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New Resources from IHRD
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The International Harm Reduction Development Program (IHRD) of the Open Society Institute (OSI) is pleased to announce the release of three new documents in October 2007 to assist global advocacy efforts for harm reduction. They have launched two new ‘Public Health Fact Sheets’ - on ‘Women’s Health and Harm Reduction’ and ‘Public Health and Public Order’ – and a policy paper on ‘Women, Harm Reduction and HIV’.
These are the latest in a long list of resources freely available to download from the IHRD website. The fact sheet on women’s health documents the punitive policies and practices from governments, health care systems and law enforcement agencies which drive women who use drugs away from potentially life-saving care. Even when women drug users do reach services, they often find them unwelcoming and poorly suited to their needs – creating a costly gender inequality in healthcare, harm reduction and drug treatment. The second fact sheet aims to emphasise the public health benefits of a harm reduction approach, while trying to dispel the myths that such interventions encourages crime and public disorder (in fact, research shows that some harm reduction programmes can decrease criminal activities by illicit drug users).
The policy paper on ‘Women, Harm Reduction and HIV’ is written by Sophie Pinkham and Kasia Malinowska-Sempruch, and discusses the difficulties that women who use drugs often face in accessing harm reduction, drug treatment, and sexual and reproductive health services. The report offers recommendations for policies and better-designed services to protect the health and rights of women who use drugs (with a primary focus on Eastern Europe and Asia - IHRD's principle areas of work). The report will be followed in 2008 by the release of assessments of women drug users' access to services in Georgia, Russia, and Ukraine. In addition, in May 2008, IHRD will be hosting a major session on women and harm reduction at Harm Reduction 2008: IHRA’s 19th International Conference.
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The International Harm Reduction Development Program works to reduce the harms relating to injecting drug use, and to press for policies that reduce the stigmatisation - and protect the human rights - of illicit drug users. For more information about IHRD, please visit www.soros.org/initiatives/health/focus/ihrd
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 Click here to view the ‘Women’s Health and Harm Reduction’ fact sheet [PDF:46KB]
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Click here to view the ‘Public Health and Public Order’ fact sheet [PDF:64KB]
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Click here to view the ‘Women, Harm Reduction and HIV’ policy paper [PDF:260KB]
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‘Get Tested’ - World Hepatitis Awareness Day
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 To coincide with World Hepatitis Awareness Day, a report was launched on October 1st 2007 by the Central and Eastern European Harm Reduction Network which shows that, across Europe, more than 90% of people who are infected with the hepatitis C virus (HCV) have not been diagnosed. This has prompted experts to warn that the official HCV prevalence statistics are unreliable and inaccurate, and that governments must ensure accessible screening systems so that people are encouraged to ‘get tested’.
At a media event in Brussels organised by the European Liver Patients Association (ELPA), Professor Gerry Stimson (the IHRA Executive Director) presented the findings from the report and told how an estimated 500,000 deaths each year are attributed to HCV around the world, and there are around 180 million people infected globally (four times more than are infected with HIV). And yet he referred to it as a “neglected disease” due to the lack of knowledge and awareness, and the stigma attached to injecting drug use (which is now the most prominent cause new HCV cases). Stephen Hughes (a member of the European Parliament) had earlier warned that “without urgent action, we are going to see a huge peak in mortality by 2020” and Professor Stimson concluded by emphasising that, through the scaling-up of proven harm reduction approaches, this is a “preventable epidemic”.
HCV is often asymptomatic, earning it the reputation as a ‘silent killer’ – as many people may be experiencing severe liver damage without knowing. At the event, Charles Gore (Executive Director of The Hepatitis C Trust) read a statement that had been written by Dame Anita Roddick (the businesswoman, environmentalist and human rights campaigner who founded The Body Shop) before she died from a brain haemorrhage in September 2007. In the statement, Dame Anita said, “I had no idea I had the virus. There was nothing to even make me suspect it. It showed up by chance [but] I’d had it for over 30 years”. She then added that “the beginning of health is to know your disease”.
The media event came after a meeting at the European Parliament, at which the issues around HCV were highlighted. World Hepatitis Awareness Day aims to bring together patient groups, doctors, politicians and the media to discuss the virus and advocate for action at the national, regional and international levels – including accessible HCV screening programmes. In a recorded message for the event in Brussels, Christopher Kennedy Lawford (the US actor and author who was diagnosed with HCV in 2001) summed up the message perfectly: “knowing whether or not you are infected gives you the power to take control and make decisions… get tested!”
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Click here to view the World Hepatitis Awareness Day website
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Click here to view the CEEHRN and IHRA press release [PDF:37KB]
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Click here to view the full CEEHRN report – ‘HCV Infection in Europe’ [PDF:280KB]
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Click here to view the larger CEEHRN report on Hepatitis C
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Click here for more information on hepatitis C
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In 2008, World Hepatitis Awareness Day will be on May 19th, four days after the end of Harm Reduction 2008 (IHRA’s 19th International Conference). As such, there will be a major focus on hepatitis at the conference (with the support of the World Health Organization) in order to pre-launch the events on the 19th.
