Findings from a cross-sectional qualitative study on the multiple vulnerabilities experienced by People Who Inject Drugs (PWID) in Bihar and Manipur

India faces one of the largest HIV epidemics in the world. While sexual transmission remains the primary mode of HIV transmission in the country, drug users are also disproportionately affected. People who Inject Drugs (PWID) are at high risk of acquiring HIV and other blood-borne viruses, such as Hepatitis B and C. Studies have reported that unsafe injection practices along with low condom use are putting PWID at dual risk for HIV.

Spanning five countries (India, China, Indonesia, Kenya, and Malaysia), the Community Action on Harm Reduction (CAHR) initiative expands harm reduction services to more than 180,000 PWID, their partners and children. The programme protects and promotes the rights of these groups by fostering an enabling environment for HIV and harm reduction programming in these five countries. CAHR is supported by the Ministry of Foreign Affairs, Government of Netherlands.

In India, CAHR is called ‘Hridaya’ and is implemented by India HIV/AIDS Alliance in partnership with community based harm reduction organisations, non-governmental organisations and networks. This programme helps build the capacity of service providers, makes harm reduction programmes more gender-responsive, improves access to services and advocates for the rights of PWID. In addition to providing services, Hridaya has a strong capacity building component to support advocacy, knowledge management and improved services for PWID.

A cross-sectional qualitative study was conducted to gain in-depth knowledge on multiple vulnerabilities to HIV acquisition among PWID in the states of Bihar and Manipur who may practice unsafe injecting practices and unsafe sexual behaviours.

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

Dynamics of vulnerability and drug use in India

The central aim of Swedish drug policy is to create a drug-free society. To achieve this aim, the country has adopted a punitive, enforcement-led approach to drugs. It is this approach, some have argued, that is responsible for Sweden’s historically low levels of drug use. This apparent success of the Swedish model is therefore often presented as an argument against drug policy reforms such as decriminalisation and legal regulation.

However, the degree to which Sweden’s low prevalence of drug use can be attributed to its repressive approach is highly questionable, as research consistently shows that wider social, economic and cultural factors are the key drivers of drug prevalence – not the harshness of enforcement.

Also of note is that levels of drug use in Sweden, while in relative terms still very low, are increasing. Furthermore, the Swedish model – in particular its antipathy to proven harm reduction measures – has had serious negative consequences that are almost never mentioned by its advocates. These include alarmingly high rates of hepatitis C among people who inject drugs, and a 600% increase in drug-induced deaths over the last 20 years.

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

Drug policy in Sweden: a repressive approach that increases harm

This report reflects a short summary of one year (2012) of ethnographic observations and ‘informal conversations’ with various stakeholders across Saint Lucia, a small Caribbean nation. The effort was undertaken to assess the profile of youth gangs and their members in order to add depth to existing analysis on gangs in the Caribbean by using one country as a model. This summary of the report focuses on the interaction between the cannabis and cocaine markets, and the role of youth in that trade on the one hand, and the increase in violence indicators on the other.

The Caribbean Community and Common Market (CARICOM) and individual member states face shared challenges of youth involvement in crime, violence, gangs and other anti-social activities. It is not uncommonly heard the “drug problem” is to be blamed for this. This briefing wants to show this relation is far more complex and often misunderstood.

Decriminalize cannabis cultivation and possession for personal use

Augment the education of young males with alternative educational opportunities

Create micro economic activities that would allow young people to legitimately earn a decent wage.

Making a mountain out of a molehill: Myths on youth and crime in Saint Lucia

UK taxpayers’ money has enabled as many as 2,917 brutal executions in Iran and more than 112 pending death sentences in Pakistan, a report from legal action charity Reprieve has shown. Many of the sentences have been handed down to women and children, as well as a number of British nationals.

Reprieve’s European Aid for Executions report is the result of a two year investigation which sourced classified overseas death row data and compared it with reports on European aid to foreign police forces. It found that UK funding routinely comes with targets encouraging arrests likely to result in death sentences, despite a Government commitment to encourage global abolition of the death penalty.

The research confirms that over the last ten years Britain has given more money than any other European country to drug police in Iran and Pakistan; countries which aggressively pursue the death penalty for drug offences and boast the world’s highest per capita execution rate (Iran) and the world’s largest death row population (Pakistan).

