This independent review, commissioned by the Community, Rights and Gender (CRG) Department at the Global Fund Secretariat, shares findings, conclusions, and recommendations for enhancing the meaningful engagement of communities in all phases of Global Fund grants, with an emphasis on grant making and grant implementation. The review synthesizes lessons learned and good practices for how communities (see definition below and Figure 1) engage meaningfully, and identifies key principles and strategic actions the Global Fund can take to ensure greater accountability between communities, Country Coordinating Mechanisms, other key stakeholders, and the Global Fund itself.

The Community Rights and Gender Advisory Group (CRG AG), a body that provides advice to the CRG Department, oversaw this independent review, which was carried out by the Community Action and Leadership Collaborative (CLAC), and led by MSMGF (the Global Forum on MSM & HIV). A team of three consultants was responsible for the research, analysis, and writing of this report. Further, preliminary findings and recommendations were validated by way of community consultations in seven countries: Cameroon, the Dominican Republic, Kenya, Moldova, the Philippines, Suriname, and Tunisia.

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

Independent multi-country review of community engagement in grant making & implementation processes

The Regional Center for Technical Assistance (CRAT in its Spanish acronym) has developed a strategy to support civil society organizations (CSOs) and community groups in Latin America and the Caribbean (LAC) to plan for sustainability of their outreach strategies to control HIV, TB and malaria. CRAT is the host of the regional communication and coordination platform under the Global Fund’s Community, Rights and Gender (CRG) Initiative. The initiative provided the funding for the development of the strategy.

Several countries in the region will receive transition funding in 2017-2019 (see GFO article). A key component of the transition process is the sustainability of programs implemented by CSOs and community groups. The governments of countries preparing for transition are expected to work with civil society and communities to ensure their programs are funded after Global Fund support ends.

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

Latin America: Strategy developed to support civil society to transition to sustainability

Ensuring availability of narcotic drugs for medical purposes

1. Some decades ago the international community made a solemn commitment with the Single Convention on Narcotic Drugs of 1961 and the Convention on Psychotropic Substances of 1971: to ensure the availability, to make adequate provision and not to unduly restrict the availability of drugs that were considered indispensable for medical and scientific purposes. Over the past decades that promise has not been fully met. . Too many people suffer or die in pain or do not have access to the medications they need. Unnecessary suffering because of the lack of appropriate medication due to the inaction, lack of know-how or unnecessary administrative requirements is a scandal that shames us all.

2. Around 5.5 billion people still have limited or no access to medicines containing narcotic drugs such as codeine or morphine, leaving 75 per cent of the world population without access to proper pain relief treatment. Around 92 per cent of morphine used worldwide is consumed by only 17 per cent of the world population, primarily living in the United States, Canada, Western Europe, Australia and New Zealand. Inadequate access violates the notion of article 25 of the Universal Declaration of Human Rights, including the Right to medical care, which also encompasses palliative care.

3. The imbalance in the availability of opioid analgesics is particularly worrying as the latest data show that many of the conditions requiring pain management, particularly cancer, are prevalent and increasing in low- and middle-income countries.

4. This situation is caused by a variety of factors, including health care professionals, that means doctors and nurses, not receiving adequate education and training as part of their professional education, lack of know-how and capacity of government authorities, concerns about overprescribing and addiction and overly onerous regulatory and administrative requirements. Many patients in most of the countries in Africa, Central America and the Caribbean, and South Asia are affected, but patients in other parts of the world are also affected.

5. Concrete steps and rapid action by Member States, the international community and the pharmaceutical industry can go a long way to remedy the situation. The most important and urgent actions would involve providing specialised training for health care professionals enabling them to prescribe and administer pain medication as well as training for the competent national authorities.

6. Governments must bring about partnerships with the pharmaceutical industry, which has a duty to act in a socially responsible manner, to ensure access to and availability of affordable medications, placing emphasis on generics.

7. Governments need also ensure that the training curricula of doctors and nurses contain, ab initio, content on the prescribing and rational use of medicines containing controlled substances.

8. At the same time, where necessary, legislation and regulations should be revised, prescribing practices brought up to day and the capacity of national agencies involved strengthened.

9. If Governments, together with the relevant international agencies, were to put together a sufficiently well-resourced plan of action, Member States would be on their way to significantly contributing towards achieving a major element of Sustainable Development Goal 3 on Ensuring healthy lives and promote wellbeing for all at all ages.

Ensuring availability of narcotic drugs for medical purposes 

Application of principle of proportionality for drug-related offences

1. The application of the principle of proportionality in the context of drug offences is a key aspect of a sound and effective drug policy. Some States have made extensive use of incarceration of low-level drug offenders, despite the fact that this approach is not mandated by the international drug control treaties, and some have even applied extrajudicial responses to drug-related offences, notwithstanding the fact that such actions are contrary to the treaties. It is essential to distinguish between the criminal justice provisions contained within the Conventions, and the criminal justice policy measures which have been taken by some Governments.

2. Implementation of the international treaties is subject to the internationally recognized principle of proportionality, which requires that a State’s treatment of illegal behaviour to be proportionate and that a punishment in response to criminal offences should be proportionate to the seriousness of the crime.

