Biometric technology allows for efficient programming and improved quality of services. But when working with key populations, there are concerns around privacy. Can biometrics be responsibly implemented when working with a key population such as People who Use Drugs?

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Biometrics: acceptability & feasibility when working with key populations

Three Kenyan harm reduction organisations conducted a study with the support of Mainline on the needs of female drug users (FDUs) on the Kenyan coast. This investigation was done in order to adapt and design services based on the needs of FDUs. In addition, female specific barriers to accessing services was investigated based on observations that FDUs often face higher access barriers than their male counterparts. In this report, results of the study will be discussed.

The report starts with an introduction as to why special attention should be payed to FDUs, the context of the Kenyan coastal area and what makes FDUs a hard-to-reach population. Next we look at the barriers in accessing services, followed by health risks and predominant needs. This reports ends with intervention suggestions which respond to the needs of FDUs, and considerations for the implementation of these interventions in order to challenge the service barriers which FDUs experience.

Women who use drugs in kenya

The teams of outreach workers in Cape Town, Durban and Pretoria (South Africa) have systematically documented human rights violations among People who Use Drugs under the Bridging the Gaps programme. The result from this hard work is a report that reveals large numbers of serious human rights violations.

Human right violations in South Africa

In 2011, the Indonesian Government issued the Government Regulation Number 25 Year 2011 regarding the Implementation of the Compulsory Report of Drug Dependents which regulates the practice of compulsory report and rehabilitation for drug users in Indonesia. By this regulation, Indonesia produced a new institution called the Compulsory Report Institution (Institusi Penerima Wajib Lapor or usually abbreviated as IPWL). This institution is not only the place where drug users can access treatment, but also the place to note, gather, and process the data of drug users.

Looking at its importance, there is a need to understand the implementation of compulsory report and its effect on drug users’ life. This research attempts to explore how the compulsory report system has addressed drug users’ human rights. Besides that, this research also tries to assess the effectiveness of IPWL according to the client’s need.

The obligation to report in Indonesia

HIV risk behaviors among crystal-meth users might contribute to increasing HIV prevalence rates in Indonesia. Related risks can be reduced if people have access to crystal-meth related health services. Prior to the development of interventions, a comprehensive understanding of structural, social, interpersonal and personal factors related to the use of crystal-meth in Indonesia is crucial. This includes a better understanding of individual and environment factors surrounding drug use and HIV-related risk behaviors, which will allow for the designing of better interventions. This study aims to gain better knowledge on patterns of meth use and its implications on HIV risk and health seeking behavior among crystal-meth users in Indonesia, including a better understanding of on individual and environmental factors shaping drug use.

A qualitative research design was developed with the aim of producing a deeper understanding of the diverse patterns of meth use and its implications for HIV risk and related health seeking behaviors. The study looked at patterns of initiation of meth use, sustained use and attempts of reducing and stopping the use of the drug, and how the drug use influenced users’ behaviors, including daily activities, HIV risk behaviors, exposure to legal problems, as well as users’ social and sexual networks and health seeking behaviors.

Chrystal meth use in Indonesia

Evaluation of a century of international efforts invested in controlling drugs, done by UNODC, showed that the system of drugs controlling and its application had some sideffects. One of these is lack of investments solving the question of harmfull consequences for public health caused by drug use. With global acceptance of the fact that drug dependence is a chronical, but preventable disease, but also a disease that one can be cured or recovered from, a widely accepted standing point is that measures and interventions directed towards achieving apstinence and recovery have to be accompanied by measures that can significantly contribute to decrease of risks and harmfull consequences of drug use. Today, interventions in the area of risk prevention and harm reduction are considered fundamental and necessary, due to the fact that there is a wide scope of evidences that can prevent disease, save lives and protect the community. On a global level we have a highly present tendency that the practice of drug use harmful consequences’ reduction is being spread and finds its application in the area of illegal, but also legal psychoactive substances use, as well as in the work of the law enforcement services. In the same time the concept of harm reduction became a mean to achieving golas of the public health policies, policies in the area of community security, policies of social protection aiming to decrease social, legal and economic problems related to psychoactive substances use.

