How can we encourage activism for the improvement of the quality of addiction treatment programmes among the most stigmatised group of citizens in Macedonia?

How can institutions be made to accept that people using drugs can be constructive participants in the process of improving the quality of drug addiction treatment programmes? How can drug policies be freed from ideological models of thinking and adapt to current trends and the needs of those concerned the most? According to the literature describing community monitoring and advocacy available on the internet, an impression is formed that disenfranchised communities should have the necessary motivation and capacity to independently mobilise themselves and jointly fight issues of common interest, but it is hard to bring this ideal model into reality in
which, evidently, wider social and political factors should be taken in consideration.

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

Community monitoring and advocacy in highly stigmatising circumstances: Eliminating institutional barriers for the improvement of quality of drug addiction treatment programmes in Macedonia

The European Association for Palliative Care (EAPC), the International Association for Palliative Care (IAHPC), the Worldwide Palliative Care Alliance (WPCA) and the Human Rights Watch (HRW) are working together to advocate for access to palliative care as human right.

Access to palliative care is a legal obligation, as acknowledged by the United Nations conventions, and has been advocated as a human right by international associations, based on the right to the highest attainable standard of physical and mental health.

The Prague Charter: Urging governments to relieve suffering and recognize palliative care as a human right

This 57-page report documents government violations of the right to health and other abuses of most-at-risk populations in New Orleans. It calls for changes in state and local laws and policies that stigmatize, discriminate against, and facilitate police abuse of sex workers and drug users, and interfere with health services for people at high risk for HIV.

The report was released in advance of the third annual Southern Harm Reduction and Drug Policy Conference, which opens in New Orleans on December 12, 2013.

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

In harm's way - State response to sex workers, drug users and HIV in New Orleans

The 55-page report documents the experiences of people recently confined in the centers, who described being thrashed with rubber water hoses and hit with sticks or branches. Some described being punished with exercises intended to cause intense physical pain and humiliation, such as crawling along stony ground or standing in septic water pits. Former female detainees described rape and other sexual abuse by male guards. Many detainees said they were forced to work unpaid in the centers – and in some cases, on construction sites – and those who refused were beaten.

Mistreatment of drug users and “undesirables” in Cambodia’s drug detention centres

Ever since its foundation in 2007, the Middle East and North Africa Harm Reduction Association (MENAHRA) has worked to support harm reduction based on scientific data. Unfortunately, in our region, there are a limited number of empirical studies available besides the bio-behavioral studies conducted by individual countries. There is an apparent weakness in the epidemic surveillance systems for the proportions of HIV prevalence. This gap reflects a lack of priority in the region in providing harm reduction services. It also confirms that sharing needles is the second cause for HIV/AIDS transmission in the MENA region.

This study arises from within MENAHRA's course of work to search for the reality of the situation with an empirical approach in order to increase the level of response to HIV/AIDS in the region.

This report should allow decision-makers and civil society organizations to expand their knowledge in regards to the needs and weaknesses of available services by guiding programs in becoming more focused on harm reduction in the region. Therefore, this report shall assist stakeholders in providing a wider scope of HIV/AIDS prevention services among people who inject drugs.

Assessment of situation and response of drug use and its harms in the Middle East and North Africa

Uptake of harm-reduction services among women is low in the Middle East and North Africa (MENA) region. A qualitative operational research was conducted to provide recommendations on how to improve the uptake of harm reduction services among women injecting drug users (WIDUs). By understanding the factors that influence service uptake, program managers can develop meaningful strategies to increase uptake of their services.

To explore the context of drug use among WIDUs

To identify barriers and facilitators to accessing harm-reduction services

To provide recommendations on how to improve access to harm-reduction services.

Women injecting drug users in the Middle East & North Africa Region 

In 2010, the 63rd World Health Assembly (WHA) adopted the first resolution on viral hepatitis (WHA63.18). A new resolution will be presented at the 67th WHA.

Globally, an estimated 185 million people have been infected with hepatitis C virus (HCV). Since 2010, more than a million people have died from HCV, although it is treatable and curable. Nine to twelve million people have been infected since 2010, although HCV is preventable. Most new infections occur among people who inject drugs (PWID), yet access to HCV prevention tools (such as sterile injection equipment) is woefully inadequate, reaching a tiny percentage of those who need it. This shocking public health failure allows the epidemic to continue spreading.

Only a tiny fraction of people who have been infected with HCV are aware of their status. Most live in low and middle-income countries (LMICs) and have no access to diagnostics, care, or treatment. Pegylated interferon (peginterferon, or PEG-IFN), the backbone of the current standard of care for HCV, is priced cruelly out of reach. Even in places where HCV treatment is available, injecting drug use is often used as a criteria for denying access: only 2-4 percent of people who inject drugs are currently receiving treatment.

