The Iranian authorities must urgently overturn the death sentence for a shop worker who was tried unfairly on drugs-related charges, Amnesty International said, amid fears his execution is imminent.

On 1 August, Saeed Sedeghi was transferred from Tehran’s Kahrizak detention centre to Ghezel Hesar Prison in Karaj, 50 km west of the capital.

The transfer came just days after he was brought before Tehran’s Revolutionary Court – without having a lawyer present – and made to sign a document informing him that his death sentence would be implemented.

“By transferring Saeed Sedeghi so soon after informing him of the intent to carry out his death sentence, we fear the Iranian authorities are gearing up to execute him,” said Ann Harrison, Deputy Middle East and North Africa Programme Director at Amnesty International.

“His death sentence should be overturned immediately and he should be retried in full accordance with international fair trial standards, without recourse to the death penalty.”

Before his transfer from the capital, Sedeghi had applied to Iran’s Amnesty and Clemency Commission for a pardon, but never received a response about the outcome.

On 2 June 2012, the Revolutionary Court had sentenced him to death for purchasing – along with three other men – and possessing 512 kg of methamphetamine (“crystal meth”).

In addition to execution, the court handed Sedeghi a fine of 2 million rials (approximately US$163) and sentenced him to 20 lashes for individual possession of 21 grams of opium and marijuana.

The convictions came after the shop worker underwent an unfair trial in which he had no contact with his state-appointed lawyer before appearing in court.

He told his family he was tortured and otherwise ill-treated while at Kahrizak detention centre – including having several teeth knocked out by officials there.

The Kahrizak detention centre was reportedly closed in 2009 on the order of the Supreme Leader following allegations of torture which led to several deaths in custody.

Subsequently, a new facility is reported to have been opened there under another name – Soroush 111 – though locals in Iran continue to refer to the facility as Kahrizak.

The vast majority of executions in Iran in recent years have been for drug-related offences, despite there being no clear evidence that the death penalty serves as an effective deterrent against such offences – the country has one of the highest rates of drug addiction in world.

Under Iran’s Anti-Narcotics Law, the death penalty is mandatory in cases of possession or trafficking of more than a specified amount of various drugs. In December 2010, the law’s scope was expanded to include a wider range of illegal drugs, among them methamphetamine.

Under Article 32 of the law, death sentences handed down by lower courts are subject to confirmation either by the head of the Supreme Court or the Prosecutor General and it appears that those sentenced to death are not granted leave to appeal, in contravention of Iranian and international law.

Iran is second only to China in terms of the volume of death sentences carried out annually, with many of the more than 600 executions believed to have taken place in 2011 carried out behind a cloak of secrecy.

By the third week of July 2012, the Iranian authorities are believed to have executed at least 272 people, including 98 executions that have not been announced by the authorities. More than 65 per cent of all executions this year have involved drug trafficking.

International standards prohibit the use of the death penalty except for “crimes with an intention to kill which resulted in the loss of life”, and the UN Human Rights Committee has on numerous occasions found that drug-related offences do not meet this criterion.

“Drug-related offences like those of which Saeed Sedeghi was convicted do not meet the ‘most-serious crimes’ threshold prescribed for the use of the death penalty,” said Ann Harrison.

“We urge the Iranian authorities to urgently review the Anti-Narcotics law to remove the death penalty as a possible punishment, and to commute the death sentences of all prisoners currently on death row.”

Amnesty International opposes the death penalty in all cases as the ultimate cruel, inhuman and degrading punishment, in violation of the Universal Declaration of Human Rights.

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

Iran: Overturn death sentence for drugs offence

Increasing rates of HIV testing or expanding the use of antiretroviral therapy will not be enough to eliminate new HIV transmissions in China, according to a mathematical model published in the online edition of 

However, a “combination prevention” approach including an expansion of testing, targeted harm reduction programmes and wider use of HIV therapy was shown to have a potentially significant impact on the course of the epidemic in China.

“This is the first study to consider the cost-effectiveness of treatment, testing, harm reduction and combinations of these strategies at a national level in China,” write the authors. “Research to date has only considered the strategies in isolation and only in certain provinces and cities.”

At the end of 2009 there were an estimated 48,000 new HIV infections in China and the total number of infections in the country is thought to be in the region of 740,000.

The epidemic is concentrated in specific provinces (Yunnan, Guangxi, Guandong, Xinjiang and Henan) and focused on certain high-risk groups (injecting drug users, female sex workers and men who have sex with men).

