This issue brief about HIV, harm reduction and the sexual and reproductive health and rights of women who use drugs is part of a series of briefing papers, commissioned by the Global Coalition on Women and AIDS (GCWA), and is designed to provide up-to-date information around key issues concerning HIV prevention, treatment and care related to women and girls.

The brief seeks to bring attention to policies, laws and practices that undermine the rights of women who use drugs, and to promote the realisation of their human rights in terms of an e#ective harm reduction response to HIV. !e brief also outlines some of the challenges speci"c to protecting women who use drugs from HIV transmission that need to be considered when designing interventions, as well as the principles that must be upheld when striving to meet the goal set in the declaration, and lists recommended actions for moving forward from the programmatic level, through to national policies and global responses.

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

Women who use drugs, harm reduction and HIV

ALICE RAP (Addictions and Lifestyles in Contemporary Europe – Reframing Addictions Project) is the first major Europe wide project studying addictions as a whole and their influence on wealth, health and stealth. The aim of this five year, €10 million, co-financed EU project is to stimulate and feed scientific evidence into a comprehensive public dialogue and debate on current and alternative approaches to addictions.

The AR Policy Paper series aims to provide succinct evidence briefs for decision-makers and advocates working on key addiction-related issues. The fourth paper in the series focuses on public health challenges arising from prescription opioid dispensing regulations and use.

This AR policy paper outlines the key issues for policy-makers considering the possible risks of increasing opioid prescription and how to balance the need for adequate medical control of pain against possible problematic non-medical use of these substances. Three key considerations for evidence-based policy are highlighted in conclusion.

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

ALICE RAP Policy Paper Series: Prescription opioids and public health in the EU

Identifying the co-occurrence of drug use and mental health disorders in the same individuals is essential for effective treatment of their drug use problems. Reviewing the available information on psychiatric co-morbidity among drug users in European countries, the paper shows that there is a need to establish guidelines to collect comparable information across Europe.

Co-morbid substance use and mental disorders in Europe: A review of the data

The production and trafficking of illicit drugs poses complex and interlinked problems, which have a negative impact on public health and the security and stability of society. Focusing on actions directed at the EU’s internal security situation, this paper elaborates who is involved in setting policy, what legal and funding basis for action has been established, and what the main priorities are.

Drug supply reduction and internal security policies in the European Union

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.

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

Young people who inject drugs have specific developmental, social and environmental vulnerabilities. They are less likely to use harm reduction and treatment services and are less informed about risks and their rights. Early onset of injecting, and being a new injector, have been associated with increased risks of HIV and hepatitis C transmission, while specific groups of young people, especially those that are street involved, are at considerably higher risk.

The legal status of being a minor, meanwhile, raises challenges for both achieving a better understanding of the situation and for the development of targeted harm reduction interventions.

Injecting drug use among under-18s

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

This study explores the civil society organisations that engage in drug policy advocacy in Europe. An Internet search in English, French and Spanish combined with information from national sources in 30 countries identified 218 organisations actively seeking to influence drug policy. The paper categorises the organisations, looking at their advocacy objectives and orientations, how they pursue these, and at what political levels they operate.

EMCDDA report - Drug policy advocacy organisations in Europe

There are growing concerns regarding the link between amphetamine-type stimulant (ATS) use and the transmission of HIV and other blood-borne viruses (BBV) in the Southeast Asian region. In January 2011, the Australian National Council on Drugs, through its Asia–Pacific

Drug Issues Committee and with funding provided by the Expert Advisory Committee on Asia–Pacific Regional Drug Issues, commissioned a review to investigate these concerns. This review focuses on the 11 countries in Southeast Asia (Brunei Darussalam, Cambodia, China (including Hong Kong and Macau), Indonesia, Lao People’s Democratic Republic (PDR), Malaysia, Myanmar, Philippines, Singapore, Thailand and Viet Nam) and covers four key areas:

the link between ATS use and the risk of HIV and BBV transmission via injecting or sexual routes

an analysis of HIV risk among ATS users compared to the HIV risk of opioid users

the interventions currently in place, both internationally and at the Southeast Asian regional level, to address ATS use in terms of HIV prevention and the effectiveness of these interventions, and

The link between amphetamine-type stimulant use and the transmission of HIV and other blood-borne viruses in Southeast Asia 

After initial training in qualitative research, the research team of the Omari Project, KANCO and LSHTM focused on interviews in Malindi, on the Kenyan coast.

This first wave of qualitative interviews were undertaken in a place called Kisumu Ngogo, which comprises around 4,000 small houses, connected by a series of small paths and alleyways.

This data from the first few months of data collection is giving clear insight in to some of the risks PWID on the Kenyan coast face. The difficulty of accessing, storing and using needles and syringes is clear, leading to risks of HIV transmission, but also of arrest and imprisonment.

Access to care: Qualitative research study in Kenya

In a report to the United Nations, the International Narcotics Control Board (INCB) stated:

One of the fundamental objectives of the international drug control treaties is to ensure the availability of narcotic drugs and psychotropic substances for medical and scientific purposes and to promote the rational use of narcotic drugs and psychotropic substances.

Countries that signed the 1961 Single Convention on Narcotic Drugs as Amended by the 1972 Protocol, hereafter referred to as the Single Convention, are expected to abide by the Convention’s provisions on the control of certain drugs while ensuring that these drugs are available for medical purposes. The Single Convention established a medicolegal principle of balance: governments have a dual obligation to prevent the diversion and abuse of narcotic drugs and to ensure adequate provision of opioid analgesics for legitimate medical and scientific purposes.

In this paper, we use the word “balance” in the way it is used by international organizations, such as the United Nations Economic and Social Council, the INCB, the World Health Organization (WHO) and the Commission on Narcotic Drugs.

Do national drug control laws ensure the availability of opioids for medical and scientific purposes?

Contradictory evidence on cannabis adds to the climate of confusion regarding the health harms related to use. This is particularly true for young people as they encounter and make sense of opposing information on cannabis. Knowledge translation (KT) is in part focused on ensuring that knowledge users have access to and understand best evidence; yet, little attention has focused on the processes youth use to weigh scientific evidence. There is growing interest in how KT efforts can involve knowledge users in shaping the delivery of youth-focused public health messages. To date, the youth voice has been largely absent from the creation of public health messages on cannabis.

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