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Global Commission on HIV and the Law: Criminal Law as a Risk Factor for IDUs

On July 9, 2012, the Commission released its final report, "HIV and the Law: Risks, Rights & Health," which can be accessed here. 

The links between HIV and the criminalization of injecting drug users generated significant discussion amongst the activists and government representatives who participated in the Regional Dialogues. Here are some of the voices that emerged.

Injecting drug users said…

  •    • “I have often been ill-treated only for the fact that I am a drug user and I was repeatedly tortured during interrogation.” — man from Ukraine

  •    • “In country there is no state rehabilitation program. There is no substitution therapy. The country has violated the rights, according to some estimates, of several million people. Several million drug users who are denied the right to be human.” — woman from Russia

  •    • “Policies on drugs and HIV are often developed separately, with neither coordination nor coherence.” — NGO submission from Nepal

  •    • “Campaigns against drug users include…stigmatizing media coverage, public beatings of drug users, and public shame.” — woman from Nepal

  •    • “There was, and is still, no clean injecting equipment available in Thai prisons, or opiate substitution therapy.” — NGO submission from Thailand

  •    • “Criminal charges against IDUs because of drug use mainly leads to their arrest. Despite the fact that the judicial authority shall decide on compulsory treatment of IDUs in prisons, no such treatment and rehabilitation programs exist. At the same time in the prisons of the country there is no methadone program.” — woman from Azerbaijan

  •    • “Quite a big number of prison inmates are drug users, who continue to inject and usually tens of people share the same needle, which exposes them to extremely high risk of transmission of HIV and other blood infections.” — NGO submission from Bulgaria

  •    • “On the basis of the substance abuse records in which I was registered when I first asked for medical help, I became a man whose rights are violated and can continue to be violated. For example, information about my diagnosis and my drug use were disclosed without my consent and on that basis that my driver’s license was taken away, even though I have not used any drugs for the past 7 months. This is a mass practice in our country and my city. Many of my friends have already suffered. This arbitrariness continues. Because of the [substance abuse] record we have many other difficulties, for instance with employment and education.” — man from Russia

  •    • “Most of our drug policies are still punitive, embracing a ‘quit or die’ approach.” — man from Nigeria

  •    • “These debates cannot ignore the consequences of drug control policies in the region: social isolation, disproportionate numbers of drug users and 'mules' incarcerated, social violence, environmental damage and violations of basic human rights.” — woman from Argentina

Women and Injecting Drug Use

Why are women in Eastern Europe and Central Asia who inject drugs reported to be at a higher risk of acquiring HIV than men?:1
(1) They are reported frequently being “second on the needle” after men when sharing injection equipment.
(2) There is a significant overlap between drug use and sex work, and many women who inject drugs will exchange sex for drugs. UNAIDS estimates that 35 percent of women living with HIV in Eastern Europe and Central Asia acquired the virus through injecting drug use, and a further 50 percent were infected through unsafe sex with partners who inject drugs.
(3) Female drug users are frequently denied health care, and many reported judgmental attitudes by health care providers.
(4) Female drug users experience high levels of poverty, incarceration, and domestic violence – all risk factors for HIV.

Debates, Controversy, Challenges…

Regional differences quickly came to light. In Eastern Europe and Central Asia, the only part of the world where HIV rates remain on the rise, the pandemic is heavily concentrated amongst injecting drug users. In contrast, there was only one submission at the African Regional Dialogue addressing injecting drug use and HIV, although activists warned of a looming crisis as drug trafficking through West Africa continues to rise.

Government representatives at the Regional Dialogues were reticent to address the issue. Russia, a country repeatedly shamed by the human rights community for its regressive, brutal drug policies, refused to send any government representation to the Eastern Europe Regional Dialogue. During the African Regional Dialogue, some of the government representatives left the room during the discussions about injecting drug use so as not to be associated with the topic. Other government representatives expressed fear that if they called for the decriminalization of injecting drug use, they would be criticized for promoting drug use or encouraging the legalization of all drugs and drug trafficking. Experts invited to present informed opinions to the Commissioners and the civil society participants at the Regional Dialogues responded thoroughly to these concerns. Here is a small sample of the debates that took place.

