Statement by Eliot Ross Albers, Executive Director
International Network of People who Use Drugs (INPUD)
Agenda item 11: The Thematic Segment of the 35th PCB on halving HIV transmission among PWID
For those of us in the injecting drug using community the 2016 UNGASS on drugs represents a crucial once in a generation opportunity to see the issues that impact so destructively upon our lives, health, and rights discussed with rigour and open mindedness upon the global stage. It is an opportunity that has the potential to put meaningful weight behind the calls for enabling legal environments, for community empowerment, for an end to institutionalised stigma, discrimination, and above all, the criminalisation that drives them that resound so often around this PCB a reality for the sixteen million people who inject drugs globally.
It is, and this is no exaggeration, a real opportunity to begin the much needed process of dismantling the global legal architecture of punitive drug prohibition that wreaks so much havoc with the lives of my community. It is an opportunity to reorient the foundations of global drug policy away from repression and towards an emphasis on, and respect for, our health, our human rights, and civil liberties.
Contemporary global drug policy is driven by a moral compass so skewed that it is believed in countries that retain the death penalty that people deserve to be hanged for using or for small scale possession of the drug of their choice. It is one in which hundreds of thousands of our brothers and sisters are thrown into detention centres in the name of ‘treatment’. It is one that ensures that criminalisation, stigma, marginalisation and discrimination are basic facts of the lives of people who inject drugs, of whom between 54 and 69% will at some point in their lives be incarcerated.
When you define the pursuit of public policy, defined by both national and international law, as a war you are going to produce war casualties, and arguably unintended, and in this case, decidedly negative consequences. In response to this war we are calling for this UNGASS to be transformed into a peace congress, a ceasefire in the war on my community. We demand an amnesty for drug war prisoners, an end to the violence and rights violations that have been heaped upon my community, and an intelligent and open debate on alternatives. This war against the supposed threat to society that the so called “evils of drugs” pose has stigmatised us, discriminated against us, pathologised us, and made us scapegoats for much of society’s ills.
This tidal wave of flagrant, systemically driven human rights violations must be brought to an end, and the only way to do so is thorough overhaul of the three international conventions that together comprise global drug prohibition. Superficial redress and minor reform will not staunch the flow of systemic rights abuses directed at people who use drugs, their families and communities. Only the end of the war on people who use drugs through international legal reform will suffice to end this panoply of rights violations. To ensure that this war ends we are calling upon human rights defenders and advocates to join with drug user activists, harm reduction and drug law reform advocates in working to ensure that ending global prohibition is firmly on the table at the UN General Assembly Special Session on Drugs in 2016.
The landmark UNDP sponsored Commission on HIV and the Law concluded that “the legal environment—laws, enforcement and justice systems—has immense potential to better the lives of HIV-positive people and to help turn the crisis around. International law and treaties that protect equality of access to health care and prohibit discrimination— including that based on health or legal status— underpin the salutary power of national laws. But nations have squandered the potential of the legal system. Worse, punitive laws, discriminatory and brutal policing and denial of access to justice for people with and at risk of acquiring HIV are fuelling the epidemic. These legal practices create and punish vulnerability. They promote risky behaviour, hinder people from accessing prevention tools and treatment, and exacerbate the stigma and social inequalities that make people more vulnerable to HIV infection and illness.”
The reality for people who use, and in particular, who inject drugs, is defined by the fact that we are subject to blanket criminalisation of our behaviour which drives, and often justifies, rampant social stigma and discrimination. The latter drives us away from what services do exist, or makes those programmes, such as needle and syringe exchange, in and of themselves illegal. It leads police officers to use the fact that we possess the sterile needles and syringes that we need to prevent HIV and HCV acquisition as an excuse for arresting and harassing us. Such repressive legal environments play a key role in driving the widespread violations of the human rights of members of key affected populations, of criminalised communities, and drive transmission of HIV amongst us.
The creation of an enabling legal environment is critical to the success of community based, prevention programmes, without which they cannot function effectively. No properly public health oriented, or meaningfully human rights compliant response to the epidemic can be effectively mounted under conditions of the war on drugs, properly called, the war on people who use drugs, without thorough reform of the global conventions which drives, and justifies, that war. This is in spite of recent claims, from numerous quarters and agencies, to the contrary. That, at a minimum, the decriminalisation of drug use and possession is a precondition of effectively preventing HIV and HCV transmission in the injecting community is also underlined by the recommendations of the recently published WHO Consolidated Guidelines on HIV Prevention, Treatment and Care for Key Affected Populations, and has been recognised by several UN agencies and multilateral institutions including UNAIDS, UNODC, UNDP, OHCHR, the World Bank, and the Global Fund.