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Drugs Policy Experts Gather for IHRA and IDPC Meeting in Lisbon
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In September 2007, IHRA and the International Drug Policy Consortium (IDPC) hosted a high-level drugs policy seminar in Lisbon, Portugal, which was attended by 45 civil society representatives from 15 different countries. The objective of the seminar was to share information about the 2008 review of the United Nations General Assembly Special Session (UNGASS) on Illicit Drugs - and to discuss the potential structure and content of any civil society contributions.
In 1998, over 150 states adopted an UN ‘Political Declaration’ committing themselves to measurable targets in the reduction of illicit drug supply and demand by 2008. A review of their progress towards these targets is due to take place at the Commission on Narcotic Drugs (CND) in March 2008, followed by a “period of reflection” which will culminate in a high-level UN meeting in 2009 to identify future actions and targets at the international and national levels.
Opening the seminar, Mike Trace (Chair of the IDPC) outlined the process for this forthcoming review, and emphasised that need for civil society to discuss, share and coordinate their advocacy priorities and plans around the review – with this meeting providing an ideal opportunity to do so.
The subsequent discussions were framed around four broad, thematic issues - the reduction of drug-related harms, human rights and drug policy, source country issues (such as crop eradication), and coherence in the UN system on drugs. These four issues are likely to shape the future work of the IDPC – which is a global network of 25 national and international organisations that specialise in issues related to illegal drug use (many of whom were present at the seminar itself).
Based on this meeting, the IDPC are going to launch a new publication in the coming months – entitled ‘The United Nations Review of Global Policy on Illegal Drugs – An Advocacy Guide for Civil Society’. This report will aim to provide those working in the fields of harm reduction and drug policy with key information about the UNGASS review processes - as well as advice and ideas on how they can engage in effective advocacy to influence the outcomes.
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UN Human Rights Report Praises Harm Reduction
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In one of the strongest ever statements in support of harm reduction from the United Nation’s human rights mechanisms, Professor Paul Hunt, the UN Special Rapporteur on the Right to Health, has stated that harm reduction is not only an essential public health intervention, but crucially, that it “enhances the right to health” of injecting drug users.
The Special Rapporteur, who reports to the Human Rights Council, is the United Nation’s expert on the right to health and is mandated to promote the implementation of the highest attainable standard of health for all. These comments from Professor Hunt are from a mission report from Sweden in February 2007, and were released recently. Whilst it was noted that Sweden has one of the highest standards of living and healthcare in the world, the Special Rapporteur stressed that “there is no room for complacency”. He was also “very surprised” at the low number of needle exchange schemes in Sweden, as these interventions have been proven to reduce and prevent blood-borne viruses among injecting drug users around the world.
Sweden is often promoted as a shining example of successful prohibitionist policies. Professor Hunt’s report actually coincides with the release of a report by the United Nations Office on Drugs and Crime (UNODC) entitled “Sweden’s Successful Drug Policy: A Review of the Evidence” – which applauds their ‘zero tolerance’ approach. The Special Rapporteur, however, could not have been clearer in his recommendations. Though recent legal reforms in Sweden now allow local governments to implement needle exchange programmes, Professor Hunt states that “such an important human rights issue cannot be left to the discretion of local government…the Government has a responsibility to ensure the implementation, throughout Sweden and as a matter of priority, of a comprehensive harm reduction policy, including counselling, advice on sexual and reproductive health, and clean needles and syringes”. There is no such statement in the UNODC report – despite the UNODC being responsible within the UN for overseeing and coordinating harm reduction responses!
What the Special Rapporteur’s report has clarified is that harm reduction is a human rights issue and that - even in a wealthy country with high standards of healthcare and living - special measures must be taken to ensure that the most vulnerable and marginalised are protected. Harm reduction is a vital component of the right to health and, therefore, it is an obligation owed by all countries to guarantee that right for injecting drug users.
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Click here to view the Special Rapporteur country visits page – including the full report from the Sweden mission
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Click here for the UNODC Report on Sweden
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IHRA Host Sub-Saharan Africa Harm Reduction Meeting
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In October 2007, IHRA will bring together representatives from civil society, UN agencies and key donors for a groundbreaking meeting in Nairobi, Kenya. The meeting will aim to discuss emerging patterns of drug use and HIV in sub-Saharan Africa, the specific challenges in the region, and the possibility of establishing a harm reduction network for sub-Saharan Africa.
Injecting drug use (IDU) has been increasing steadily in Africa during the past 15 years. At least 26 countries from the continent have now reported the presence of IDU - with Kenya, Tanzania, Mauritius, South Africa, Nigeria, Cote d’Ivoire, Benin and Togo among those most affected. High-profile studies carried out in numerous countries (such as Tanzania, Mauritius and Kenya) have shown that concentrated HIV epidemics among injecting drug users, sex workers and prisoners are emerging and that risky injecting practices are widespread.
Non-injection drugs (including alcohol) are also having a significant impact on HIV infection in the region – mainly through associated high-risk behaviours such as unprotected sex. Given the high prevalence of non-injection drug use and dependence in the region, this will be of utmost importance for discussion at the Nairobi meeting.
