 more than 50 drug users’ community representatives from 10 Eastern Europe and Central Asia (EECA) countries (Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Lithuania, Moldova, Russia, Ukraine, Uzbekistan and Tajikistan) gathered in a small city of Irpin located in Kiev Oblast to the 

AIDS Forum “Ensuring That Our Voice Is Heard”

 – the approved pre-conference of the XIX International AIDS Conference (IAC), which took place in Washington, DC USA on

. Many of them had, for the first time, an opportunity to meet high level decision-makers who make an impact on their health and lives - former executive director of the Global Fund Mr. Michele Kazatchkine, UNAIDS Regional Director for Eastern Europe and Central Asia Mr. Jean-Elie Malkin, UNAIDS Senior Advisor Ms. Alison Crockett, director of International Network of People Who Use Drugs (INPUD) Mr. Eliot Ross Albert – and to discuss with them issues of importance to people who use drugs in EECA. In total the Forum attracted around 100 participants.

The discussions were held in plenary sessions and parallel sessions on 3 key topics: Quality of opioid substitution treatment in EECA; Rights and health of women who use drugs in EECA; and Changes in the Global Fund – perspective for EECA countries. List of prioritized problems faced by Forum participants and their friends in communities where developed under each of the topics and based on them messages to international and national decision makers (international organizations, donors, governments) formulated. So that the voice of drug users on decisions that make an impact on their lives would be heard and considered in addressing their needs.

The messages were afterwards recorded in cooperation with Hungarian Civil Liberties Union (HLCU); and were subsequently screened at the XIX IAC in Washington.

The strategic planning of recently established Eurasian Network of People Who Use Drugs (ENPUD) was held, and the agreement on mission statement was reached during the session: “We are community of people who use drugs and our allies who united for a purpose to decriminalize drug use and to achieve personal and social well-being”. Mission based on the belief that drug policy can be changed and drug using won’t be the reason for detention, refusal to provide medical help, social exclusion or using violence in any country.

For the first time the Forum was organized before IAC. Since the IAC in Mexico in 2008 AIDS hubs were organized to help people who were not attending IAC to listen to what is discussed at the conference, to learn more about the most recent scientific and political developments. For the first time the AIDS Forum was designed so that drug users could be listened and heard rather than listening.

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

Drug users communities from Eastern Europe and Central Asia raise their voices in the lead up to AIDS 2012

IDLO is an established provider of high quality training services, with more than 26 years of experience working with legal and development professionals. More than 20,000 people have been trained by IDLO, creating one of the largest practitioner networks in the world. These alumni continue to work with IDLO and in partnership with each other to share information and improve their knowledge and skills.

This year IDLO will hold four online e-learning courses (English, French, Spanish and Russian) on HIV law and policy. The curriculum is designed for non lawyers and deals extensively with the intersection between vulnerable populations, HIV and the legal system.

The English course will be conducted online for four weeks (15 October - 9 November, 2012) and is intended for government officials, civil society representatives, development agency staff and others who are designing or implementing HIV and AIDS programs. It will also be useful for lawyers providing services for people living with and vulnerable to HIV. Kindly see the course description for further information.

IDLO HIV law and policy e-learning courses

Виртуальное обучение на русском языке будет проводиться в течение четырех недель (24 Сентября - 19 Октября 2012 / 19 Ноября - 14 Декабря 2012) и будет предназначен для государственных служащих, представителей гражданского общества, сотрудников международных агентств по поддержки национальных ответных мер на ВИЧ. Курс также будет полезен для юристов, работающих с сообществами с повышенным риском ВИЧ-инфекции и с людьми, живущих с ВИЧ.

Использование права и правовой политики для эффективных ответных мер на ВИЧ и СПИД

This film by the International HIV/AIDS Alliance, which was launched at AIDS 2012, features Alyona and Nga - two people whose lives have been improved by accessing harm reduction services, including needle exchange and methadone.

We do this because we know it works. The body of evidence and momentum for change is growing. Yet the criminalisation of people who use drugs continues to fuel the HIV epidemic. People who inject drugs account for 30% of HIV infections outside of sub-Saharan Africa, and up to 80% of infections in Eastern Europe and Central Asia.

Somebody's mother, somebody's brother

Needle exchanges for injecting drug users and the decriminalization of people who use drugs are the most effective ways of preventing HIV and hepatitis C infections in Thailand, say experts.

“When users do not have access to sterile injecting equipment they will share needles, [and] that will lead to HIV transmission as well as to hepatitis C,” said Pascal Tanguay, programme director in the Thailand office of the international NGO, Population Services International (PSI).

