earlier when a police officer confiscates a sterile needle from a user”.

Conclusions & future directions

• Reported abuses are abhorrent in themselves and must be combated for this reason alone.

• Many also have a negative effect on the health of people who use and the communities in which they live.

• Joining human rights law with public health evidence should help shift responses to drug control away from failed emphasis on prohibition to more rational, health-promotion framework.

13

Conclusions & future directions• reform of laws and policies• decriminalisation of drugs for personal use• human rights programming as part of national

responses to drug use & HIV• reform of international drug policy and policy-

making processes

Rights Here, Right Now!

• AIDS 2010: first conference with human rights theme; and focus on drug use & HIV

• Human rights activists & scientists working together, using science and human rights for advocacy

• Moving from rhetoric to real, programmatic action