Punitive drug policies undermine the health and welfare of our communities as a whole. But their destructive impacts have been disproportionately borne by people already experiencing multiple and intersecting forms of oppression, including poverty, patriarchal violence, racism, ableism and xenophobia. Drug policies that prioritise punishment and criminalisation feed off and potentiate these socio-structural barriers to health and wellbeing, leading to an unequal distribution of resources and harm. Drug policy reform can greatly contribute to addressing and repairing these inequities, and provide pathways for our communities to thrive. On the occasion of #WorldDayOfSocialJustice, join us for a discussion on the role of drug policy reform in advancing social justice, and how IDPC’s Strategy seeks to translate this imperative into collective action. With 

Drug policy reform at the service of social justice

According to the latest report from the United Nations Office on Drugs and Crime (UNODC), an estimated 11.3 million people inject drugs globally, while HIV prevalence is estimated to be 12.6% and hepatitis C prevalence 48.5% among this population. However, while 179 of 206 countries report some injecting drug use, 110 countries and territories worldwide have no data on its prevalence. This data gap highlights the need for more and higher quality data to inform our efforts to implement appropriate harm reduction services that can address public health issues, including HIV and hepatitis C, soft tissue infections, and overdose.

Harm reduction implementation has worsened since our last report in 2018, after having stalled since 2014. The number of countries where needle and syringe programmes (NSPs) remained level at 86, and the number of countries where opioid agonist therapy (OAT) is available decreased by two to 84. There are also large differences between the regions in terms of harm reduction implementation: while NSPs and OAT are available in most countries in Eurasia, North America and Western Europe, these core harm reduction interventions are severely lacking in the majority of countries in other regions. An unfavourable drug policy environment hinders harm reduction service implementation in many countries across Asia, Latin America and the Caribbean, the Middle East and North Africa (MENA), and sub-Saharan Africa. Several countries have adopted more punitive drug strategies since the Global State of Harm Reduction last reported in 2018, including Bangladesh, Brazil and Sri Lanka.

Even where harm reduction services are available, there is often insufficient coverage and quality, or a lack of access to these services. Significant geographical gaps and an uneven distribution of services exist even in countries pioneering harm reduction or in countries where harm reduction has been available for decades. Rural communities are particularly underserved in many countries and regions. In addition to the geographical gaps in coverage, there are sub-groups of people who use drugs that experience barriers in access because harm reduction services aren’t tailored to their unique needs. These groups include women who use drugs, men who have sex with men, people who use stimulants and/or non-injecting methods, and people experiencing homelessness.

Overarching structural problems also negatively affect access to services. Criminalisation, racism and discrimination against Indigenous, Black and brown people results in low household incomes, unemployment, food insecurity, poor housing and lower levels of education. This, in turn, results not only in worse health outcomes for these communities but also in people from these communities disengaging or actively avoiding health services.

Women who use drugs are still frequently overlooked despite the complex harms, stigmatisation and structural violence they face. A substantial increase in gender-sensitive services is necessary to appropriately address their needs.

For all people who use drugs, stigma and discrimination are public health issues creating barriers precisely where more support is needed. Harm reduction services are equipped to address these gaps, as non-judgmental, communitybased service delivery is among the core principles of harm reduction.

The Global State of Harm Reduction 2020

Experts and ministers on drug control, health and population from over 20 African countries met in Cairo, Egypt from 29th July to 2nd August for the 3rd Ordinary Session of the African Union (AU) Specialized Technical Committee on Health, Population and Drug Control (AU-STC-HPDC).

As part of the general deliberations, the drug control meeting sought to appraise and review the implementation of the current AU Plan of Action on Drug Control 2013-2017 (which was later extended to 2019), and to adopt its successor, the AU Plan of Action on Drug Control and Crime Prevention (2019-2023).

Among the participants, there were 25 civil society representatives, the highest number of civil society representatives to participate in such a meeting. Through the support of the PITCH project, IDPC, Youth RISE Nigeria and the UNODC Civil Society Team, we were able to bring African civil society delegates to the meeting and facilitate a week of interaction – to ensure that CSOs had the space to engage with each other, and more importantly to take part in the thematic discussions with member states. The first three days were also spent reviewing various documents including the AU Plan of Action and an African Civil Society Common Position on Drugs, as well as looking at the next steps post the 2019 UN Ministerial Declaration that was adopted in March 2019 in Vienna.