Reprieve found that the UK has given more than £20 million to drug agents in these countries, frequently citing capital convictions secured in formal measurements of the money’s success. This funding is channelled through the UN’s Office for Drugs and Crime, and goes toward training, intelligence-sharing and equipment used for pursuing alleged drug offenders (including body scanners, sniffer dogs and night vision goggles).

British support of this nature can be directly tied to at least 2,917 executions in Iran and 112 death sentences in Pakistan, based on the periods over which British aid was provided and the law-enforcement led “supply control” operations it supported. While drug offences made up the main charges in all of these cases, both countries’ drug courts fall woefully short of international standards, and in Iran’s case drug allegations have been used as a pretext for the persecution of political dissidents.

European aid for executions

The earliest examples of drug use being allowed in drug service centres, either unofficially or on a semi-official basis, date back to the 1970s in the Netherlands (the Prinsenhof and the HUK Amsterdam) and from the early 1980s in Switzerland (‘Fixerraum-Experiment’ at the AJZ in Zurich). These initiatives were fundamentally different from today’s drug consumption rooms, as the supervision of drug use or distribution of hygienic equipment was not their primary objective. They primarily focussed on protected places for the consumption of drugs and further on to get in contact with people who use drugs. These facilities attracted large numbers of people who use drugs (PWUD) and also suppliers, which created problems both in terms of the dynamics between service users and also in maintaining a safe environment. These experimental initiatives were stopped after a relatively short period of time either by the agencies themselves or after police intervention.

The first drug consumption room (DCR), in a modern sense, was established in Bern, Switzerland in 1986. This was at a time of increasing concern about the spread of HIV/AIDS, the significant increase of drug related deaths, and the growth of public drug scenes in a number of European cities. At that time, it became evident that drug policy focusing exclusively on abstinence (e.g. via detoxification treatment, drug free rehabilitation or imprisonment) was ineffective. It was during this period that ‘harm reduction’ approaches began to emerge, including needle and syringe exchanges (NSP) and opiate substitution treatment (OST).

There are approximately 90 DCRs worldwide, including DCRs outside Europe in Canada (Vancouver) and Australia (Sydney). In Europe, DCRs are well established in countries like Spain, Germany, the Netherlands and Switzerland. These success stories have stimulated debates about DCRs in a number of countries and, in European countries like Portugal, France, Great Britain and Austria, campaigning groups have been established to champion the cause of DCRs in their countries.

Drug consumption rooms in Europe: Models, best practice and challenges

Despite many programmatic and structural challenges the OST program has been one of the most effective medical and psychosocial interventions for the people who inject drugs (PWIDs) and who use opioids in Ukraine, reducing health risks and improving the quality of their life.

Social and political crises affect vulnerable populations and have negative consequences. The political crisis and military invasion which Ukraine faced in 2014 is a critical example of such negative influences. The OST program and its implementers met difficulties and obstacles never seen before. Starting from February 2014 waves of unrest originating in Kyiv and Western Ukraine spread all over the country creating a fertile environment for the interruption of treatment.

Impact of armed conflicts and warfare on opioid substitution treatment in Ukraine: Responding to emergency needs

On 1 January, 2011, the International HIV/AIDS Alliance began implementation of a four year project entitled, 'Community Action on Harm Reduction (CAHR)', funded by the Social Department/Health and AIDS Division of the Ministry of Foreign Affairs (Buitenlandse Zaken) of the Government of The Netherlands as Project Number 23389.

CAHR is an ambitious project involving five countries – China, India, Indonesia, Kenya and Malaysia – and a number of international technical partners with the overall objective to expand coverage of HIV prevention, treatment and care, sexual and reproductive health and other services to a total of more than 230,000 people who inject drugs (PWID), their partners and children. Due to specific higher-risk behaviours, PWID are at increased risk of HIV irrespective of the epidemic type or local context; they often have legal and social issues related to their behaviours that increase their vulnerability to HIV.

The programme is implemented through a consortium of Alliance Linking Organisations (LOs): AIDS Care China, India HIV/AIDS Alliance (Alliance India), Rumah Cemara in Indonesia, the Kenya AIDS NGO Consortium (KANCO) and the Malaysian AIDS Council (MAC), in collaboration with four international policy partners: the International HIV/AIDS Alliance, Harm Reduction International (HRI), the International Drug Policy Consortium (IDPC) and the International Network of People who Use Drugs (INPUD). Several other agencies also provide specialised technical assistance in various areas.

