On 4 November, the UNAIDS Reference Group on HIV and Human Rights Reference Group launched its new website, containing all the Reference Group's statements, papers, and recommendations since its first meeting in 2002. The Reference Group is an independent, advisory group that advises the Joint United Nations Programme on HIV/AIDS (UNAIDS) on all matters relating to human rights, law and HIV. The Reference Group is comprised of human rights and HIV experts, including people living with HIV, jurists and HIV service providers and funders.

The website brings together expert opinion on a range of HIV-related human rights issues such as HIV testing and treatment, international and domestic funding obligations, protecting human rights defenders, and the rights of vulnerable, marginalized, and criminalized populations.

"Publicizing these documents in one dedicated place is part of our effort to be transparent in our advice to UNAIDS on human rights. We want to be held accountable for what we do and how we do it," said Reference Group co-chair Jonathan Cohen.

Among many other documents, the website contains the report of the Reference Group's most recent, 14th meeting, with many recommendations aimed at strengthening the response to HIV. Discussions at the meeting focused on three issues, each of which has critical human rights dimensions: shared responsibility and global solidarity for the HIV response; the investment approach to HIV; and scaling up HIV treatment.

"The Reference Group agrees that low and middle-income countries with HIV epidemics have a responsibility to progressively realize the right to health of their people, and that it is a major achievement to increase domestic spending for HIV." Said Reference Group co-chair Michaela Clayton. "But the Reference Group advises UNAIDS to continue to advocate strongly for wealthier development partners to fulfil their own responsibilities in ensuring universal access to prevention, treatment, care and support, including by providing funding in middle-income countries for key populations at risk". Beyond that, the Reference Group recommended that UNAIDS contribute to developing and promulgating clear standards on shared responsibility as a matter of human rights and ethical responsibility.

With regard to the new strategic investment approach to the HIV epidemic, the Reference Group highlighted that "faster, better and smarter" results in the global response are impossible without strong financial and political support for the "critical enablers" that support human rights, such as removal of punitive laws and law enforcement that impede HIV responses, access to justice, anti-discrimination laws and their enforcement, stigma reduction, gender equality measures and others.

With regard to scaling up HIV treatment, the Reference Group emphasized that treatment expansion is the human rights imperative of the epidemic and that it is right and critical for the UNAIDS Secretariat and Co-sponsors to make treatment expansion a priority.

"UNAIDS can and should be bold, direct, and challenging about the serious human rights and funding challenges that stand in the way of HIV treatment scale-up, said Cohen. "We urge UNAIDS to provide such leadership by expressly affirming the human rights to life, health, and non-discrimination as vital, not only in their own right, but also as essential strategies to facilitate the work necessary for an effective HIV response."

Specifically, the Reference Group urged UNAIDS to take on intellectual property issues; stock outs; inequitable and inadequate delivery; state-level denial and discrimination against people living with HIV and other key populations and marginalized groups; stigma and discrimination in health care systems; and punitive laws and law enforcement that impact treatment and/or promote low self-esteem, stigma, discrimination, retaliation, and risks of violence and imprisonment suffered by people living with HIV who are marginalized and criminalized.

For the full summary of the Reference Group's discussions and recommendations, please click here.

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

UNAIDS Reference Group on HIV and Human Rights launches new website

The United States is withdrawing troops from Afghanistan having lost its battle against the country’s narcotics industry, marking one of the starkest failures of the 2009 strategy the Obama administration pursued in an effort to turn around the war.

Despite a U.S. investment of nearly $7 billion since 2002 to combat it, the country’s opium market is booming, propelled by steady demand and an insurgency that has assumed an increasingly hands-on role in the trade, according to law enforcement officials and counternarcotics experts. As the war economy contracts, opium poppies, which are processed into heroin, are poised to play an ever larger role in the country’s economy and politics, undercutting two key U.S. goals: fighting corruption and weakening the link between the insurgency and the drug trade.

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

Despite the big U.S. investment since 2002 to combat it, the country’s opium market still flourishes

The Hepatitis C Trust is delighted to announce a success in our campaign to secure better services for people in prison with hepatitis C.

A new National Partnership Agreement between The National Offender Management Service (NOMS), NHS England (NHSE) and Public Health England (PHE) for the Co-Commissioning and Delivery of Healthcare Services in Prisons in England contains a commitment to introduce the offer of an opt-out test for hepatitis C, and other blood borne viruses (BBVs), by April 2014.