A national government-led strategy advocates a comprehensive package of prevention, treatment and support as a way of controlling the epidemic. Nevertheless, the rate of testing among high-risk groups is generally low; there is limited access to harm reduction services such as needle exchange; and only a quarter of eligible patients are receiving antiretroviral therapy.

Given this situation, investigators wanted to gain a better understanding of the potential course of the HIV epidemic in China. They also wished to determine which of four prevention strategies would avert the greatest number of new infections and be most cost effective. The strategies were:

Expanded voluntary couselling and testing (VCT).

Expanded antiretroviral therapy: coverage of HIV treatment is increased to 50% of those eligible (CD4 cell count below 350 cells/mm3).

Expanded harm reduction programmes: expanded to reach entire populations of injecting drug users.

Combination strategies: a combination of any two or more of the above.

Cost-effectiveness was measured by calculating incremental quality-adjusted life years (QALYS) per life year gained.

The model predicted the course of the epidemic over 30 years.

The investigators’ calculations showed that without any new interventions, by 2040 the cumulative number of HIV infections in China would be 3.41 million. Three-quarters of these infections would be in high-risk groups. An estimated 25% of all injecting drug users would be HIV positive, whereas prevalence in men who have sex with men would reach 14%.

A VCT-only strategy, which involved annual HIV tests for high-risk individuals and one-off screening in lower-risk groups would avert an estimated 7% of all new infections at a cost of $5810 per QALY.

Expanding treatment would prevent an estimated 340,000 infections at a cost of $4840 per QALY. A targeted harm-reduction programme would prevent 710,000 infections, costing $5010 per QALY.

“Biomedical interventions, such as VCT and treatment, can have a significant impact on HIV and are cost effective under certain implementation strategies,” comment the authors. However, they caution that, on their own, these interventions will not be able to eliminate HIV transmissions.

Combination prevention approaches were shown to have a bigger potential impact on the epidemic.

A combination of any two interventions would avert between 17 and 29% of new infections at a cost of between $5030 and $5310 per QALY. A combination of all three interventions – testing, treatment and harm reduction – was shown to avert 1.2 million new infections at an estimated cost of $5550 per QALY.

The investigators repeated their calculations to take account of the marginalisation of drug users and men who have sex with men in China. They believed that this would potentially make these high-risk groups harder to reach.

However, they showed that the combined use of all three methods of prevention could avert between 21 and 43% of projected infections over the next 30 years.

“This study shows that it may be possible to significantly control HIV growth amongst high-risk populations in China through a combination of VCT, treatment and harm reduction programmes,” conclude the authors. “These raise the possibility that China will face a future largely free of this disease if it acts now to implement a widespread expansion of both biomedical and harm reduction strategies.”

Combination prevention approach could have a big impact on HIV epidemic in China

The UN Office of Drug Control (UNODC) has thoroughly documented the violence, crime, and corruption linked with the worldwide heroin and opium trade. The U.S. news media report every day on the mayhem and corruption of government officials caused by the drug wars in Mexico, Colombia, and other points south of our border. In Afghanistan, the Taliban tax the opium trade and protect poppy farmers from eradication, fueling the insurgency and our 11-year war.

However, these problems are all consequences of drug prohibition, not of the drugs themselves. In legal terms, drugs are 

 (wrong because prohibited by law) rather than 

(inherently wrong, such as theft or murder). During the U.S. experiment with Prohibition (1920-1933), alcohol was 

; as soon as it was legalized, it again became a normal regulated, traded, and taxed consumer product.

We need to rethink our prohibition of drugs. What problem are we trying to solve by making drugs illegal? Have we chosen the most effective and affordable solution? Are the collateral consequences worth it?We should start with the premise that neither demand for drugs nor the drugs themselves can be eliminated. UNODC estimates the ultimate street value of drugs originating in southern Afghanistan, primarily Helmand and Kandahar, as $68 

. Where there is demand, there will be supply. If Afghan supplies were reduced, production would simply move elsewhere—as it did when it moved into Afghanistan in the 1980s after being pushed out of Southeast Asia’s Golden Triangle.

The American experience of Prohibition is instructive.

The U.S. ban on alcohol served primarily to corrupt public officials and endanger the public. Supplying the unabated demand for alcohol required traffickers to pay bribes to police and politicians. As prices increased as a result, cutting quality was one way to keep the retail price down, which resulted in deaths from adulterated products. Moreover, the rise of violent, organized crime during this period—required to move the product and handle disputes within the trade—created criminal organizations that endure to this day.