Although each of the five CAHR countries are at different stages in the development of a comprehensive package of harm reduction services for PWID, all but one objective of the CAHR programme have been achieved and many of them have far exceeded their original target. As a result, CAHR is a practical demonstration of the approaches recommended by WHO, UNODC and UNAIDS for the prevention, treatment and care of HIV for PWID that include the following interventions:

Opioid substitution therapy (OST) and other evidence-based drug dependence treatment

Prevention and treatment of sexually transmitted infections (STIs)

Condom programmes for people who inject drugs and their sexual partners

Targeted information, education and communication (IEC) for people who inject drugs and their sexual partners

Prevention, vaccination, diagnosis and treatment for viral hepatitis

Prevention, diagnosis and treatment of tuberculosis (TB)

Independent evaluation: Community Action on Harm Reduction

该报告的主要目的是考察与毒品有关的替代监禁在世界不同的国家的使用。英语版本拥有更多信息，请阅读下文。

随时掌握与药物政策发展相关的最新信息。

The main objective of the report is to examine alternatives to incarceration that have been used in different countries of the world for drug-related offenses. It is intended to offer Member States a wide range of options to move forward in the design and implementation of policies that are both effective and uphold human rights.

Drafted for the 56th Meeting of the CICAD in November 2014 in Guatemala City, this four-part document provides a four-part synopsis of the major findings and alternatives identified by the TSG.

The first part of the document explains the rationale behind the project, laying out why it is important to design and implement alternatives to incarceration for drug-related offenses. The second part outlines the legal, conceptual and methodological approaches guiding the TSG’s work. The third part provides essential information about the alternatives identified in this exercise, arranging these experiences by their most salient components and proposing a system of categorization thereof, as well as a few specific examples. Lastly, in the fourth part, conclusions are drawn and a list of guiding principles is provided for the adoption and development of alternatives, recognizing the importance of taking into account the context and particular needs of each country.

替代去监禁毒品相关的犯罪人

现有三十年的可获得的科研数据评估关于伤害减少服务的有效性和成本效益以及那些毒品注射者的健康权。英语版本拥有更多信息，请阅读下文。

At its 34th meeting, the UNAIDS Board, called for Member States and the UN Joint Programme to pursue, in line with the UNAIDS vision of the three zeros, a clear commitment in the post-2015 development agenda to ending the AIDS epidemic as a public health threat and an obstacle for overall sustainable development by 2030, provisionally defined as the rapid reduction of new HIV infections, stigma and discrimination experienced by people living with HIV and vulnerable populations and key populations, and AIDS-related deaths by 90% of 2010 levels, through evidence based interventions to include universal access to HIV prevention, treatment, care, and support, such that AIDS no longer represents a major threat to any population or country. A process of establishing new targets for 2020 and 2030 is underway, within which targets and commitments on reducing HIV transmission among people who inject drugs will be considered.

There is now three decades of available scientific research data assessing the evidence regarding the effectiveness and cost effectiveness of harm reduction services and the right to health for people who inject drugs. This data shows that evidence-based harm reduction interventions such as Needle and Syringe Programmes (NSP) and Opioid Substitution Therapy (OST) are effective, pragmatic and cost effective—provided they are delivered in a way which is accessible and acceptable to people who inject drugs, for example at sufficient scale. Nevertheless, in many countries this evidence has not been translated into programmes of sufficient size or reach.

艾滋病在毒品注射者中的传播被减半

该审查评估乌克兰联盟的工作是否是一个“良好做法”以及其是否能在其他国家试用。英语版本拥有更多信息，请阅读下文。

The development of a HIV prevention, treatment and care programme in Ukraine by the Government has been spearheaded through support from Alliance Ukraine and its many local NGO partners across the country. A major achievement in this regard is that over the past 3 years, HIV prevalence among PWID under the age of 25 years has decreased. Such a reduction is largely due to the implementation of a comprehensive HIV prevention programme, including harm reduction, led by Alliance Ukraine and its partners, a response that began at the end of 2000 and was accelerated from 2004 to the present day at national scale. It is the national scale of this response by Alliance Ukraine through its partners that is of particular note for possible replication elsewhere.

The International HIV/AIDS Alliance is an international nongovernmental organization with its international secretariat in Brighton, United Kingdom, and currently comprises 40 nationally based, independent, civil society organizations around the world as well as seven Technical Support Hubs, all of which are dedicated to ending AIDS through community action. The Alliance seeks to work with communities through local, national and global action on HIV, health and human rights and is committed to collective action that will lead to a world without AIDS in which the lives of all human beings are of equal value, and everyone has the right to access the HIV information and services that they need for a healthy life.