For the past 18 months, the Trust has campaigned tirelessly to introduce opt-out BBV tests for all prisoners upon entering the prison setting. Hepatitis C prevalence is higher in prisons than the general public, so testing in this setting is vital. One study estimates that almost 1 in 10 prisoners had the virus , yet only 6% of inmates were tested for it in 20112. It is estimated that more than half of those living with the condition are undiagnosed, but if caught early it can be treated and cured.

 The Hepatitis C Trust welcomes success in prison health campaign in the UK

“It’s a bit counterintuitive to people; somebody’s addicted to heroin and you’re giving them the thing they're addicted to—that’s a bit counterintuitive,” Bernstein said in a telephone interview. “But ultimately, the reason the treatment works is because it recognizes that a lot of the harm that comes to people who are addicted to heroin is not coming from the drug itself, it is coming from the fact that it’s an illicit substance.”

He explained that for some hard-core users, putting patients on a prescribed dose of heroin is proving the only effective means of bringing people into the health-care system and helping them avoid the health risks that come with using heroin on the street.

Vancouver hosts Canada's first public forum on prescription heroin and harm reduction

With Bolivian President Evo Morales running for a third term in 2014, the government will probably limit efforts to eradicate illegal coca fields in areas where Morales' political support is strong. Since the U.S. State Department stopped cooperating with Bolivian anti-drug operations in August, local security forces have been solely responsible for eradicating illegal coca fields. Destruction of illicit coca has risen in some regions, such as Yungas in western Bolivia, while pressure in the Cochabamba tropics -- where Morales has traditionally enjoyed strong political support -- remains steady. But despite the reduced pressure on certain coca producers, Bolivian cocaine production will not rise significantly if Morales is re-elected unless eradication efforts intensify in neighboring Peru, displacing producers to Bolivia.

Bolivia is the third-largest supplier of cocaine to the international drug market. The native plant from which cocaine is derived, coca is widely cultivated in Bolivia's western and central highlands. It is illegal in other South American countries, such as Colombia and Peru, but Bolivia allows government-regulated coca cultivation for medicinal and traditional cultural purposes. However, producers and corrupt government officials also divert legally produced coca toward cocaine production, and numerous illicit coca farms exist alongside legal ones. This ensures a steady supply of coca for Bolivian cocaine manufacturing labs, which are concentrated mostly in the country's eastern lowlands.

It is unclear exactly how much of Bolivia's 25,300 hectares of coca are diverted toward cocaine, which remains unlawful in Bolivia. Estimates are generally inaccurate because cocaine labs take both legally and illegally grown coca leaves. However, coca production in Bolivia far exceeds national demand.

Under Bolivian law, the coca that exceeds demand must be destroyed by the government or removed by growers. However, the sale of coca for cocaine production helps support poor farmers, and there is relatively little violence associated with cocaine production in Bolivia. Combined with corruption in the security forces and insufficient resources, the government does not have a great deal of interest in seriously cracking down on illicit coca.

Read here the full article (restricted access)

The effect of Bolivian elections on coca production

The take home naloxone program in Estonia was launched in September 2013. The program started with training on naloxone/ overdose prevention and naloxone distribution for 20 persons. Among them mostly people who inject drugs (PWID), some patients of Opioid Substitution Therapy (OST), some outreach workers and few partners of the PWID. 500 kits with the pre-filled naloxone syringes has been ordered for this year. The work started in two sites - one in Tallinn and one in North-Eastern region of the country in the city of Jõhvi. Naloxone in pre-filled syringes is not a licensed medical product in Estonia. Fortunately it has been licensed in EU (UK) this spring that allows to import it specifically for the national naloxone program based on the special authorization from State Agency of Medicines. The Prenoxad Injection is used.

Program design. In Estonia it is not possible to distribute naloxone for civil society organizations. Legislation supports only distribution of the naloxone by medical doctors as it is a prescription drug. Therefore the program is structured so that healthcare institutions, mostly drug treatment agencies (doctors), and needle-syringe programs (NSP) work in collaboration. NSPs spread the information

among the target groups, recruit trainees and arrange trainings at least once a week. Doctors come to the NSP to conduct the training and after the training and knowledge test they distribute naloxone. No prescriptions are actually written, but so-called patient lists are generated and distribution of naloxone is documented according to national legislation. The program is largely based on the Scottish experience and is fully funded by the state.

Program development. Increase is planned both in number of sites and kits next year. It is planned to distribute at least 1000 kits and to gradually involve all harm reduction services in the program. Geographically program will be expanded first of all to other cities in the North-East - Kohtla-Järve and Narva.