Providing free clean needles and syringes has proven to be the safest and most effective way to prevent new infections among injecting drug users (IDUs). But the Council of State, Thailand’s central legal advisory body, has interpreted any needle distribution programme as promoting drug use, Petsri Siriniran, Director of the National AIDS Management Centre in the Public Health Ministry’s Department of Disease Control, told IRIN.

Nevertheless, the ministry is collaborating on a pilot project, run by PSI since 2009, in which counselling and sterile syringes are provided through drop-in centres and outreach services in 19 of Thailand’s 76 provinces.

PSI has partnered with various local NGOs and support groups for people living with HIV to distribute clean needles to the country’s estimated 40,000 IDUs, 20 percent of whom share needles, according to 2010 government figures.

The Urban Health Research Initiative of the British Columbia Centre for Excellence in HIV/AIDS and the local Thai AIDS Treatment Action Group released a survey of 468 injecting drug users from a community in Bangkok, the capital, in 2012.

The study found that 30 percent of participants borrowed needles from other drug users, largely because there was nowhere to buy new ones or because pharmacies refused to sell them syringes.

A 2011 World Bank review of HIV prevention among IDUs in Thailand indicated that needle exchange programmes could be one of the key factors in decreasing HIV infections among them.

HIV prevalence among Thai IDUs dropped from 49 percent in 2008-2009 to 22 percent the following year. However, this is still among the highest in the Southeast Asia region, according to the Global AIDS Response progress report by the UN Joint HIV/AIDS Programme (UNAIDS).

Anne Bergenstrom, regional adviser on HIV/AIDS at the UN Office on Drugs and Crime (UNODC), questions the apparent drop. “Some of this reduction may be due to deaths in this population. There is no recent national survey on drugs, so we do not know how many initiate drugs and how many are HIV positive,” she said.

In Bangkok, Sak Aim Kien, 47, said, “When I am with friends and I have money, I still inject heroin, although I try hard to quit.” He has attended government drug rehabilitation programmes for the past eight years with faltering success. “My family does not know about my addiction and I tell my children I have a lung disease to hide it.”

Another man at the same local drop-in centre who went by the name of Aun, 37, went from injecting heroin to midazolam - a legally available psychotropic drug that alters brain function by affecting the central nervous system - after completing a methadone treatment programme five years ago.

Daily doses of methadone, a pain reliever, have been shown to help wean injecting drug users off heroin by blocking drug-induced euphoria and blunting their withdrawal symptoms, but in some cases, users have simply substituted one addiction for another.

Since 2009, PSI has distributed more than 300,000 needles and syringes, reaching up to 8,000 drug users, but workers say they operate on the margins of the law. “We currently run the only needle and syringe distribution project in Thailand, but the Thai government refuses to implement needle and syringes distribution, proclaiming falsely that such projects would encourage drug use,” said Tanguay.

“Sometimes the police are waiting outside our premises, arresting people who come here,” Piyabutr Nakaphiw, the manager of O-Zone, a drop-in centre for drug users in Bangkok, told IRIN. The centre employs drug users as outreach workers to distribute clean needles to other users in their communities. “They stop our outreach community workers, and if they are tested positive for drugs, the police either ask for money or arrest them,” said Nakaphiw.

UNODC’s Bergenstrom noted that “The government always had an ambivalent attitude towards the needle exchange. If we try to achieve HIV reduction, then coverage to needle exchange, access to rehabilitation programmes and to counselling services should be increased.”

The 2012-2016 national AIDS strategy calls for a review and amendment of current legislation that prohibits needle exchange and criminalizes drug users. A past effort to change the relevant laws failed.

Although the Drug Addict Rehabilitation Act passed in 2002 promotes the treatment of people who use drugs as patients, under the 1979 Narcotics Act drug addicts can still be arrested.

“It will be virtually impossible to halt HIV transmission as long as the national legal and policy framework around drug issues focuses on punishment and deterrence at the expense of the health and human rights of citizens,” said Tanguay.

Hepatitis C infection is another concern. A recent study published by the UK medical journal, The Lancet, reported that almost 90 percent of IDUs in Thailand are living with hepatitis C, which is transmitted through needle sharing, and can lead to liver failure and cancer.

Tanguay said although needle exchange programmes alone will not halt the spread of HIV and hepatitis C, it can be a major part of the solution if combined with the decriminalization of drugs and drug users.

THAILAND: Ambivalent about needle exchanges

Last Wednesday (July 25) the UN Office on Drugs and Crime issued a report with its latest findings about coca, the plant used to make cocaine, in Colombia.

