World AIDS Day 2017

What does good health mean in a context where people who use drugs desperately struggle just to survive another day?

The right to Health has been established as a Right since 1948. Governments and policy makers are well aware of the universal declarations yet they consciously decide to condemn people who use drugs to an early death. What part of the words ‘Universal’ and ‘Human Rights’ do they not understand? Many might disagree thinking ‘something is better than nothing’ but we want all of it because it is our right. This is not the future we were promised by our leaders.

HIV among people who inject drugs in Asia and the Pacific

The Asia and the Pacific Region has the second highest number of people living with HIV in the world and one third of world’s population of people who inject drugs live here. (1) More than one in eight People Who Inject Drugs (PWID) are living with HIV and one out of ten people living with HIV are PWID. (2) Despite the substantial progress in the HIV response, UNAIDS suggests that there was no decline in the annual number of new HIV infections among people who inject drugs between 2010 and 2014. (3)

Ten countries China, India, Indonesia, Malaysia, Myanmar, Pakistan, Papua New Guinea, the Philippines, Thailand and Viet Nam—accounted for 96% of the region’s new HIV infections in 2015. (1) So what are we doing wrong or are we repeating the same mistakes and expecting different results?

Based on the 2006 Political Declaration on HIV/AIDS, (4) in 2009, the WHO, UNODC and UNAIDS technical guide recommended a comprehensive package of interventions for the prevention, treatment and care of HIV among people who inject drugs. Member states reaffirmed these commitments in the 2011 and 2016 and were also widely endorsed by the Economic and Social Council, the UN Commission on Narcotic Drugs, the UNAIDS Programme Coordinating Board, the Global Fund and PEPFAR. (5-7)

Asian countries have introduced some combinations of harm reduction interventions including the Needle Syringe Program (NSP) and Opioid Substitution Therapy (OST), however the coverage of these essential services have been very low despite the significant proportion of new HIV infections among people who inject drugs. Countries with a high HIV burden like Pakistan do not implement OST services and the Philippines do not have NSP or OST. (3)

“We always feared that promises are made to be broken and now it looks as if our fear has become a reality”, says Anand Chabungbam, the regional coordinator of ANPUD. “A number of countries in the region are left out from accessing optimal regimen recommended by the WHO, not to mention the existing under-resourced infrastructure, lack of service coverage, medicine stock-outs and stigma and discrimination towards PWID fueled by the criminalization of drug use.” he further added.

The 2016 UNGASS adopted the agenda for the Sustainable Development Goals (SDG) target 3.3 on AIDS, Tuberculosis and viral hepatitis among PWID and included the strongest human rights provision ever. (8) In June 2017, United Nations and WHO called for a review and repeal of punitive laws that criminalize drug use and possession of drugs for personal use. (9) Behind these fascinating documents are the realities that the target 3.3 will be impossible to meet without a significant reform of current drug policies. Harm reduction does not have a sustainable future under the current poor level of political will and public receptivity. The criminalization strategy adopted by national drug control systems severely hinders the HIV response, as fear of arrest inhibits PWID from access and uptake of HIV services. Punitive laws have also contributed to police harassment and a variety of human rights abuses, thereby deterring access to HIV services. (10) This is particularly true in the region where countries have consistently opposed human rights and harm reduction approaches for people who use drugs.

“We live in the region where the Philippines war on drugs has resulted in more than 13000 killings and over a million arrests/surrenders of people who use drugs. Similarly the Cambodian war on drugs has resulted in more than 13000 arrests of people who use drugs. Countries like Indonesia, Thailand, Myanmar, Malaysia, Vietnam, Pakistan, India and Nepal are implementing similar forms of strategy, including compulsory detention centres and the death penalty. How can we expect anything more than mere survival with what is going around?”, said Rajiv Kaflay the Project Coordinator of ANPUD.

In the context of people who use drugs, the UNAIDS famous rhetoric of ‘Ending AIDS’ by 2030 has become another fantasy just like the vision of a drug free world. This has somehow failed to consider the fact that drug use is an inevitable and significantly growing reality and availability and access to comprehensive harm reduction services is essential beyond 2030. Additionally , the region is witnessing a transition of donors, shrinking funds and community spaces in the HIV response and everyone seems to naïvely expect that governments in the region are willing to support community participation and health and right-based approaches.

On World AIDS Day 2017, we, the Asian Network of People who Use Drugs (ANPUD) call on Asian governments, UNODC, UNAIDS, WHO, OHCHR and other Bi-lateral and Multi-lateral funding agencies to:

Remove all forms of criminalization, violence and inhumane treatment & detention for drug use and possession of drugs for personal use.

Continue to fully fund and scale up comprehensive HIV prevention and harm reduction interventions for people who use drugs.

Ensure adequate access to viral load testing, drug resistance testing and a robust drug supply chain mechanism.

Recognize community expertise and meaningfully engage networks of people who use drugs at all levels.

Facilitate countries to benefit from TRIPs flexibilities and make optimal HIV medicines available and accessible.

References:

  1. UNAIDS. Prevention Gap Report. 2016.
  2. UNAIDS. HIV and AIDS Data Hub for Asia-Pacific: People who inject drugs 2016. Available from: http://www.aidsdatahub.org/people-who-inject-drugs-2016-slides.
  3. UNAIDS. Do No Harm: Health, Human Rights and People Who Use Drugs. 2016.
  4. United Nations. Political Declaration on HIV/AIDS 2006.
  5. WHO, UNODC, UNAIDS. Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users.2009.
  6. United Nations. Political Declaration on HIV and AIDS: Intensifying Our Efforts to Eliminate HIV and AIDS. 2011.
  7. United Nations. Political Declaration on HIV and AIDS: On the FastTrack to Accelerating the Fight against HIV and to Ending the AIDS Epidemic by 2030. 2016.
  8. Harm Reduction International. The Global State of Harm Reduction. 2016.
  9. WHO, United Nations. Joint United Nations statement on ending discrimination in health care settings 2017. Available from: http://www.who.int/mediacentre/news/statem ents/2017/discrimination-in-health-care/en/.
  10. UNAIDS. The Gap Report. 2013.

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