Transcript Countdown to 2015 for Maternal, Newborn & Child Survival

Paper 7 Time to Act:
A Call for Comprehensive
Responses to HIV among People
Who Use Drugs
Chris Beyrer, Kasia Malinowska-Sempruch, Adeeba
Kamarulzaman, Michel Kazatchkine, Michel Sidibe,
Steffanie Strathdee
Time to Act
The evidence for action for HIV among people who use drugs
is clear and compelling
We know enough to act now
The costs of inaction are high: ongoing spread of HIV in new
populations and regions; increasingly complexity of HIV-1
epidemics at molecular levels; decreased access to opiates
for pain and palliative care; the human, family, health and
social costs of mass incarceration and detention
Opium production in Afghanistan 1980-2009
Modified from data from the UNODC World Drug Reports
Copyright, The Lancet
Estimated numbers of IDUs and regional
prevalence of HIV in people who inject drugs, 2010
* No countries have a prevalence of 5% to <10%
Copyright, The Lancet
Triple Therapy: NSP, OST, ARV
HIV epidemics among people who use drugs can be
largely controlled and their harms mitigated with
currently available tools and strategies.
What we need is massive scale-up of combination
prevention, treatment and care.
In opioid-driven epidemics this includes an essential
minimum package of safe injection programs, opioid
substitution therapy, and anti-retroviral therapy.
Drug treatment is HIV prevention
treatment and care
Universal access to evidence-based drug
treatment is a fundamental right to health, an
urgent public health priority, and a legal
obligation for States
Harm reduction is a legal obligation
Effective and comprehensive national harm
reduction policies, programs and services are
essential to countries meeting their legal
obligation to realize the right to health
Higher-income countries need to provide more
than essential services
Pilot programs no longer suffice
Advocacy, not Complicity
Expanded action and advocacy by health professionals is
urgently needed in both health care and criminal justice
Health professionals should not be complicit in programs
and policies which have no evidence base or which violate
human rights
The voice of people who use drugs themselves needs to
be heard at all levels, from service delivery to policy
decision making
Reform of justice systems
is part of harm reduction
It is time for decriminalization of drug users
An end to punitive and legalistic approaches to drug dependency
Due legal processes
Access to health services for people who use drugs in all forms of
prison and detention
Detention is not Treatment:
A voice from China
“I was addicted to heroin for several years before being sent to into
an involuntary treatment centre in my country. Since the day I was sent, I was
never given any medicine … As soon as I was considered ‘detoxified’, the
warden hurriedly arranged for me to labour at a locked factory. I worked 16
hours a day, overstretched, and if I failed to complete my workload, I would
be treated with violent beatings…
“It is dubbed ‘rehabilitation through labour’ but I never felt that I was
rehabilitating; the only thing I felt was punishment, and I believe everyone
else there felt the same.”
--Li Wei
Accountability
Progress on scaling up interventions, improving
access, and reducing rights abuses among
people who use drugs should measured.
States need to held accountable for failures to
act when the evidence is this clear
Toward Accountability: Measures for HIV in
6 countries: an assessment matrix, 2008-10
Country
China
Estimated
Estimated Estimated IDU
Coverage of proportions of all Coverage of
Needlesnumber of
with HIV
IDU on ARV (%) persons with HIV
OST
syringes
people who
infection*
who are
(methadone distributed
inject drugs
IDU/Proportion of and/or bup.)(# from NSPs
1
)
(1000s)
(1000s)
all persons on ARV
per IDU per
who are IDUs
year
(ratio)**
# drug users in
detention
2,350
289 (143-557)
3
38.5/10.7 (.28)
3
32 (1-84)
330,000
205
21 (18-25)
9
70/25
(.36)
2
9 (7-13)
50,305
Russia
1,825
678 (4-1,751)
1
0
4 (3-5)
62,200-366,700
Ukraine
325-425
94 (2-244)
9
83/20-30 (.24.36)
60.5/24
(.40)
2
32 (23-43)
57,800
Vietnam
135
49 (3-89)
4
44/6.3
1
189
(107-323)
Around 100,000
1,857
308 (113-580)
Not available
13
22 (15-31)
19.5% of state
prisoners (2005)
53% of federal
sentenced
prisoners (2007).
Malaysia
USA
(.14)
Not available
Conclusions
Global control of the HIV pandemic cannot be achieved if punitive
policies and practices continue to trump evidence based and right
affirming approaches for people who use drugs
It will take political courage, advocacy, and the real engagement of
people who use drugs and their communities, to make universal
access to drug treatment, and to HIV prevention treatment and care
a reality, but it can and must be done
The War on Drugs has failed, but the War on HIV cannot fail