1 People who use drugs, HIV, and human rights The Lancet : HIV in people who use drugs Vienna, 20 July 2010 Ralf Jürgens Joanne Csete, Joe Amon Steven Baral, Chris Beyrer

2 Acknowledgements Nick Crofts, David Stephens Jonathan Cohen, Daniel Wolfe Damon Barrett, Rick Lines, Richard Elliott people who use drugs who 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 violations 2.their negative outcomes for health & other human rights of people who use drugs 3.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