INTERIGHTS Bulletin

INTERIGHTS Bulletin
Volume 16 Number 4 2011
191
prescribes OST, although coverage is
low.
In the Middle East and North Africa,
six countries, including Iran, have
needle and syringe programmes and
three have OST, although none have
responses sufficient to meet identified
need. Across the region there is a low
awareness of risks associated with
injecting drug use. Few NGOs are
working on harm reduction in the
region, and in several countries
restrictions on NGOs further limit the
harm reduction response from civil
society.
Although data on drug use in the
region are limited, injecting has been
reported in 31 of 47 sub-Saharan
African states. Where data are
available, they suggest high HIV
prevalence among people who inject
drugs. A Kenyan study, for example,
found that six of every seven female
injectors were living with HIV.
Responses to HIV in the region
currently include little focus on people
who inject drugs. Mauritius, where an
estimated 17,000-18,000 people inject
drugs, is the only country where needle
and syringe programs are operating.
It should be noted with some concern,
that in international political forums,
harm reduction has been weakened in
the past year. At the General Assembly
in the context of the 2011 political
declaration on HIV/AIDS, harm
reduction, previously seen as an
obligation in declarations of 2001 and
2006, was relegated to an optional
consideration. 32 This is largely as a
result of the weakening of the
European Union on the issue, the
unwillingness of many countries to
expend political capital arguing about
it and the staunch views of a handful of
countries opposed to harm reduction.
These include Russia, Iran, Egypt and
the Holy See.
Funding for harm reduction is very low
globally and is neither representative
of what is needed to address the HIV
epidemic among injecting drug users,
nor proportionate to injection-driven
HIV transmission versus sexual
transmission. Harm Reduction
International estimates that just three
US cents per day per injector is spent
on HIV prevention in low and middle
income countries. 33
One of the most positive developments
of recent years, however, has been the
change in position of the US
Government. From opposing and
blocking resolutions at the UN
Commission on Narcotic Drugs that
referred to HIV prevention for
injecting drug users and to human
rights, the US has begun cosponsoring
them. Even more
importantly the US has lifted the ban
on federal funding for needle and
syringe programmes. At the time of
writing, however, the President's
Emergency Plan for AIDS Relief
(PEPFAR) has yet to purchase any
needles. That money, from the world’s
largest donor to HIV/AIDS, would go a
long way to improving the scale-up of
harm reduction where it is most
needed and realising the right to health
of those affected. 34
With this in mind, it is important to
note that global funding for healthbased
interventions related to drug use
is vastly outstripped by the tens of
billions of dollars spent annually on
police, courts, prisons and military
actions as part of law enforcement and
other counter-narcotics initiatives. And
it is in this context that many human
rights abuses against people who use
drugs and others are committed.
Human Rights Abuses Against People
Who Use Drugs in the Context of
Health Care
Criminal Laws and Policing
In almost every country in the world,
possession of drugs for personal
consumption is a crime. In many, drug
use itself is a crime. 35 The
implications for those who have a
dependency – a chronic, relapsing
medical condition – are particularly
serious. Individuals have a right to
obtain lifesaving health services
without fear of punishment or
discrimination. In some countries,
many people who inject drugs do not
carry sterile syringes or other injecting
equipment, even though it is legal to
do so, because possession of such
equipment can mark an individual as a
drug user and expose him or her to
punishment on other grounds. 36
Many do not seek treatment or attend
harm reduction services, again, for fear
of arrest and conviction. 37
Appropriate, human rights compliant
policing is essential for effective drug
policies and positive health outcomes
for drug users. Unfortunately, in
country after country, the experience is
often the opposite, partly due to the
poor laws being enforced and partly
due to policing practices. In many
places, police target drug users and
harm reduction services, seeing easy
opportunities to harass, entrap and
extort clients – or simply to fill arrest
targets. 38
Police presence at or near harm
reduction programmes drives people
away from these services due to fear of
arrest or other punishment. In
Ukraine, for example, drug users have
reported being arrested multiple times
at legal needle exchange sites. 39
Individuals have been severely beaten
for possessing syringes at or near
needle exchange points. 40 Withdrawal
has been used as a means to extract
evidence or to extort money once
detained. 41
In Georgia, drug crackdowns in 2007
resulted in 4 per cent of the country’s
male population being tested for
drugs, many under forced conditions.
Thirty-five per cent of these went on to
be imprisoned on a drug-related
charge. 42
In Thailand, the 2003 ‘war on drugs’
that resulted in more than 2,300
extrajudicial killings has had a lasting
impact on drug users’ access to
fundamental health care services. 43
Studies reported a significant decline
in the number of people seeking
treatment for drug use during the ‘war
on drugs,’ and also reported that a
significant percentage of people who
had formerly attended drug treatment
centres went into hiding. 44 Years later,
many people who use drugs still