We can’t end HIV unless we end the war on drugs

On 29 November 2023, I attended the HIV Outcomes high-level conference “Building political momentum: Towards Ending HIV in Europe” at the European Parliament in Brussels. Leading up to World AIDS Day and European elections next year, the event focused on strengthening HIV policies and policy actions to advance the goal of ending HIV in Europe. While progress has been made in the fight against HIV, the needs of people who use drugs need to be addressed and tackled. An integrated and person-centred approach is required to address the needs of people who use drugs and harm reduction services.

Here is what stressed in my panel intervention:

My name is Magdalena Bartnik. I’m a member of European AIDS Treatment Group and I also represent PREKURSOR Foundation – a leading harm reduction organization based in Warsaw, offering comprehensive support for people who use drugs.

 

We are working on the front line, operating low threshold services, engaging with people and providing direct, unconditional, nonjudgmental support for them. We stand by the most vulnerable and marginalized, protecting their rights, challenging inequalities and safeguarding the social wellbeing of individuals, families and communities. PREKURSOR initiated and conducted, progressive by Polish standards, interventions and projects – peer work, drug testing, drug consumption site. We are the originator and leader of the take-home naloxone pilot project, which is planned to begin next year.

 

Non-governmental organizations in Poland make an enormous effort, carrying the burden of responsibility for the health of citizens, while governmental institutions show their inaction, their lack of commitment or even undermine the organization’s activities. This has been happening for the last 8 years.

 

And the question must be stated whether civil society and government actually go hand in hand in efforts to reduce HIV and improve the lives of People Living with HIV.

 

Or whether it is rather NGOs that are doing their best to overcome barriers and be able to implement effective strategies against passivity or reluctance of those in power. Lack of political will and vision, political cowardice reinforce the taboo around HIV. The fact is that this has been the case so far for practically all political options. We do hope that in a newly appointed government, there will be politicians with the sense of duty and responsibility, understanding that cooperation with civil society is essential.

 

But again – are there mechanisms in the EU to oblige national governments to fulfill the commitment towards ending HIV by 2030? I can easily imagine strong declarations which are not followed by anything.

 

HIV response mechanism in Poland needs reform or rather has to be built from the ground up on new foundations and assumptions appropriate for the current times.  And the key issues in this context – sexual minority rights, women’s rights, harmful gender norms, attitudes towards sex work, the authority of the Catholic Church – cannot be overlooked here.

 

We can’t end HIV unless we end the war on drugs. People who use drugs – particularly those who inject, face heightened stigma and discrimination.

 

Criminalization of drug use and drug possession is a major impediment to the realization of the right to health and causes human rights violations in a broader sense. It prevents people from accessing life-saving care and creates a legal basis for human rights abuses by law enforcement.

 

Restrictive drug law introduced in Poland over 20 years ago resulted in a gradual reduction in the number of clients of harm reduction programs, as well as the number of programs themselves by two thirds. Harm reduction is under-resourced, under-funded and under-supported. It operates on the periphery of the health system instead of being a core element of a public health response to HIV/AIDS.

 

When discussing the acceleration of HIV prevention among People Who Use Drugs, we need to embed it in broader contexts – homelessness, loneliness, poverty, violence. Poor access to mental health care, primary health care and social services – for Polish citizens, but also – for immigrants without legal status in the country. Access to OAT which is very low in Poland. “Once I entered the treatment and caught my breath, I then started to think and care for my health” – this sentence from one of our clients reflects well the dramatic situation in which many people find themselves. If you are homeless, experiencing violence, with no access to treatment, just trying to survive, you don’t need any more bad news.

 

What is urgently needed is a reform of drug policies, scaling up harm reduction services nationwide and making them available and accessible to People Who Use Drugs. This also applies to health care and social services. We need to support and empower community-led programs. At the heart of it all is the fight against stigma and discrimination, the need of changing the narrative about drugs and drug use.

 

Achieving the elimination targets requires broad cooperation between policy makers and governments, affected communities, healthcare providers, harm reduction services, researchers, media representatives, and the pharmaceutical industry. Organizations cannot be left on their own, operating in a hostile environment and unable to count on institutional support, trying as hard as they can to protect the health and lives of those who are most vulnerable.

Magdalena Bartnik

EATG member | PREKURSOR Foundation