This case study was conducted by the TB/HIV Care Association, which works to prevent, find and treat TB and HIV in communities in South Africa. Partly through funding and support from Bridging the Gaps Alliance partner Mainline, TB/HIV Care and its partner OUT Wellbeing (providing direct health services to LGBT people, MSM, sex workers, and injecting drug users) have established a joint programme for people who inject drugs (PWID). Bridging the Gaps played a key role in the initial procurement of sterile injecting equipment, enabling the launch of the project, and has continued to support Step Up’s advocacy for the human rights of PWID.

This case study illustrates how TB/HIV Care Association (THCA), and its partner OUT Wellbeing (OUT), have implemented the Step Up Project, an innovative joint initiative to support PWID in South Africa.

The criminalisation and stigmatisation that PWID experience in South Africa, combined with a fear of using health services due to the criminalisation of PWID, has contributed to the widespread use of unsafe injecting practices, such as the sharing and improper use of injecting equipment. In addition to facing stigma and discrimination from health service providers and the public, PWID also face abuse by law enforcement agencies.

The prevalence of high-risk injecting practices identified by a United Nations Office of Drugs and Crime (UNODC) 2013 study, indicated that services were urgently required to address the potential public health impact of injecting drug use, and improve the wellbeing of PWID.

Introducing and developing harm reduction strategies in South Africa

Welcome to the Ana Liffey Drug Project’s Strategic Plan for 2018-2020. The last number of years have seen significant and welcome changes in Ireland, both in terms of the general economic outlook for the country and in terms of broad drug policy trends.

The Ana Liffey Drug Project’s primary activity is to provide ‘low threshold - harm reduction’ services to people who use drugs. By low threshold, we mean that the barriers to availing of our services are kept as low as possible. By harm reduction, we mean that we seek to reduce the harm that drug use causes to individuals, families and communities. In addition to our direct services, we also perform advocacy and support roles at an organisational level in the addiction sector in Ireland and beyond.

We will work hard, we will work together internally as a unit and in partnership externally to achieve these goals and ensure that we continue to deliver on our mission to work with people affected by problem substance use and the organisations that assist them.

Safer From Harm: the strategic plan of the Ana Liffey Drug Project 2018-2020

To ensure the 52nd Parliament makes health a central focus of drug policy and law in New Zealand, the Drug Foundation has sent a comprehensive briefing to all MPs.

We are all concerned about the harm caused by drugs in New Zealand. But there are solutions. We need our politicians to see that these solutions are sensible and achievable.

We think we can achieve an Aotearoa free from drug harm, if we focus on these four priorities:

Priority 1: Keep young people in school and keep them safe.

Priority 2: Reform our laws to treat drug use as a health issue

Priority 3: Invest more effectively in prevention, harm reduction and treatment.

Priority 4: Reduce drug harm in communities and respond to emerging challenges.

Briefing to the incoming New Zealand Parliament 2017

The uneven distribution of HIV risks and burdens across populations is a well-substantiated fact, though seldom publicly acknowledged. Gay men and other men who have sex with men, people who inject drugs, sex workers, and transgender women are 24, 24, 13.5, and 49 times more likely to acquire HIV, respectively, than other reproductive aged adults (15 years old and older). Globally, new infections among these key populations account for 45% of all new HIV infections. This figure is likely to be an underestimate, given the intense stigma associated with disclosing and reporting acquisition risks for HIV among gay men, people who use drugs, sex workers, and transgender people. In addition, HIV epidemics in the majority of low- and middle-income countries (90 of 120) have concentrated epidemics among key populations. In countries with more broadly generalized epidemics, risks are still not evenly distributed and key populations still shoulder disease burden that is markedly disproportionate.

Specific interrelated determinants converge to create the higher probability of HIV infection among key populations (biological, social, structural). For example, key populations are rendered vulnerable to HIV by discriminatory laws and politically driven policies, creating stressors that exacerbate risk for HIV acquisition and make the problem of HIV worse. In addition, the absence of protective laws and policies, and the failure of governments to uphold rights also enables the persistence of unchecked stigma and discrimination in healthcare and social service settings. These barriers to healthcare means untreated sexually transmitted infections and therefore heightened risk for HIV infection and transmission.

Propelled by the introduction of powerful and life-saving antiretroviral medications, the increasingly bio-medicalized global HIV response challenges us to rigorously reimagine prevention. While this is a welcome development in the global response to HIV, access to medical interventions is hampered by the costs of medicines, healthcare, testing and monitoring, and the politics of funding. In addition, gay and bisexual men, people who use drugs, sex workers, and transgender people are not prioritized for antiretroviral treatment or are offered only a limited number of places in treatment programs because these groups are not seen as deserving. Moralistic decision-making about who should have access to treatment is common (e.g., the requirement of absolute abstinence from drug use as a condition for services).