In addition to the IHRA meeting, the UN is also holding two high-level meetings in the region to address HIV among injecting drug users and prisoners – one towards the end of 2007 and one in early 2008. It is hoped that the discussions in Nairobi will feed into these meetings as well. Of key importance will be how internationally implemented, evidence-based harm reduction measures (such as needle exchanges) can be adapted to the particular problems and contexts in sub-Saharan Africa. In other continents, harm reduction measures have often been implemented in response to widespread IDU and associated HIV epidemics. In sub-Saharan Africa, however, we now have the opportunity to halt the spread of IDU and HIV in a region that has not yet experienced IDU at the same level found elsewhere.
Thus far, there has been a major interest in this meeting - with over 35 participants confirmed. With funding from the UK Department for International Development (DFID), IHRA is supporting the attendance of civil society delegates from over 15 countries from across the continent. For more information on this meeting, please contact Damon Barrett.
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Argentinean Government Officials Support Harm Reduction
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Three senior government officials in Argentina have made public statements in favour of harm reduction at the 5th National Conference on Drug Policy, which took place in Buenos Aires, Argentina on August 27th and 28th. Daniel Scioli (the Vice President of Argentina and President of the Chamber of Senators), Andrés Leibovich (Sub-secretary of Prevention Programs for the Ministry of Health) and Aníbal Fernández (the Home Affairs Minister) all spoke out for harm reduction as a policy approach, and outlined a commitment to prosecute drug traffickers while improving the health care of drug users.
In the conference’s opening session, Home Affairs Minister Aníbal Fernández said, “In a democracy, a person who is addicted to legal or illegal substances should be able to exercise the right to health and to a harm reduction plan”.
The event was organised by Intercambios Civil Association, an Argentinean non-governmental organisation that has been dedicated to studying and addressing drug-related problems for the last twelve years. It was attended by more than 450 participants and was designed to allow key Argentinean decisions makers, policy planners, researchers and members of civil society to meet together with the aim of improving current drug control policies to make them more effective, viable and credible.
Closing the event, Pablo Cymerman (from Intercambios Civil Association) said, “We hope that, with this conference, we have inspired multi-sector work involving different areas of government, academia and civil society”. He highlighted the “importance of exchanging views in relation to the criminalisation of drug possession for personal consumption”. It is hoped that this conference will have implications for national research and policies – promoting regulatory models that have a positive affects on the health of drug users and support their human rights.
Click here for more information about the conference
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Click here to view the Intercambios Civil Association website
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October 2007 Article of the Month
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Ball A (2007) Universal Access to HIV/AIDS Treatment for Injecting Drug Users: Keeping the Promise. International Journal of Drug Policy, 18 (4), pages 241 - 245.
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This month’s article is an editorial introducing the recent International Journal of Drug Policy ‘Special Issue’ on HIV treatment and care for injecting drug users. The entire issue (Volume 18, Issue 4) has been guest edited by Andrew Ball (from the World Health Organization), Michel Kazatchkine (from the Global Fund to Fight AIDS, Tuberculosis and Malaria) and Tim Rhodes (from the London School of Hygiene and Tropical Medicine).
The editorial by Andrew Ball provides an interesting overview of the current global situation with regards to access (or lack of it) to life-saving antiretroviral treatment (ART) for HIV-positive injecting drug users. In the past, ART for injecting drug users was considered to be infeasible, but the availability of ART around the world is now steadily increasing and more people living with HIV and AIDS are benefiting from expanded ART coverage. The continued ‘scaling-up’ of ART is a top priority in the global response to HIV. In June 2006, a UN General Assembly set out to achieve ‘universal access’ to HIV services (including ART) by 2010. A fundamental underlying principle to this goal is the populations that are disproportionately affected by the virus (such as injecting drug users) must be given equal access to treatments. Despite this powerful international commitment, the situation for HIV-positive injecting drug users has remained largely unchanged.
This article outlines six major challenges that must be overcome in order to scale-up ART for injecting drug users:
1) Expanded access to voluntary HIV testing and counselling is needed in order to increase the numbers of injecting drug users that know their HIV status
2) Simplified and affordable ART courses are needed in order to maximise treatment adherence amongst people who use drugs
3) Increased HIV prevention efforts (such as needle exchanges) must be targeted at drug using populations in order to reduce new infections
4) Health care systems must be strengthened in order to effectively deliver ART to vast numbers (including injecting drug users)
5) A supportive social and legal environment must be developed in order to reduce the considerable stigma and discrimination faced by injecting drug users
6) Evidence-based and context-specific interventions for injecting drug users must be implemented
In his article, Andrew Ball discusses each of these challenges in depth and refers the reader to the other journal articles that make up the ‘Special Issue’, such as the report on the need to provide integrated services to people who use drugs.
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Click here to view the ‘Special Issue’ of the International Journal of Drug Policy
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Click here to view IHRA’s ‘50-Best Collection’ on HIV Prevention and Care for Injecting Drug Users
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