Ninety-nine percent of people who inject drugs live in countries that lack adequate harm reduction services, including the three countries with the largest populations of people who inject drugs: China, Russia, and the United States. That is one of the key findings of a new UNAIDS report to which I contributed, Health, rights and drugs: Harm reduction, decriminalization and zero discrimination for people who use drugs. The report also shows that rates of HIV infection are not declining among people who use drugs, and may be on the rise. It calls for urgent action.
This was a hard report to write, because the picture it paints is so unbearably grim. While the world continues to wage a brutal war on drugs, people who use drugs and their families pay the price. They are marginalized, imprisoned, tortured, beaten, turned away from health care services, and in some countries, summarily executed. The war on drugs has been a colossal failure, but on it goes, while thousands of pointless and preventable deaths continue to mount. In the U.S. last year, young men were more likely to die of overdose than in a road accident, for the first time. Many of those deaths could be prevented with a dose of naloxone.
The solution is clear. As the report says, “Study after study has demonstrated that comprehensive harm reduction services reduce the incidence of blood-borne infections, problem drug use, overdose deaths and other harms. Countries that have successfully scaled up harm reduction have experienced steep declines in HIV infections among people who inject drugs.” A few countries have adopted this evidence-based approach, providing clean needles and syringes, access to opioid substitution therapy, access to naloxone, and more. But funding is nowhere near enough. Only three countries—Austria, Luxembourg and Norway—reported that they had achieved UN-recommended levels of coverage for these programmes.
Countries also need to decriminalize drug use. I happen to live in one place that has done so. In Geneva, Switzerland — by far the safest, calmest and most boring place I have ever been lucky enough to live in — mild forms of cannabis are available at local tobacco shops, and there is a medically-supervised safe injecting site for heroin users in the center of the city. The Swiss tend to favor peace and quiet over dramatic police raids, and thanks to their sensible approach, HIV infections have plummeted among people who inject drugs here.
In January 2018, the UN Chief Executive Board issued a common position that explicitly recommended decriminalization of drug use and possession for personal use. But in countries, change has been unbearably slow. Where change has come, it has been led by grass-roots organizations of people who use drugs and their allies, who persist in mobilizing, marching, and doing whatever they need to do to reach and save the lives of their peers. Unfortunately, in some of the countries where their work is most urgently needed, including China and Russia, these groups face police harassment, shutdown, arrest and even disappearance.
The wit, resilience, bravery and courage of community advocates is one small point of light in all this darkness. Recently, activists joined with UN agencies to celebrate one milestone: the launch of the new International Guidelines on Human Rights and Drug Policy, the product of years of hard work by many individuals and organizations. It starts with these inspirational words:
Universal human dignity is a fundamental principle of human rights. It is from the inherent dignity of the human person that our rights derive. No drug law, policy, or practice should have the effect of undermining or violating the dignity of any person or group of persons.
It sounds so simple, doesn’t it?