Reconsidering primary prevention of HIV: New steps forward in the global response

Upon winning the presidential election in 2014, Joko Widodo, often referred as Jokowi – launched the war on drugs in Indonesia. He claimed that Indonesia is in a drug emergency situation. This emergence is marked by the existence of 4.5 million people who use drugs in Indonesia; worse, 1.2 million of them ‘can no longer be rehabilitated because of their deteriorating condition’.

When Jokowi made such statement, it was expected that he would adopt a policy that was aimed to address the impact of drug trafficking. For example, by providing wider access to drug dependency rehabilitation. The question was and still relevant, is, how drug dependency rehabilitation is currently implemented in Indonesia?

Through this report, LBH Masyarakat seeks to provide information on how drug dependency rehabilitation is carried out in Indonesia. This report consists of information on the type, methodology, inclusiveness and participation, financing, and human resources situation with regard to implementing drug dependency rehabilitation. We find that there are barriers, both practical and structural, that hinder effective implementation of drug rehabilitation. At the end of this report, we develop recommendations for relevant stakeholders with a view that the proposed recommendations would contribute in creating drug dependency rehabilitation in Indonesia that is more accessible and with good quality.

We would like to express our sincere gratitude to …?? for their tremendous help and contribution in the development of this report. We thank the Ministry of Health, the Ministry of Social Affairs, and the National Narcotic Board for welcoming us to interview and observe drug dependency rehabilitation facilities under their auspices, or that they support. We thank all the patients, doctors, health care workers, and managements of drug dependency rehabilitation at YPI Nurul Ichsan, RS Jiwa Atma Husada, RSUD Sanglah, Yayasan Ar-Rahman, Yayasan Hikmah Syahadah, Balai Rehabilitasi Lido, Balai Rehabilitasi Badokka, AKSI NTB, Yayasan Karisma, Puskesmas Gambir, and RSKO Cibubur.

We thank Mainline Foundation for their support and assistance from the beginning until the finalisation stage of this report.

This report is just a part, or even a beginning of the long and winding road in the advocacy towards a more humane drug policy in Indonesia. To close this, we believe that #PrisonIsNotASolution, #BecauseEeryHumanMatters.

Mapping out drug dependency treatment in Indonesia

Mainline works with the Middle East and North Africa Harm Reduction Association (MENAHRA) to improve the position of women who use drugs (WWUD). We designed a manual for local organisations in the MENA region. The aim of this manual is to provide practical guidelines to advocate for harm reduction services for women.

The manual aims to be of practical help to anyone, regardless of their experience level, who wants to advocate for the needs of WWUD within a harm reduction framework. You can be working as a professional within a governmental- or non-governmental organisation or be a journalist, working in health care, be a woman who uses drugs yourself or simply care about the cause. The geographical focus of this guide is the Middle East and North Africa (MENA).

In 2013, the Middle East and North Africa Harm Reduction Association (MENAHRA) which is a network focusing on harm reduction strategies for People Who Use Drugs (PWUD) in the MENA region, conducted operational research on women injecting drug users in 6 countries of the MENA region. In the follow-up on this research, the Guidelines on Gender Equality in HR services and an Advocacy Brief on specific harm reduction services for women were developed. Both the research and the guide clearly show the needs of WWUD and the present situation of limited access and availability of harm reduction services for women in the MENA region. They also describe the most ideal situation of full access and availability of gender specific harm reduction services. Many changes are needed to make harm reduction accessible for women.

Knowing what you want to change and what you want to achieve is essential. Unfortunately, it’s often not enough to make it a reality. That’s where advocacy comes in.

When Mainline set out to develop the manual, it explicitly decided not to reinvent the wheel. There are already many excellent guides available – both to advocate for harm reduction and to advocate for women’s health and rights. Mainline collected what is there, made smart combinations and connected this information to the realities in the Middle East and North Africa. The result is a practical guideline, easy to use and culturally appropriate.

Advocacy for women who use drugs in the MENA region

On May 15-22 2017, 30 young activists from European civil society organizations working in the field of drugs with young people gathered in Belgrade, Serbia. They discussed how the people we work with are having their basic rights violated in the key areas related to drug use, such as access to healthcare, criminal law and social services. The purpose of this meeting was to discuss the experience of young people affected by drugs in different countries, and the challenges faced by both them and civil society organizations that represent them. Participants also shared the solutions that they already apply in their countries, so that others were able to learn about examples of how particular problems were overcome. One of their priorities was to highlight how existing international laws can be applied to the cases participants see in their everyday work, and to establish what additional tools should be available in order to better support young people in difficult life situations.