The Prohibition experiment was relatively short-lived. Part of the impetus for repeal was that Prohibition was not having the intended effect of cutting either alcohol use or the social problems resulting from its abuse (the potential for alcohol tax revenues in the midst of the Great Depression was another factor). Whatever successes the experiment had were outweighed by the costs in corruption and violence, not to mention widespread public cynicism and hypocrisy.

Most importantly, the substantial and unanticipated costs of Prohibition were borne almost entirely by the United States. It was our own police and elected officials who were corrupted. It was our own cities afflicted by the criminal patronage networks battling over turf. We never attempted to force other countries to make the trade in alcohol illegal or participate in our war on alcohol.

The day after Prohibition was repealed, beer distributors no longer had to turn to the Mafia for enforcement of their franchise agreements. They took their disputes to court. The collateral violence largely stopped, and corrupt politicians and police suddenly lost a source of income. Product quality could be standardized. States could make individual decisions about regulating and taxing alcohol.

Of course, the social problems—particularly family violence—that were the ostensible reason for Prohibition continued, as they do to this day. My own experience as a prosecutor in Domestic Violence Court in Chicago in the 1980s is illustrative. If it hadn’t been for alcohol-related crimes, the court could have been closed. Alcohol had adverse effects on families that many other drugs did not have.

But by 1933, we had come to the realization that prohibition was an ineffective way to address abuse and indeed sidelined attempts to address alcoholism and family violence. There is still no simple solution to these problems, but we understood then that any response must directly address the problem. We as a society have come to terms withthe inescapable downsides of a product that the public insists on having but that is subject to abuse. We have struck a balance since realizing that criminalizing the trade in alcohol only made everything worse.

Federal statute criminalized narcotics beginning in 1914. There was no nationwide public advocacy campaign as there was leading up to Prohibition. Legislation seems to have been driven primarily by racial fears—of “cocaine-crazed Negroes” raping white women and “Chinamen” in California both using opium and seducing white women into becoming opium addicts. Perhaps there was political value in coming out against the evil of drug use by disfavored groups when it seemed costless to do so.

But we now know a great deal about the worldwide costs in violence, crime, and corruption of making drugs illegal. If the downsides of our drug policy are now so clear, why haven’t drugs (opium and heroin as well as marijuana) been legalized? Why is the calculation different from that made 

After spending more than four years in Afghanistan and seeing first-hand the impact of our drug policies—consequences most Americans never see—I have come to the conclusion that we persist on this course primarily because the costs of our drug policies are borne by other countries, not by us. In contrast with our experience under Prohibition, the corruption of American police and politicians by the drug trade is a relatively minor problem. Demand within the United States is just not high enough to necessitate much bribery.

The serious corruption is instead all on the production end, and this we have succeeded in outsourcing to foreign countries. Our war on drugs is fought on the territories of countries such as Colombia, Honduras, and Mexico. The headless bodies in Mexico barely make the inside pages of American newspapers (imagine if dozens of mutilated bodies were dumped in suburban Maryland). We have requisitioned foreign turf for our war on drugs.Citizens of these countries have no voice in the matter. Their leaders’ acquiescence to U.S. policies undercuts electoral accountability, and corruption of their police and courts undermines the rule of law. We have compromised democracy in our own hemisphere.

In Afghanistan, we have failed to connect the dots between drugs and corruption. At the July 2012 donors’ conference in Tokyo, donor after donor urged President Karzai to combat corruption. However, as long as we insist on the illegality of poppy, we are making a demand that cannot possibly be met.

A country that supplies 80-90 percent of the world’s demand for poppy products must necessarily be corrupt. To move the heroin, opium, and marijuana from field to market, officials and police can demand payment to look the other way (or engage in the trade themselves). The import of chemicals for processing requires the cooperation of customs and border police. Even the poppy eradication process itself has been corrupted, as officials target the fields of rivals while protecting their own. And any eradication in one area inevitably pushes production to another, simply pushing a bubble around in a balloon.

Afghan citizens are well aware of the suitcases full of dollars that leave Kabul Airport every day for Dubai. While kickbacks from development and military contracts are undoubtedly involved, drug profits in particular have to be moved out of the country. In Helmand Province, district chief of police positions are reportedly purchased for sums as high as $150,000 (and that is only the initial payment, not the yearly “rent”), and the chief expects to recoup his investment. District governors, appointed by the president, are merely shifted in musical-chairs fashion around the province when citizens or the U.S. military complains about corruption.