How it became possible? The main driver behind the launch of the naloxone program was high number of the overdose related death in Estonia during recent years and increasing awareness of the problem both on political and on grass-root level. The program became possible thanks to the joint effort of different governmental agencies (including State Agency of Medicines, National Health Board), drug treatment and harm reduction organizations who joined the program lead by National

Institute for Health Development to elaborate the best model for Estonia. Initiative was supported by international colleagues from Eurasian Harm Reduction Network and Scotland.

For more information please write to National Institute for Health Development, Department of the Infectious Diseases and Drug Abuse Prevention at nneo@tai.ee.

New take home naloxone programme in Estonia

Last week, more than 1,200 drug reformers from around the world gathered in Denver at the International Drug Reform Conference to talk about policy reform and find "an exit strategy from the war on drugs," as Tony Newman with the Drug Policy Alliance said in a statement about the conference.

One of the most energetic and impassioned speeches over the three-day conference was delivered by Drug Policy Alliance executive director Ethan Nadelmann who said that the world has hit "the tipping point on marijuana."

"[It's] Because of what Colorado and Washington did and what Uruguay is going to do," Nadelmann said, referring to both states' legalization of recreational marijuana in 2012 and Uruguay's expected passage of its own marijuana legalization laws, which will make it the first country in the world to establish rules for the production, distribution and sale of marijuana for adults. Nadelmann also cited the Department of Justice's decision to let Colorado and Washington's new marijuana laws go into effect without a challenge.

"And we've hit the tipping point because 58 percent of our fellow citizens say it's time to legalize marijuana," Nadelmann said to applause from the conference audience.

Ethan Nadelmann: We have reached the marijuana policy reform 'Tipping Point'

The Global Fund’s New Funding Model (NFM) has passed its pilot phase. The upcoming GFATM Board Meeting (November 7/8 in Geneva) will tie up some of the loose ends. Full roll-out of the NFM is envisaged for 2014. This is great news. But: Geneva, we have a problem!

New Allocation Criteria a Bitter Pill for Many

One of the most fundamental shifts in the NFM is the newly developed allocation criteria for countries and diseases. In a nutshell, the NFM tries to correct a perceived distortion in the way the Fund’s resources have historically been distributed. At the core is a calculation of epidemiological data such as HIV, TB or malaria disease burden, coupled with a measure of a country’s “ability to pay”. The latter is an assumption based on the respective country’s income ranking according to World Bank Criteria. This model might work well to increase funds for the poorest countries with the highest disease burden in Africa and elsewhere. However, some perceive the Global Fund’s use of national income and disease burden as the only two main allocation criteria a ‘blunt tool’ that cannot truly indicate where the greatest needs really are.

The trouble starts if you happen to be born in Russia or many others so called middle- or high-income countries in the region referred to as Eastern Europe and Central Asia (EECA)[1]. The region has a high burden of Multi Drug Resistant Tuberculosis and is the only place globally where HIV continues to rise. Many EECA countries face quite concentrated epidemics. In essence this means that, e.g. HIV or TB does not affect so much the general population – yet – but is spreading primarily in what is referred to as Most at Risk Populations (MARPS).

Some problems posed by the Global Fund's New Funding Mode

On behalf The European Harm Reduction Network, Foundation Rainbow Group (FRG) in Amsterdam is conducting an overview study on drug consumption rooms (DCRs) in Europe.

The aim of this inventory is to get an overview of different concepts, working methods, organisational aspects and client experiences of European DCRs, to enable comparisons and professional inspiration on a transnational scale. To achieve this goal, FRG - in collaboration with Lancaster University and Akzept e.V. – is conducting evaluations and developing survey tools for further study.

Since 1986, more than 90 DCRs have been set up in Switzerland, the Netherlands, Germany, Spain, Luxembourg, Norway and Denmark. Moreover, France is preparing their first DCR.

Outside Europe, Australia and Canada have one DCR each. Both facilities have published a significant amount of evaluations in English. In Europe some publications can be found on DCRs, but inventories on a European level are limited to basic overviews. This makes it necessary to gain a better understanding of DCR values, challenges and international differences and commonalities.

Currently two surveys are being conducted, namely: a client survey among DCR visitors in Amsterdam and Rotterdam (The Netherlands) and a facility survey for DCR managers.

116 client interviews have been completed and will be analysed and reported before May 2014, when they will be presented at the European Harm Reduction Conference in Basel. This survey focused on two major aspects: individual Quality of Life (QoL) and DCR experience. Regarding the latter, clients were for instance asked about their general satisfaction and to what extent the DCR has contributed to changed drug use behaviour, knowledge on drug use related matters (e.g. overdose) and access to services.