Only injecting drug use directly spreads HIV, through the sharing of needles, and in the context of HIV and the law, this is the only type of drug use that policymakers should address.
  •    • Criminal prosecutions for possession of drug use place huge numbers of people who use drugs of any kind in state custody, in conditions where their vulnerability to HIV is further heightened.
  •    • A comprehensive harm reduction program for injecting drug users includes switching to snorting or smoking drugs.  If the Commission only calls for injecting drug use to decriminalized, rather than encouraging harm reduction, they would be calling for approaches that could potentially encourage people to inject.
  •    • Recent epidemiology suggests stimulants are also major drivers of the HIV epidemic.
Depriving injecting drug users of drugs will reduce drug consumption.
  •    • Injecting drug users are placed in jail for long sentences, and in many countries prisons do not provide any form of substitution therapy or syringe exchange.  As a result, most continue to inject drugs but are forced to use covertly and to share dirty needles in prison, placing them at high risk of contracting hepatitis C or HIV.  This deprivation ultimately becomes a death sentence because in many countries prisoners receive no medical treatment for tuberculosis, hepatitis C or HIV.
If governments take a strong stance on injecting drug use, they will be criticized for calling for the legalization of all drug use and drug trafficking.
  •    • Governments should amend their laws to decriminalize drug use not for trafficking.  This will allow countries to implement harm reduction, focus on critical, life-saving public health measures, and protect the human rights of individual drug users who are not causing harm to others. 
It is sufficient to recommend that countries decriminalize the possession of “small amounts of drugs.”
  •    • Russia and other countries in Eastern Europe and Central Asia have already decriminalized trace amounts of drugs.  Some activists from the region requested the Commission to specifically call for “decriminalization for the purpose of personal use.”
  •    • Others urged the Commission to specifically state that threshold amounts that are deemed for “personal use” should not be set so law as to render decriminalization illusory in reality – in many countries incredibly small amounts of a prohibited substance are deemed to be “large” and attract serious penal consequences.

AIDS-Free World Says…

The testimony provided to the Global Commission at the Eastern Europe and Central Asia Regional Dialogue was heartbreaking. The laws and policies inflicted daily on people who use drugs violate their human rights and their basic humanity. Activists from these countries recounted the long string of abuses they have faced because of their drug use — from the denial of methadone, to police extortion, to the lack of adequate legal aid, to interrogation and torture, to long prison sentences without any basic medical care or treatment for HIV. Those who emerge from the grip of incarceration and try to restart their lives are often placed on national drug registries, allowing the state to deny them social support or employment, to arbitrarily arrest them again, or to take their children away. The system is simply stacked against them from the very beginning. Within a context of rising HIV rates, these policies are regressive and unconscionable — and even more so because the spread of the virus is preventable.

“At some point, reasonable people must surely recognize that injecting drug use is an illness, a public health issue, not a target for punitive attack, or incarceration, or assault by the police. The mentality is profoundly warped … it’s as though injecting drug users weren’t human, and this environment of personal malice turns into the malice of the state.... When you have a conspiracy of hate directed against a vulnerable group, you can almost be certain that they’ll go underground, they won’t get tested, they won’t turn to prevention or treatment or care, and your prevalence rates for AIDS will soar through the roof.” — AIDS-Free World Co-Director Stephen Lewis

AIDS-Free World stands behind all of the courageous activists who came forward to testify and who work on these issues every day in incredibly difficult circumstances. We will continue to advocate for harm reduction, for drug policies driven by public health goals, and for the human rights of people who use drugs.

Read more here.

The Global Commission on HIV and the Law says…

The final report of the Global Commission on HIV and the Law will be released in the first half of 2012.

See our introduction to the Global HIV Commission and the Law here.

1 HIV and the Law in Eastern Europe and Central Asia, Regional Issues Paper, May 2011. Available at http://www.hivlawcommission.org/index.php?option=com_content&view=article&id=61&Itemid=67&lang=en