The Karzai government has also chosen not to implement those provisions of the 2004 Afghan constitution that call for the election of mayors and district and city councils. Instead, these councils do not exist, and all local officials report to the president. One can only imagine that all these officials are in place for a reason. For example, the mayor of Kandahar, a city of 800,000, is a presidential appointee, not answerable to local citizens. As a result, prior to his assassination in 2011, the president’s brother, Ahmed Wali Karzai, had a free hand in managing affairs in Kandahar province. As in Latin America, democratic accountability is the loser. The money at stake is so overwhelming that honest and accountable government cannot be implemented without changing the drug nexus. The incentives are just too strong.

If opium and heroin (as well as marijuana) were legalized, what would happen? Corrupt Afghan officials would suddenly lose a source of income, as poppy is illegal in Afghanistan primarily at U.S. insistence. The Taliban would be unable to extract protection money from farmers, or tax the drug trade. The war might wind down to a speedy conclusion, and Afghanistan could fund its own development and security forces out of sales of a legal commodity. Latin American democracy too would undoubtedly be strengthened and violence would decrease.

The U.S. government could save all the money it now spends on the DEA, interdiction, and drug prosecutions. States could make their own decisions about drugs. Local police and sheriffs could quit chasing after pot growers (who could now standardize and advertise product quality and potency), and devote scarce public safety budgets to the crimes that the average citizen prioritizes. State prisons that are overwhelmed with drug offenders could downsize. Of course, the entire anti-drug enterprise of U.S. officials and government contractors, greased by U.S. security assistance to drug producer nations, would drastically downsize too—and so the anti-drug lobby seeking to preserve its livelihood would undoubtedly be a political force in opposition. Likewise the manufacturers of medicinal morphine who have a monopoly on licensed poppy from India.

On the demand side of the equation, prices might well drop as the costs of paying protection were eliminated. It’s possible that usage would increase, but users don’t seem to have much difficulty obtaining supplies right now. With all the resources freed from fighting an unwinnable war against drugs, we could attend to the social problems that facilitate certain kinds of drug use (heroin use being primarily a lower-class phenomenon) and result from substance abuse. There are many options to explore once the problem is defined honestly and resources are available for experimentation.

Even if the middle class doesn’t care what happens to the lower class, the costs of prosecution and incarceration are a direct drain on the public purse, and an indirect drain as imprisonment itself causes family disruption and disintegration. Under a legalization regime, we would no longer have so many poorly educated young men with drug convictions rendered ineligible for future legitimate employment. Curtailed voting rights for those with felony convictions also means that individuals affected by drug laws have had no voice in changing them—a fundamental requirement of a democracy. Citizens in the 1930s could vote their interest in repealing Prohibition. These rights must be restored.

The immediate response to potential drug legalization is usually, “Why do you want our children hooked on drugs?!” (The rationales of 1914 are no longer mentioned.) Remember, however, that those campaigning for repeal of Prohibition did not say, “We’re in favor of alcohol-induced family violence.” Or, “Let’s have more alcohol-related carnage on the highways.” People were quite aware of the problems—which continued during Prohibition as before and since. We as a society concluded in 1933, however, that prohibition was an ineffective way of dealing with this particular societal ill, and that illegality created second- and third-order effects that were far worse than the evil that Prohibition was supposed to address.

As with alcohol, we need to be honest with ourselves about the costs and benefits of our social policies and recognize that not all problems have comprehensive or entirely satisfactory solutions. We can only do our best to make decisions that take into consideration all of the costs and benefits of our choices and not pretend that moral crusades are costless. We need to address honestly the morality of foisting upon other countries the violence, corruption, and damage to democracy caused by U.S. drug policies and driven by U.S. demand.

Legalization is the only solution to the problem of Afghan and Latin American violence and corruption—and the less obvious but more insidious problems of poverty, over-incarceration, and the misallocation of public resources within the United States. Only legalization can change the worldwide nexus of drugs and criminality.

On drugs and democracy

Activists at the International AIDS Conference disrupt a session sponsored by the pharmaceutical giant, Roche - why did they take action? Watch the HCLU's movie and learn more!