3. The INCB has repeatedly called upon States to give due regard to the principle of proportionality in the elaboration and implementation of criminal justice policy in their efforts to address drug-related crime.

4. While the choice of legislative or policy measures to address drug-related crime, including the determination of sanctions is the prerogative of States, the international drug control treaties require that these sanctions should be adequate and proportionate, taking into account the gravity of the offence and the degree of responsibility of the alleged offender.

5. The international drug control treaties do not automatically require the imposition of conviction and punishment for drug-related offences, including those involving the possession, purchase or cultivation of illicit drugs, in appropriate cases of minor nature or when committed by drug users. While “serious offences shall be liable to adequate punishment, particularly by imprisonment or other penalties of deprivation of liberty”, offences of a minor or lesser gravity need not necessarily be subject to harsh criminal sanctions, such as incarceration. The Conventions afford discretion for Parties to provide, either as an alternative to conviction and punishment or in addition to conviction and punishment, that drug users undergo measures of treatment, education, after-care, rehabilitation and social reintegration.

The 9th annual report by Iran Human Rights (IHR) on the death penalty provides an assessment and analysis of the death penalty trends in 2016 in the Islamic Republic of Iran.

The report sets out the number of executions in 2016, the trend compared to previous years, charges, geographic distribution and a monthly breakdown of executions. Lists of the women and juvenile offenders executed in 2016 are also included in tables at the end of the report. Drug-related executions, the status of the cooperation between the United Nations Office for Drugs and Crime (UNODC) and Iran in fighting drugs and the ongoing debate inside Iran, and the new legislation proposed by the Iranian Parliament, Majles, will be briefly reviewed. We will also look into whether Hassan Rouhani’s presidential period, which will end in June 2017, has had any impact on the issue of the death penalty.

The issue of due process will be discussed. Revolutionary Courts have received much attention as regards the mass executions in the 1980s. In this report, we will provide data which, in particular, sheds light on the role of the Revolutionary Courts in recent executions.

2016 Annual Report on the death penalty in Iran

In all regions of the world, people who inject drugs are disproportionately affected by HIV.1 Globally, people who inject drugs are 28 times more likely to be living with HIV than the general population. The United Nations Office on Drugs and Crime (UNODC), the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Bank estimate that worldwide as of 2014, about 11.7 million2 people inject drugs, of whom an estimated 14% (1.6 million) are living with HIV.3 Injecting drug use accounts for 30% of new HIV infections outside subSaharan Africa. People who inject drugs also have higher rates of hepatitis C (HCV) and tuberculosis than the general population. The global rate of HCV among people who inject drugs is 52%, greatly surpassing even the high prevalence of HIV among them.

This tool does not seek to ignore the complex policy and legislative environment around drugs and injecting drug use in most countries, nor the need for advocacy to confront the stigma, discrimination and human-rights violations faced by people who inject drugs. However, it aims primarily to address the question: what can we do now, with the resources we have, in the kinds of environments we face, to prevent the spread of HIV and hepatitis C among people who inject drugs?

Implementing comprehensive HIV and HCV programmes with people who inject drugs

In 2016, the annual village survey was conducted in 591 villages in Shan state, the main opium poppy cultivating area in Myanmar. An independent area estimation was not part of the survey this year; however, UNODC expanded largely on the socio‐economic analysis of opium cultivation in the context of the UN Guiding Principles on Alternative Development and achieving the Sustainable Development Goals.

UNODC is assisting the Government of Myanmar in implementing an alternative development strategy, and has been requested to increase support in this area. UNODC has therefore developed several projects to improve short‐ and medium‐term accessto food and income. The scale of these programmes requires significant large funds to become effective at a regional level, however.

Successful implementation of a national drug control strategy is also dependent on international efforts to control drug trafficking and organized crime in the region. A comprehensive approach is needed to tackle the challenges that may be posed by the possible links between drug trafficking, corruption and different forms of organized crime. Owing to the transnational nature of drug‐ related crimes, coordinated cross‐border collaboration and alternative development activities are important, where appropriate and feasible, which requires support of the international community

Evidence for enhancing resilience to opium poppy cultivation in Shan State, Myanmar

Cannabis is the most commonly consumed illegal substance. The current system of prohibition and its sanctions do not prevent the use of this substance. The most recent data indicate that about 15% of the Québec population report having used cannabis in the past 12 months. More than half of those who have used cannabis report having used it less than once a month. Those who use it weekly or daily represent about a quarter of cannabis users.

Cannabis is not an ordinary product. It carries risks for public health and safety. Its psychoactive effects affect the ability to drive motor vehicles, can lead to dependence, can impair brain development in youth, and can potentially give rise to mental disorders. Smoking cannabis can also cause respiratory diseases. The legalization of non-medical cannabis provides an opportunity to create a regulatory system aimed at reducing the social and health problems associated with the use of this substance.

There are several possible regulatory scenarios or options. The choices made concerning the production, distribution and consumption of cannabis are necessarily interrelated and should be the subject of integrated reflection. These choices will be key to the success of the legalization process, the flattening of the illicit market and the achievement of public health goals.