Whilst we are seeing an increasingly triumphalist biomedical rhetoric that the end of AIDS is within reach, such language seems particularly untenable and unrealistic when viewed from the perspective of the drug using community. Within the positive injecting community we currently have a treatment gap of 96%, combined with a massive funding crisis for harm reduction. In such an environment, talk of ending HIV seems empty, without a serious commitment to both scaling up and maintaining multilateral and bilateral funding and investments in harm reduction in middle income countries where the bulk of people who inject drugs live, and a significant commitment to root and branch political reform of the disabling environments that place barriers in the way of access to vital services.
Over the last few years it has been increasingly widely recognised that two bodies of international law, namely human rights law on the one hand and drug control law on the other, exist in “parallel universes”. Professor Paul Hunt former UN Special Rapporteur on the right to the highest attainable standard of health made the latter remark in a report in which he also noted that “This widespread, systemic abuse of human rights is especially shocking because there is no public outrage, no public outcry, no public inquiries, on the contrary. Sometimes it even receives some public support.”
The pursuit of repressive drug control in the name of the war on drugs, has inexorably driven rampant human rights abuses against people who use drugs and their communities. That one set of international laws is systemically driving breaches of another is an increasingly untenable situation. When the pursuit of drug control law becomes a driver of widespread human rights abuses, on what is unquestionably a massive scale, it is without doubt time to call for a thorough review of those laws. As The Global Commission on Drug Policy put in their report ‘The Negative Impact of the War on Drugs on Public Health: The Hidden Hepatitis C Epidemic’: “instead of investing in effective prevention and treatment programmes to achieve the required coverage, governments continue to waste billions of dollars each year on arresting and punishing drug users – a gross misallocation of limited resources that could be more efficiently used for public health and preventive approaches”.
Countries that early on in the epidemic rolled out comprehensive access to needle and syringe programmes have managed to drive HIV rates in the injecting community to negligible levels. But other nations, and here I must address my remarks to the Russian Federation after their dishonest remarks this afternoon, who having maintained the criminalisation of all evidence based, human rights respecting harm reduction programming, and executing a particularly vicious war on the drug using community has prevalence rates amongst people who inject drugs of up to 75% or more in some regions. The remark from our Russian colleague was, as the late Robert Carr would have said “bullshit”. Members of my community die by their thousands in the Russian Federation, and in the Crimea, at least 40 have died since the abrupt and brutal cessation of harm reduction services following its annexation.
In several South East Asian countries which maintain compulsory drug detention centres hundreds of thousands of people who use, or are suspected to use illegal drugs, languish with no access to harm reduction programmes, limited access to ART, and under a regime that amounts to cruel, inhuman or degrading treatment, and often reaches the level of torture, HIV and hepatitis C rates, not surprisingly, are particularly high.
Almost everywhere, drug policy falls under the aegis of law enforcement and not of health, it is certainly not in line with human rights norms. In many countries laws mandate compulsory treatment for drug dependence, testing for suspected drug use and impose registration of people who use drugs. Several decades of experience show that repressive drug control laws and policies fail to achieve their purported goals, and do not meet even their own metrics, whether these be fighting crime or reducing drug use or drug-related harm, on the contrary these laws worsen health and contribute to systemic human rights violations against people who use drugs. And they decidedly do not stem HIV infection.
Without thorough implementation of the recommendations of the Global Commission that impact upon people who use drugs, we will not, and I say this quite bluntly, see any end to the HIV and HCV epidemics amongst the injecting community. Those recommendations include: the closure of all compulsory drug detention centres; the abolition of national registries of people who use drugs, and the end to mandatory and compulsory HIV testing and forced treatment for people who use drugs; the repeal of punitive conditions on funding such as the US federal ban on supporting NSP; the decriminalisation of the possession of drugs for personal use; and most significantly, decisive action to review and reform relevant international laws and bodies.
These decisive steps are the minimum that is needed to ensure that the health and human rights of people who use, and in particular, who inject illegal drugs, are protected and realised, and the bedrock of any effective and meaningful attempt to seriously address and reverse the interlocked epidemics of incarceration, HIV and hepatitis C that are ravaging the drug using community.
We have missed the target of halving HIV transmission amongst people who inject drugs. We have missed it emphatically. Definitively. We have missed it, I am afraid to say, entirely predictably. However, if we seize the opportunity presented by the 2016 UNGASS on drugs with determination, clarity, unity of purpose, and the humility that is required to admit that the current system is fatally ill. We have a chance, a real chance to reverse the historical catastrophe that global prohibition has been. We must replace it with a human rights approach, embedded in the proven success of the harm reduction approach. We must listen to the voices of an increasingly empowered drug using community, and chart a new course that can enable people who use drugs to live healthy and fulfilled lives, with the full realisation of our human rights, free from the threat of incarceration, and in an atmosphere that respects our choices and gives us the tools to prevent us from contracting HIV, HCV, or dying needlessly from overdose. Join us in saying enough is enough. Join us in calling for a drug war peace in 2016.