Hepatitis C has been dubbed "the silent epidemic” – because the infection can remain unnoticed for several years or even decades after transmission of the virus, and also because this epidemic has received much less public attention than HIV. Hepatitis C is much more infectious than HIV and in the majority of cases leads to potentially-fatal liver cirrhosis. Approximately 2 million people are infected with Hepatitis C every year, many of them belong to marginalized groups such as injecting drug users. The treatment for Hep C (pegylated interferon) is marketed by big pharmaceutical companies (Merck and Roche) and costs thousands of dollars for a few weeks. As a result, access to treatment in transitional and developing countries is very low. Activists at the International AIDS Conference disrupted a seminar sponsored by Roche to protest the high prices and "Big Pharma’s greed”. HCLU’s video advocacy team filmed the action and asked participants to explain their cause.

Pharma greed kills

The use of an AR-15-type rifle in the tragedy in Colorado has caused many to question whether it makes sense to allow the purchase of military-style assault rifles. What a lot of people don’t know is that these rifles are also the weapons of choice among ruthless Mexican drug cartels. In the last 5 years, nearly 60,000 people have lost their lives in Mexico’s wave of violence.

The brutal truth is this: 70 percent of the AR-15s and other guns used by drug lords, gangs, and kidnappers in Mexico, come from the United States.

WOLA has partnered with Cuéntame, an online community of Latino activists, to produce a short video showing how these guns are trafficked to Mexico, who profits from their sale, and what President Obama can do to stop this kind of trafficking.

Join Mexico’s peace movement and our coalition* by signing the petition at the end of the video asking President Obama to act now.

U.S. guns: The awful, shocking truth

It is a challenge to wean farmers off opium poppy cultivation in Lao People's Democratic Republic, once part of the Golden Triangle of South-East Asia. Without meaningful employment, subsistence farmers fall back on the lucrative cash crop to support themselves and their families.

As recently as 1998, Lao PDR was the third-largest illicit opium poppy producer in the world and had one of the highest opium addiction rates. From 1998 to 2005, opium poppy cultivation in the country was reduced by 93 per cent and opium addiction by 68 per cent, thanks to the Government's strong commitment.

In 2005, it became illegal to cultivate opium poppy in the country, and while this was a move to reduce the production of opium, it left many farmers without the means to make a living. Without an alternative source of income, many of these farmers were at high risk of reverting to opium poppy cultivation.

Although Lao PDR had significantly eliminated opium poppy cultivation by 2007, the country has seen a recent resurgence in opium poppy cultivation, endangering the progress made. From 2008 to 2011, the area under cultivation more than doubled, now amounting 4,100 ha.

To help farmers pursue alternative sustainable livelihoods projects as opposed to opium poppy cultivation, UNODC is working in six South Asia countries, including Lao, PDR.

In Lao PDR, farmers in the Oudomxay province with the support of UNODC have benefited from an alternative development project that supports the implementation of improved production technology. Farmers have been supported to develop greenhouse technology and small irrigation systems, and received training on cultivation techniques, such as producing and high-yield and disease-resistant seeds. Since the project commenced, farmers' incomes from the sale of produce such as peaches and organic vegetables have increased tenfold.

Encouragingly, areas where sustainable alternative development has been provided, such as Oudomxay Province, have not experienced an increase in opium poppy cultivation.

The project in Oudomxay Province takes a holistic approach and has been designed to increase the production of legal crops, create income generating activities, develop small farmer associations and cooperatives and prevent opium production and consumption. Special attention is given to increasing women's participation in project activities.

By addressing food insecurity, the project in Lao PDR will assist the government in long-term efforts to reach the Millennium Development Goals (MDGs) on poverty eradication and hunger, while at the same time helping the country achieve the MDG targets for gender equality and environmental sustainability.

An important component is promoting south-south cooperation for development. The project, funded by the German Government, is being implemented in partnership with the Thai Royal Project Foundation and the Highland Research Development Institute of Thailand (HRDI), which has more than 40 years of agricultural experience in working with ethnic hill tribes and with highland crops.

In March, UNODC and the United Nations Industrial Development Organization (UNIDO) stepped up efforts to promote grass-roots development in poor rural communities dependent on the cultivation of illicit drug crops. Since 2007, the two agencies have been working on projects to help rehabilitate opium addicts and involve them in income-generating activities; provide social services and basic infrastructure; and improve market access for products.

