The Global Fund to Fight AIDS, Tuberculosis and Malaria welcomes the UN General Assembly Special Session on the world drug problem as an opportunity to bring public health and human rights concerns at the center of the current debate.
We welcome this meeting as an opportunity to shape drug policies that facilitate good health outcomes. Good drug policy can help in many ways: by ensuring adequate investment in essential, cost-effective health services for people who use drugs, including comprehensive HIV, TB, and Sexual and Reproductive Health services; by supporting the meaningful participation of people who use drugs in health programs; and by ensuring that resources are used for programs that minimize health harms and protect human rights, rather than incarceration of large numbers of people who use drugs.
People who inject drugs have consistently poor and inequitable access to HIV prevention, treatment, care and support. To compound the issue they often face discrimination, marginalization and abuse. As their behaviors are criminalized in the majority of countries, they often face incarceration (or, in some countries, extrajudicial detention) – settings in which access to comprehensive HIV services is even more limited. Worryingly, NSP provision in prison has significantly decreased, with only eight countries globally providing this harm reduction intervention in at least one of their prisons.
In too many countries, approaches to drug use still focus overwhelmingly on prohibition and criminalization, yet the limits and harms of this approach are becoming increasingly well documented and drug policies need urgent reform to remove barriers to effective HIV prevention, treatment and care. UNAIDS “estimates suggest that 56-90% of people who inject drugs will be incarcerated at some stage during their life”. Often, they will continue using (and injecting) drugs while in closed settings.
Until these maladaptive drug policies are reformed, particular efforts are needed to ensure continuity of ART, TB treatment, needle and syringe programs, and opioid substitution therapy at all stages – upon arrest, pre-trial detention, transfer to prison and within the prison system, and upon release. It is therefore essential to promote alternatives to detention and to provide harm reduction in these settings as well as in the community.
The Global Fund recognizes in its current strategy the importance of human rights-based approaches to addressing HIV, TB and malaria. This is especially true of most-at-risk populations such as people who inject drugs. The denial of essential, and potentially lifesaving, harm reduction interventions is a violation of the human right to the highest attainable standard of health – yet is the practice in too many countries. Discriminatory laws and policies can further stigmatize and marginalize this population – such as rules excluding current drug users from ART.