The 112-page report explains that, from 2010 to 2011:

the area cultivated with coca in Colombia increased, from 62,000 to 64,000 hectares (1 hectare = 2 1/2 acres).

because traffickers were able to extract a bit less cocaine per hectare of coca, the country’s production of cocaine dropped slightly, from 350 to 345 metric tons.

The UN agency has not yet produced estimates for the world’s two other coca-growing countries, Bolivia and Peru. Its report got a lot of press in Colombia, though, because for the first time since 2007, it did not show a decrease in coca cultivation. Despite over 100,000 hectares sprayed with herbicides and 34,000 hectares of coca bushes physically uprooted by eradicators, the amount of coca left over actually increased last year.

Estimates of coca and cocaine production are only produced by two sources: the UNODC and the U.S. government. Washington had not issued any estimates for 2011 cocaine production when the UNODC released its report. However, five days later, Monday July 30, the White House Office of National Drug Control Policy produced a press release.

This 600-word document explains that, from 2010 to 2011:

the amount of cocaine produced in Colombia fell by 25 percent, from 270 to 195 metric tons.

The press release doesn’t say how much coca was grown in Colombia last year, or even whether the land area increased or decreased. Nor does it say whether growers were extracting less cocaine from the coca they harvested, and if so why or how much less. The document did tell us that Colombia, the world’s largest cocaine producer since the mid-1990s, has now fallen behind Peru (325 metric tons) and Bolivia (265 metric tons).

This is mysterious because in 2010, the last year for which the U.S. government and UNODC have coca-crop estimates for all three countries, Colombia and Peru show nearly the same amount of coca, and Bolivia shows about half as much as the other two. For Bolivia to be producing more cocaine than Colombia from half as much coca is difficult to fathom.

(All available coca and cocaine data from the U.S. and UN since 1999 is at the bottom of this post.)

The Bolivia result is especially surprising because the country’s coca cultivation, in both U.S. and UN estimates, had stayed about the same in 2008-2010. Why would cocaine producers be getting so much more of the drug from the same land area planted with coca?

Asked that very question by a Bolivian interviewer in mid-July, U.S. Chargé d’Affaires John Creamer explained that Bolivian cocaine producers are using “Colombian methods.” These methods, however, are apparently not at work in Colombia.

Here, using the data below, is a chart of how much cocaine the U.S. government believes that producers are deriving from each hectare of coca. It shows producers in Colombia getting 

 of the drug out of coca bushes than their counterparts in Bolivia and Peru. A hectare of coca in Peru produced 6.1 kilograms of cocaine in 2010. In Bolivia, it produced 5.7 kilograms of cocaine. In Colombia, it produced only 2.7 kilograms. (The difference may be even greater in the 2011 estimates, but since the U.S. government has not issued coca cultivation land-area estimates for 2011, we can’t calculate it.)

This discrepancy may be a result of frequent eradication in Colombia, which may force growers to replant more often and thus harvest from smaller bushes. However, the UNODC doesn’t reach the same conclusion. The UN estimate of how much cocaine Colombian producers extracted from coca in 2011 (5.4 kilograms per hectare) is closer to the Bolivia and Peru estimates, and 

. (The UNODC, meanwhile, has not even ventured a guess for Peru’s and Bolivia’s cocaine tonnage since 2008.)

Since the U.S. government is not at all transparent about how it gets its cocaine production numbers, this kilograms-per-hectare discrepancy leaves a strong impression that a political agenda is involved. Washington has a strong incentive to reward close ally Colombia and to show that the billions spent on forced coca eradication since 2000 are “working.” It has a strong incentive to prod Peru, whose center-left government may be tempted to take a nationalistic, independent course, to toe the line of the current strategy. And it has a strong incentive to punish Bolivia which, though controlling illicit coca cultivation far better than neighboring Peru, has a government that sharply (and sometimes unfairly) criticizes the United States and is perceived as opposing other U.S. interests.

We want to think that these numbers are not pulled from the U.S. anti-drug bureaucracy’s nether regions, and are based on a considered, reasoned process. But with no transparency at all over how these tonnage estimates are derived, the U.S. cocaine-production numbers are wide open to charges of politicization.

News

Drug users communities from Eastern Europe and Central Asia raise their voices in the lead up to AIDS 2012

IDLO HIV law and policy e-learning courses

Использование права и правовой политики для эффективных ответных мер на ВИЧ и СПИД

Somebody's mother, somebody's brother

THAILAND: Ambivalent about needle exchanges

Un and U.S. Estimates for Cocaine Production Contradict Each Other