UNODC assists Lao PDR farmers to find alternatives to opium poppy cultivation

By Kristel Mucino, Latin America Program, Global Drug Policy Program

In Uruguay, the consumption of drugs, including marijuana, is not punishable with prison time. Paradoxically, the cultivation of marijuana for personal consumption is a crime, as is the purchase of marijuana. As a result, users who buy small amounts of marijuana and those who cultivate it to avoid buying it from criminal networks end up at odds with the legal system. Currently, Uruguay is debating the creation of a legal, regulated marijuana market. This is a sensible step that would allow police to direct resources and attention to more dangerous drugs. It would also help minimize the harms inflicted on non-violent offenders whose lives, and those of their families, are often ruined by harsh prison sentences.

To illustrate the futility and damage of current drug laws, the Washington Office on Latin America (WOLA) and the Transnational Institute (TNI) interviewed Alicia Castilla. At 66 years of age, she was arrested and imprisoned in Uruguay for three months for cultivating marijuana that she uses for her research books and personal consumption (to help her sleep). In this video testimony, she talks about the suffering caused by her imprisonment in Canelones (an Uruguayan prison) and her experience with the justice system in Uruguay.

This video was produced by WOLA and TNI with the support of Open Society Foundations. It is the latest in a video-series featuring people who have spent time in prison for drug-related crimes, enduring harsh sentences that are disproportionate to the crimes they committed. These personal stories represent the rarely revealed human cost of the war on drugs. The series complements a WOLA-TNI study investigating the prison systems of eight countries in Latin America, and the impact of harsh drug laws and sentencing. The study compiled statistics from the Uruguayan National Drug Board showing that 79 percent of the police operations between 2006 and 2009 related to marijuana involved quantities of less than 100 grams.

A regulated marijuana market would free police resources to focus on criminal gangs distributing dangerous drugs such as 

 and ensure that people like Alicia Castilla are not criminalized and imprisoned.

The case for coherent policy on marijuana in Uruguay

Commemorating those who have met with death or permanent injury as a result of drug overdose, it also acknowledges the grief felt by their families and friends.

Celebrated around the world, International Overdose Awareness Day aims to raise awareness of drug overdose and eradicate the stigma attached to drug use. It also spreads the message that overdose is a preventable tragedy.

International Overdose Awareness Day hopes to diminish the shame and guilt associated with drug use. That includes all drugs, licit and illicit (and alcohol, too). Taking its themes as prevention and remembrance, its goals are:

To provide an opportunity for people to publicly mourn for loved ones, some for the first time, without feeling guilt or shame.

To include the greatest number of people in Overdose Awareness Day events, and encourage non-denominational involvement.

To give community members information about the issue of fatal and non-fatal overdose.

To send a strong message to current and former drug users that they are valued.

To stimulate discussion about overdose prevention and drug policy.

To provide basic information on the range of support services that exists in the local community.

To prevent and reduce drug-related harm by supporting evidence-based policy and practice.

For more information, please visit the International Overdose Awareness Day website.

International Overdose Awareness Day

The 19th International HIV/AIDS Conference was held between 22nd and 27th July 2012 in Washington D.C., USA. Organised every two years, the conference aims to gather policy makers, people living with HIV and other individuals committed to ending the pandemic, in order to present new scientific evidence and lessons learned on tackling the HIV epidemic.

This year, however, some of the most affected populations were not able to attend the conference because of the US travel ban on people who use drugs and sex works. This situation was highly criticised throughout the conference (see, for example, a protest during the conference’s press briefing). Two hubs, one focusing on drug use and the other on sex work, were organised prior to and during the conference to ensure that the voices of these vulnerable groups be represented at AIDS 2012.

A pre-conference session entitled “The twin epidemics of HIV and drug use” highlighted the importance of drug policy reform and harm reduction interventions to curb the HIV epidemic among people who use drugs.

Within the conference’s main programme, there were some powerful speeches delivered on harm reduction and drug policy reform, including that from Debbie McMillan, Michel Kazatchkine and Michel Sidibe. A limited number of sessions also focused on HIV prevention among people who use drugs.

It was the Global Village, and particularly the Harm reduction and drug policy networking zone, coordinated by the Harm Reduction Coalition, which provided the main forum for discussing drug-related HIV issues. The zone provided a useful space for networking and sharing documentation on HIV and drug use. Many sessions were also organised at the zone, including the launch of the Global State of Harm Reduction by Harm Reduction International, an overview of the Community Action on Harm Reduction project by IDPC and the AIDS Alliance, or the broadcast of a series of videos by the Hungarian Civil Liberties Union.

For more information, please read IDPC's blog post on AIDS 2012.

Highlights from the 19th International HIV/AIDS Conference

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.

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

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

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.

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