We, people living with HCV, HIV/AIDS, people who use drugs and our advocates, urge United Nations Member
States to act strongly in order to tackle the hepatitis C epidemic; it is feasible!

Defuse hepatitis C, the viral time bomb!

This is a guide to regulating legal markets for the non-medical use of cannabis. It is for policy makers, drug policy reform advocates and affected communities all over the world, who are witnessing the question change from, 'Should we maintain cannabis prohibition?’ to ‘How will legal regulation work in practice?'

Just a few years ago, this book would have been largely theoretical. Now, however, the cannabis regulation debate has moved decisively into the political mainstream, and multiple cities, states and countries are considering, developing or implementing a range of regulated market models for the non-medical use of cannabis. So this book draws on evidence not only from decades of experience regulating alcohol, tobacco, and medicines, but also from Spain's non-profit 'cannabis social clubs', commercial cannabis enterprises in the US and the Netherlands, and Uruguay's government-controlled system of cannabis regulation.

This book will help guide all those interested in cannabis policy through the key practical challenges to developing and implementing an effective regulation approach aimed at achieving the safer, healthier world we all wish to see.

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

How to regulate cannabis: A practical guide

The latest in the Global State of Harm Reduction series, when sex work and drug use overlap : Considerations for advocacy and practice examines the multiple and varied contexts within which drug use (including use of alcohol, hormones and image- and performance-enhancing drugs) and sex work overlap. It provides a snapshot of available evidence on the factors that contribute to vulnerability among people who sell sex and use drugs. Drawing on experience from the harm reduction and sex work communities, the report explores implications for practice, highlighting existing programmes that reach people who sell sex and use drugs around the world, and offering practical suggestions on how programmes can better serve this overlapping population.

When sex work and drug use overlap

Taking stock of an off-track AIDS response: During 2011-2012, Uganda attracted concern—and criticism—as a result of its troubling epidemiological trends, indicating an off-track response to HIV. The Uganda AIDS Indicator Survey showed that prevalence had risen from 6.4 to 7.3% between 2006 and 2012 and incidence also rose during the same period. Condom use by men and women declined starkly over the same period—reported condom use during sex with a non-cohabitating partner declined significantly between 2005 and 2011 from 47% to 29% and from 53% to 38% among women and men, respectively. Importantly, Uganda was the only PEPFAR “Focus Country” reporting rising HIV incidence—all other PEPFAR focus countries have consistently reported declines in incidence as well as prevalence in recent years.

At the same time, recent game-changing scientific advances in HIV prevention and clinical care are making it possible for all high-burden countries to begin to achieve an “AIDS Free Generation,” defined as a halt to sexual transmission, an end to disease progression for those who are HIV positive, and an end to perinatal transmission. In particular, recent data show that HIV treatment is not only life saving but is also one of the most powerful prevention tools available—groundbreaking new research shows that earlier treatment of HIV positive people—at CD4>350—results in 96% reduction in the risk of HIV transmission through sex with an uninfected partner,4 is highly cost effective, and provides significant clinical benefit.6 Uganda’s faltering response means an attaining an AIDS Free Generation will take stronger, more urgent action—with bolder leadership.

Ending AIDS in Uganda: What will it take?

The epidemiological reality of HIV infection in Egypt favours prioritizing efforts to the high risk groups rather than the general population. Hence, harm reduction should be at the core of interventions targeting HIV.

The current study revealed that there is still a long way to go to enhance the role of these interventions in influencing a significant behaviour change among target group.

Harm reduction in Egypt: The insight of injecting drug users

Responses to problematic drug use continue to improve in Scotland. Service provision is more coherent, waiting times are down and there is a clearer understanding that all steps in the recovery journey need to be supported.

Commissioners and services are focusing on raising standards at a time when resources are at a premium. SDF’s Big Lottery-funded National Quality Development Programme has helped in excess of 80 projects to implement changes aimed at improving recovery outcomes – often identifying ways to make better use of existing resources.

This is an evolving process. Needs identified by managers and frontline workers have led to the development of SDF’s well-received Sexual and Reproductive Health Initiative and intensified our focus on New Psychoactive Substances through training, events and collaborative working at local and strategic level.

We hope to attract further funding for our Quality Development initiative to help services implement the recommendations in the Opiate Replacement Therapies Review and the new Quality Improvement Framework, both of which underline the need for the wider psycho-social supports.

Publications from IDPC Members