In all, we had CSOs from Ghana, Kenya, Malawi, Morocco, Mauritius, Nigeria, Senegal, Sierra Leone, South Africa, Tanzania, Uganda and Zimbabwe, ensuring that most of Africa was represented. Having had the opportunity to comment on an earlier draft of the AU Plan of Action at the SA Drug Policy Week in October 2018, it was fulfilling to see the Plan finally adopted by member states on Friday, 2nd August. It was significant because for the first time, the words ‘harm reduction’ were kept in the document, and more importantly ‘alternatives to punishment’ were also mentioned throughout. There is even mention in the Plan to supporting ‘the local production of controlled substances and plants for scientific and medical use, in line with the international drug conventions’.

Governments within the continent have always made efforts to address the drug situation through the adoption of various methods and strategies over the years. The African Union continues to demonstrate strong commitment to addressing the drug situation in the region by facilitating the availability of a wide range of evidence-based treatment options, including opioid substitution therapy (OST). The new AU Plan of Action also calls for harm reduction services to be made available, which is a great step taken by AU member states. It also includes a commitment to review and collate drug policies across the region and continuous support of the epidemiology network and its research across the region.

Now the hope is that this Plan of Action will pave the way for member states to adopt a different stance away from punitive approaches, which have consistently failed and exacerbated problems related to drug use by creating a system that marginalises already vulnerable communities. The real work begins now, to convince member states to follow the Plan of Action they have ratified by formulating local national drug master plans that will follow the recommendations that have been laid out.

The energy and passion felt during last week in Egypt, being among African civil society representatives who are committed to pushing for drug policy reform, was nothing but amazing. It is safe to say Africa does not have only one voice, it has many. But we are ready to unite to advocate for changes that can and will benefit citizens all over the continent.

Largest ever civil society delegation attends the African Union meeting on Health, Population and Drug Control in Cairo 

Kunal is the Harm Reduction and Drug Policy Advisor for DRIP, a Mauritian-based NGO focusing on empowering young community leaders on evidenced based prevention, programmes and policies. His advocacy work has focused mainly on HIV, Harm Reduction, Drug Policies, and Key Populations. He was the chair of the Mauritian Country Coordinating Mechanism (MCCM), which oversees the Global Fund Grant to fight AIDS in Mauritius from 2014 to 2021. He is a member of the High Level Drugs and HIV Council of Mauritius. Kunal is a psychologist specialized in addiction.

Kunal es el asesor de reducción de daños y políticas de drogas de DRIP, una ONG con sede en Mauricio que se centra en capacitar a los jóvenes líderes de la comunidad en materia de prevención, programas y políticas basadas en pruebas. Su trabajo de promoción se ha centrado principalmente en el VIH, la reducción de daños, las políticas de drogas y las poblaciones clave. Fue presidente del Mecanismo de Coordinación de País de Mauricio (MCCM), que supervisa la subvención del Fondo Mundial para la lucha contra el SIDA en Mauricio desde 2014 hasta 2021. Es miembro del Consejo de Alto Nivel sobre Drogas y VIH de Mauricio. Kunal es psicólogo especializado en adicciones.

Kunal est Conseiller en réduction des risques et en politique en matière de drogues pour DRIP, une ONG mauricienne qui s'efforce d'autonomiser les jeunes leaders communautaires en matière de prévention, de programmes et de politiques fondés sur des preuves. Son travail de plaidoyer s'est principalement concentré sur le VIH, la réduction des risques, les politiques en matière de drogues et les populations clés. Il a été Président de l'Instance de coordination nationale mauricienne (MCCM), qui supervise la subvention du Fonds mondial pour la lutte contre le sida à Maurice de 2014 à 2021. Il est membre du Conseil de haut niveau sur les drogues et le VIH de l'île Maurice. Kunal est un psychologue spécialisé dans les addictions.

Kunal Naïk

Sub-Saharan Africa (DRIP)

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Drug policy reform at the service of social justice

The Global State of Harm Reduction 2020

Largest ever civil society delegation attends the African Union meeting on Health, Population and Drug Control in Cairo