Concerning the inventory among DCR managers basic data has been collected on the different facilities in and outside Europe in order to write up a renewed general overview. Additionally, in October 2013, an online survey will be distributed among all facility managers outside the Netherlands (N= 51). In the Netherlands, the Trimbos Institute in 2002 and 2010, already collected data on Dutch facilities (N=30) in 2002 and 2010. With the cooperation of DCR managers it shall result in ample opportunity to compare DCR services, goals, approaches and good practices.

Besides, it could give basic insight into the essentials for developing DCRs.

Developed for this study and for future evaluations three survey tools have resulted, which will be made available for other interested organisations in 2014:

* The client survey on quality of life (QoL) and DCR experience.

* The online DCR manager survey on facilities and organizational aspects of the DCR. This will be made available through Lime survey.

* A staff survey, which may be used as a basic evaluation tool on the DCR staff views.

(swoods@correlation-net.org<mailto:swoods@correlation-net.org>) if you have any questions on this overview study or wish to receive one of the survey tools once it is ready to go public.

EuroHRN conducts a study on drug consumption rooms. Get involved? 

The Hungarian Civil Liberties Union created a series of videos at the International Drug Policy Reform Conference in Denver, Colorado, where more than 1000 drug policy reformers have come together to discuss how to end the global war on drugs. Below are a few v ideos of the speeches from the opening session.

Ifetayo Harvey, an activists whose father was incarcerated and later deported because of the drug war:

Reverend Sanders, the board member of the Drug Policy Alliance :

Ethan Naderlmann, the head of the Drug Policy Alliance :

Congressman Jared Polis' speech, who introduced legislation that would end federal marijuana prohibition:

Films from the International Drug Policy Reform Conference

The Global Drug Survey (GDS) is the world’s biggest annual survey of drug use. And this year, we’re bigger than ever before.

This year, GDS is about to become truly global. Our findings will be translated into Spanish, Portuguese, French, Flemish, German, Hungarian and Danish with media partners in the USA (Huffington Post); UK (Guardian, Mixmag, Hot Press & Gay Times); Australia and New Zealand (Fairfax Media) and Europe including Liberation in France, Der Morgen in Belgium and still others in the Netherlands, Spain, Portugal, Denmark as well as Brazil and Mexico. We are asking for your help.

This year other than drug prevalence, cost and patterns of use including new drug trends, GDS has a big focus on marijuana. We will ask what effects the weed you smoke at the moment has. Does it make you sleepy, or tired? Hyper and excited? Relaxed or paranoid? Then we ask users to describe their perfect smoke, so we can share that information with weed growers – so they might diversify away from strong skunk weed, which we know from our other research is not want most people prefer.

Most people who drink and / or use drugs don’t become dependent or experience significant problems with them. In the vast majority of cases neither are they used to manage underlying emotional or physical problems: people take them to enhance or even create an experience. And of course they are, in many cases, intensely pleasurable. Users know that, and to speak solely of harm, means many switch off. But drugs 

 also harmful, andthe best way to discuss ways to reduce those harms is to acknowledge many people’s main motivation for using them: pleasure and fun.

This year alongside our ground-breaking research into users’ marijuana preferences, we will be undertaking the biggest ever survey of harm reduction strategies among drug users, finding out what people do and what they might be willing to do in the real work to maximise the fun they have while minimising the risks of harm. We’ll be asking about nitrous oxide (laughing gas) and prescription drug use, spotting new psychoactive drugs, exploring what happens around the world when you get caught with drugs and the whole murky and increasingly controversial area of workplace drug-testing.

You can respond to the survey anonymously atwww.globaldrugsurvey.com/GDS2014. The results will be published in March 2014

Global Drug Survey - The world’s biggest annual survey on drug use

The World Health Organization, HIV Department, is currently in the process of consolidating guidance on HIV and key populations and developing technical briefs on adolescent key populations.

Although a significant effort has been made by many countries to reach people in key populations, the response remains inadequate with coverage low and access to services often inadequate and unacceptable.

To illustrate how a broad range of HIV programmes and services cater to the needs of adult and young key population groups, we are calling for examples of good practice to be included as case studies within the guidance. These examples of good practice will assist in improving the quality, coverage and equity of services and interventions for key populations.

Through this survey you can offer programme examples of good practice for key populations affected by HIV through completing a short scoping survey.

The closing date for programme examples is 30 November 2013.

News