The choices made for regulating the distribution and consumption of cannabis should avoid tending toward a trivialization of the substance. In addition, they should not produce setbacks in other areas of public health, for example, by leading to the social renormalization of smoking.

The commercialization of cannabis products, even within the context of a strict regulatory framework, sets up an opposition between the profit motive of businesses and the public health goal of reducing cannabis use within the population as a whole. In contrast, a not-for-profit approach makes it possible to focus squarely on prevention, health and safety.

The legalization of non-medical cannabis carries its share of uncertainties and requires innovation on the part of Canada and Québec. Moreover, flexibility must be built into the system so that it can be adapted to the evolving portrait of cannabis use prevalence and practices within the Québec population. Caution should also guide the choices made concerning the regulation of this substance.

Legalisation of non-medical cannabis: A public health approach to regulation

Opening letter from the President and Executive Director

The work of the Drug Policy Alliance is both all about drugs and ultimately not really about drugs at all.

We are at the front lines of much larger struggles in U.S. and international society – over what it means to remain a free society and how we deal with both real and phantom threats to health, life and security.

Donald Trump’s election and his appointment of drug war extremists to senior positions are going to make it harder to consolidate our marijuana legalization victories, and to make progress in Congress on rolling back harsh drug laws, repealing civil asset forfeiture laws, reducing overdose fatalities, and integrating harm reduction principles into federal drug policies.

But what most concerns us is the assault on the values for which we’ve fought for so long.

We advocate for drug policies grounded in science, compassion, health and human rights because we believe those values should infuse all public policies. Only through our shared strength and vision can we uproot the drug war and advance the broader values that guide our struggle.

Drug Policy Alliance Annual Report

The HAT clinic model, initially developed by the Swiss, differs from the old “British System” (still in place for around 100 people in the UK) in that rather than being given ‘take home’ heroin prescriptions, patients attend a clinic once or twice a day, and use their prescriptions on site, under medical supervision.

The first Swiss pilot HAT clinics opened in 1994. In 1997, the federal government approved a large-scale expansion, aimed at 15% of the nation’s estimated 30,000 heroin users, specifically long-term users who had not succeeded with other treatments. Other countries followed suit, with the UK opening three pilot NHS supervised injecting clinics (London, Brighton and Darlington) in 2009 - the Randomised Injectable Opiate Treatment Trial (RIOTT) - extended to 2016 after proving successful.

Heroin Assisted Treatment (HAT): Saving lives, improving health, reducing crime

Morocco continues to be the world’s largest producer of cannabis resin (hashish). Over the past 50 years, the Moroccan cannabis growers shown a remarkable resilience to government attempts to eradicate or reduce cannabis cultivation as well as a noteworthy ability to adapt to changing international market conditions.

Since Morocco’s independence the government has practiced a policy of containment regarding cannabis cultivation, allowing no new areas but tacitly allowing those already in production to be maintained.

The rapid increase in illicit cannabis cultivation in the Rif during the last decades, as well as poor soil conservation practices, have taken a heavy toll on the Rif’s already threatened forests and fragile ecosystems.

The unregulated cannabis market in Morocco has negative social consequences. Some 48,000 growers have arrest warrants hanging over their heads, which is a source of corruption and repression. An amnesty and decriminalization could be effective measures to diminish negative social consequences and open the debate about regulation.

Cannabis farmers in Morocco should have access to emerging legally regulated cannabis markets that are gaining ground worldwide. The challenge is to find a sustainable development model that includes cannabis cultivation in Morocco, instead of excluding cannabis and ignoring the realities of more than 50 years of failed attempts to eradicate the only viable economic option in the region.

Morocco and cannabis

The sharing of drug injecting equipment most often occurs between sexual partners, but the ways in which couples manage risks and care for each other have been largely ignored by harm reduction services, say Australian researchers.

In-depth interviews showed that drug users’ relationships were based on mutual trust, honesty and care. Couples tried to avoid sharing their equipment but when they did, they took into account what they knew about each other’s hepatitis C status and genotype to minimise risks. This could be described as a form of ‘negotiated safety’, say the researchers.

Jake Rance, Tim Rhodes, Carla Treloar and colleagues have published the findings in articles published online ahead of print in 

The programmatic implications are summarised in a document from the University of New South Wales.

Publications

Independent multi-country review of community engagement in grant making & implementation processes

Latin America: Strategy developed to support civil society to transition to sustainability

Ensuring availability of narcotic drugs for medical purposes

Application of principle of proportionality for drug-related offences

2016 Annual Report on the death penalty in Iran

Implementing comprehensive HIV and HCV programmes with people who inject drugs

Evidence for enhancing resilience to opium poppy cultivation in Shan State, Myanmar

Legalisation of non-medical cannabis: A public health approach to regulation

Drug Policy Alliance Annual Report

Heroin Assisted Treatment (HAT): Saving lives, improving health, reducing crime

Morocco and cannabis

Harm reduction should address the specific needs of couples who inject drugs