Blog AIDS 2014, 18 July 2014
People who inject drugs remain one of the highest-risk groups for contracting HIV, but infringements of their human rights around the world threatens to derail progress on ending AIDS.
Globally, around 16 million people inject drugs (WHO) and 3 million of them are living with HIV – and it is critical that their needs are represented at the 20th International AIDS Conference .
Asia Pacific is the second region in the world most affected by HIV and now home to an estimated 4.9 million people living with HIV (UNAIDS). The majority of infections have occurred through sharing injecting equipment and unprotected sex.
India and drug users
Kabir* arrived in Mumbai, India as a runaway in his teens. It wasn't long before he was introduced to heroin and began injecting the drug. In a few years his body was ravaged by disease and malnutrition.
In 2012 Kabir met some peer educators from Sankalp Rehabilitation Trust, an organisation that works with street-based drug users and fights for their human rights. They began exchanging his used needles for clean ones and educated Kabir about medical treatments and counselling services at their drop-in centre.
During the course of his treatment at Sankalp and Nair hospital for a knee injury, Kabir got tested and discovered he was living with HIV.
Harm reduction versus criminalisation
Efforts to provide HIV prevention, treatment and care to injecting drug users are shaped by tensions between approaches that regard them as criminals and those regarding them as people with human rights, including access to health services.
Anand Grover, UN special rapporteur and director of the Lawyers Collective HIV/AIDs in India, stresses: "The current drug control regime is damaging the health and human rights of people who use drugs. Criminalization and excessive law enforcement practices undermine public health initiatives, perpetuate stigma, and increase health risks to which entire populations, and not only those who use drugs, may be exposed."
Grover recommends that: "Governments decriminalize drug use and take a human-rights-based approach to drug control."
Harm reduction programmes
In the past two decades, needle and exchange syringe programmes have been drastically scaled up across the Asia Pacific region. Such 'harm reduction' programmes provide clean needles to injecting drug users so that the risk of transmitting HIV through used needles can be eliminated. These efforts have contributed to a declining trend of HIV prevalence in people who inject drugs.
But the continuation of such programmes is now under threat as international funding is set to decrease for middle income countries and national governments are reluctant to take over the reins.
Luke Samson, executive director and secretary of Indian Harm Reduction Network (IHRN), says: "National budgets do not allocate enough resources to ensure a transition from donor dependent financing to a national financing structure. International donors must step up their commitment to the goal of universal access to HIV treatment, care and support for people who use drugs."
Support for injecting drug users
AIDS 2014 is a key opportunity for advocates to push governments and donors to look at the evidence and the need to scale up harm reduction programmes.
Kabir has been clean for a year now. Sankalp's support in getting him on opioid substitution therapy, as well as providing vocational training has been invaluable in helping him turn his life around.
"Young drug users who come to cities are away from mainstream services, they are not very visible and often stigmatised, marginalised and undergo police brutality," Kabir says. "They live on streets and outside the experience of policy makers."
Protection of the human rights of drug-dependent individuals has particular urgency if a sustainable response to HIV is to become an achievable reality.
As Kabir says: "With the right support anyone can live a drug-free life. Sankalp gave me the chance to be human again."
By Ishdeep Kohli, International HIV/AIDS Alliance
Source: Blog AIDS 2014