The purpose of this review is to document the work of Alliance Ukraine and to assess whether such work is a ‘good practice’ that could be replicated in other countries faced with a serious HIV/AIDS epidemic driven largely by unsafe injecting behaviours. The review was undertaken during July 2013 and data was updated were available in April 2014. Criteria have been developed to undertake a comprehensive assessment of the full range of support given by Alliance Ukraine and its local NGO and Government partners relating to the implementation, management and ongoing development of the national HIV prevention programme throughout Ukraine.

欧洲的良好实践：通过注射使用毒品者的艾滋病预防

本摘要概述了世界毒品问题以及毒品管制制度对性别平等和妇女赋权的影响。英语版本拥有更多信息，请阅读下文。

This summary note outlines how the world drug problem and drug control regimes intersect with gender equality and women’s empowerment. It is not comprehensive or prescriptive, but it is meant to inform the work of the UN System Task Force on Transnational Organized Crime and Drug Trafficking as Threats to Security and Stability in its preparation for the 2016 Special Session of the UN General Assembly. UN Women does not address the drug problem directly, either in its first Strategic Plan (2011-2013) nor its current one (2014-2017), but is a member of the task force and shares its main message that transnational organized crime, including drug trafficking, fuels violence, corruption, and income inequality, inhibits legitimate social and economic activity, poses a serious threat to public health and international peace and security, and undermines gender equality and women’s empowerment.

Women’s rights or gender equality rarely feature in discussions about the world drug problem. Men are, after all, a large majority of those using or trafficking drugs. Women’s roles, both as participants and victims, are underestimated and understudied.

However, it is clear that the world drug problem is undermining gender equality, and that a gender perspective is needed in all efforts to prevent and respond to this issue. For example, in the Northern Triangle in Central America (Honduras, El Salvador, and Guatemala), the drugs problem is mainly responsible for the skyrocketing levels of violence in those countries, with the highest homicide rates in the world. In Honduras, femicide has increased by 93 percent since 2009. This is directly linked to increasing levels of sexual violence and sex trafficking, and the humanitarian crisis provoked by tens of thousands of unaccompanied boys and girls trying to cross the US-Mexico border in 2013 and 2014. In Colombia, women in rural areas are mainly responsible for the food safety of their families, but the fumigation of coca crops affects other crops and water sources, while crop substitution programmes mainly benefit men, who are traditional title holders and often the sole beneficiaries of agricultural extension services, training, credit, and tools. In Afghanistan, only 4 percent of female drugs users have access to treatment facilities, despite the high rates of opium and heroin use among women. As just one example of how drugs and violence against women are interrelated, in December 2013 an addicted husband cut the nose and lips of his wife in front of their children when she refused to give away her jewelry to exchange it for drugs.

从性别的角度看吸毒的影响，毒品交易和毒品管制制度。

这项调查对东南亚鸦片生产的最新数据进行了概述。英语版本拥有更多信息，请阅读下文。

The roots of the opium production problem in Southeast Asia go back to the 19th century. The region is home to the “Golden Triangle”, an area long associated with opium and heroin production, located where the borders of Myanmar, Lao People’s Democratic Republic (Lao PDR) and Thailand converge along the Mekong River. Twenty years ago, the Golden Triangle was the largest heroin‐producing area in the world, supplying the region’s own demand as well as exporting its surplus to North‐east Asia, Europe and the United States of America. In the 1990s and early 2000s, national and regional efforts succeeded in reducing both opium production and trade in the region, though they subsequently increased.

UNODC started annual Opium Surveys in Lao PDR in 2000, and Myanmar in 2002, in order to measure trends in the cultivation of opium poppy and help formulate an effective response to it. The surveys undertaken from 2000 to 2006 underscored the fact that efforts to counter opium production had succeeded in eliminating much of the cultivation in the Golden Triangle, but more recent opium surveys have indicated a resurgence in production over the last few years. As the Southeast Asia region also continues to include high levels of demand, the large quantities of opium produced provide opportunities for transnational crime networks and pose a challenge to the stability and development of the region.

The Southeast Asia Opium Survey 2014 provides an overview of the latest available data on opium production in the Southeast Asia region. It serves as evidence that transnational organized crimes, such as the production and trafficking of drugs, can be a challenge to development and need to be prioritized by both the region itself and the
international community.

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