Protecting the rights of young people in the areas related to drugs and drug policy

According to MENAHRA, this is what we can do to improve adherence to tratment and access to services:

Awareness raising and training on: positive health impacts of early detection and routine screening among family members; harms related to drug use; importance of support for PLHIV; availability of harm reduction and HIV services; rights of PLHIV and PWUD; stigma and discrimination for health care providers; Promotion of: availability of services among health care providers and PLHIV; harm reduction strategies for behavior change; routine testing of other infectious diseases included within package of harm reduction and healthcare services; anti-discrimination strategies and laws; Service development through: integration of harm reduction services within healthcare package of services; increasing OST availability and coverage; providing HIV testing for all partners and children of newly diagnosed people; increasing availability of condoms and needles/syringes in harm reduction and other health programs; involving PLHIV who use drugs in programming and decision making; Accountability and support through establishing: complaint mechanism for rights violations and mistreatment; support system for regular follow-up of beneficiaries in healthcare settings; Evaluation and research through: service quality assessments; population size estimates to inform program development.

Less discrimination, better services, more support for PLHIV using drugs

People who use drugs are heavily affected by HIV, hepatitis C (HCV), and tuberculosis (TB) and are often neglected in countries’ and cities’ responses to the epidemics. There are effective means to prevent and treat HIV, HCV and TB among people who use drugs, but resources (financial, human and material) are often not adequately invested to make them accessible. The reasons for this are multifaceted and include criminalization, stigma, discrimination and denial of basic human rights to people who use drugs. This 

IDUIT Brief Guide for People who Use Drugs

 is intended to outline the key concepts of Implementing Comprehensive HIV and HCV Programs with People who Inject Drugs: Practical Guidance for Collaborative Interventions (the IDUIT) related to prevention, treatment and empowerment with regard to HIV and HCV, and point to how activists and professionals from among the community of people who use drugs might promote better policy and practice.

The IDUIT brief guide for people who use drugs

In this article, we trace the operations of power, i.e., how different forms of power combine, compete and resist each other in the emergence, later evolution and the present dynamic of the international drug control regime (IDCR). We confirm the assumption that the prohibition in the IDCR, as well as other features of the system, has been the result of a series of political decisions taken by a specific group of powerful states at the center of global capitalist economy, and the USA as the system hegemon above all. The regime, we argue, however also betrays powerful inertia factors associated with institutional, structural and productive types of power that pose an obstacle to its transformation even when, in some respects, there exists convincing evidence that suggests other approaches would be more effective and less costly. In view of the current challenge to the IDCR’s core prohibitionist rationality which we align with an evolutionary change in the operation of compulsory power, in the conclusion we discuss how a change to the status quo may be steered to avoid the regime’s gradual obliteration.

Click here for the full publication (paywall).

The global drug prohibition regime: Prospects for stability and change in an increasingly less prohibitionist world

Since the Andrey Rylkov Foundation (ARF) was founded in 2009, we have been on a mission to achieve Health and Social Justice by promoting and developing humane drug policy based on tolerance, protection of health, dignity and human rights. We owe our inspiration and name to Andrey Rylkov, a Russian harm reduction activist and an outstanding human being, whom we lost in 2006.

Our work is based on the following five strategies:

• Advocating for humane drug policies at the domestic and international levels;

• Defending the rights of people who use drugs, including through strategic litigation;

• Providing direct services to people who use drugs to protect their health and rights (Harm Reduction – Moscow);

• Supporting and building the capacity of the community of people who use drugs;

• Information and education, including the promotion of public debates on drug policy issues through working with mass media and building alliances with social, art and political activist

2015 – 2016: two more years of saving lives

In the past decade, national and international interest in harm reduction in the MENA has increased. As a result, there has been an increase in research, improvements in disease surveillance, and establishment of significant health policies throughout the region.

• Scale up advocacy and harm reduction practices. Specifically in countries with a very high prevalence of HIV and large amount of PWIDs, like Egypt, Pakistan and Morocco.

• Improve data collection and surveillance by increasing research and/or collaboration among researchers in order to create usable sets of data. Data is most unreliable or unavailable in Yemen, UAE, Qatar, Iraq, Bahrain, Egypt, Libya, Saudi Arabia, Afghanistan, and Pakistan.

• Scale up surveillance of HCV, HBV, and tuberculosis among PWIDs. These diseases are highly prevalent in certain areas in the region and data is extremely limited

Publications from IDPC Members