Harm reduction approach and interventions derived from it have been introduced on a larger basis, principally as a response to a high number of overdose cases as well as fast spread of HIV&AIDS and other STIs due to intrevenous drug use. From the perspective of public health, subpopulations with a high infections burden have direct and indirect onerous effect on the society, and prevention can substantially limit these effects. The first effect is direct morbidity due to heavy forms of chronical infections, having high treatment expenses as a result. The second is reflected in the lost of human productivity, which increases social expenses. The third is high prevalence of diseases among persons who use drugs, which, especially if sustained a long period of time, can increase the risk in the wider population. Practice shows that harm reduction measures represent a noteworthy input to the conventional public health approach, can have a strong effect on spreading blood-borne and other infections among people who inject drugs, therefore the society in general. Prevention is feasible and effective if populations most at risk of acquiring infection have been provided with adequate services, in an adequate manner, in their own surrounding and in the adequate time.

Harm reduction measures, i.e. prevention and reduction of mortality, reduction of health and social risks and harms, as well as general feeling of insecurity of the community due to drug use,in most countries of Europe and world represent an integral part of national strategies and policies of fight against drugs, applied in different scope and combinations, dependant to drug policies’ goals. All European and international refferent organizations and bodies strongly support harm reduction as an efficient, evidence based approach to prevention of infective diseases transmition and treatment of persons who use drugs.

Harm reduction approach has been supported by the “Strategy of Montenegro for prevention of drug abuse 2013 – 2020”, but there is no unique national doctrine, i.e bylaws that regulates this particular area. Although there are the most important harm reduction services set in place, which proved their worth and necessity on multiple occasions, ending of a nine year long donation program of the Global Fund for Fight against AIDS, Tuberculosis and Malaria in July 2015, brought the sustainability of certain services into question and the same are facing closure. This is especially related to service functioning within the NGO sector, without which the harm reduction approach in a certain country can not be neither complete nor efficient, daily centers i.e. drop in centers for people who inject drugs and outreach work with most at risk populations in respect to HIV, Hepatitis C and B. In order to make services mentioned mentainable and developed according to growing needs, it is necessary to permanently secure their functioning and sustainability. Due to all things mentioned it is necessary to adopt this document as a referent conceptual and practical framework for further development and improvement of the national policy in the domain of reduction of harm caused by drug use in Montenegro, according to strategic goals set. Drug users’ access to adequate treatment must not be a priviledge, but a right coming from the fundamental right to health, as well as an obligation of every responsible system. Likewise, the possibility of access to programs and measures of decreasing drug related harm represents the right of every individual, which must be recognized as such.

Reduction of drug related harm in Montenegro

By Lenka Vavrincikova, Hana Fidesova, Barbara Janikova & Jean-Paul Grund

New Psychoactive Substances (NPS) are becoming a major challenge to public health and drug policies in Europe and have become a high priority in Europe. The “new psychoactive substances in Europe” project (NPSinEurope.eu) aims to contribute to the development of innovative and effective health promotion interventions targeting emerging NPS use in Europe, in particular in response to more hazardous patterns of use and in vulnerable populations. The overall project objectives are:

 provide an overview of the use of new psychoactive substances (NPS) in populations of People Who Use Drugs Heavily (PUDH) in the EU28 countries and identify the associated risks for harm and the existing legislative, preventive and harm reduction responses;

 assess, identify and describe harmful patterns of NPS use among PUDH, NPS related risks and harms in 5 selected countries, as well as identify and prepare adequate tailored public health responses;

 develop and implement targeted pilot interventions for prevention, demand reduction and harm reduction targeting NPS use among PUDH;

 build best practice guidance and capacity among harm reduction workers towards improving harm reduction responses; and,

 disseminate the results of the Europe-wide inventory, 5 country assessment and local pilots on public health responses, through an online resource centre and a training manual, and at regional and national conferences.

This document concerns the second objective, a “Rapid Assessment and Response” (RAR) of harmful patterns of NPS use and the associated risks and harms in the 5 selected countries, as well as the identification and preparation of adequate tailored public health responses.

NPS Correlation report

Drug policies have traditionally sought to achieve a ‘drug‑free world’ through crop eradication campaigns, drug seizures and the incarceration of all actors involved in the illicit drug market. This has resulted in law enforcement targeting those at the lowest levels of the drug chain, such as drug couriers, low‑level dealers, subsistence farmers engaged in illicit crop cultivation, and people who use drugs. This approach has led to an increase in drug‑related violence, corruption, mass incarceration and prison overcrowding, while patterns of drug production, trafficking and consumption have tended to evolve in order to evade law enforcement actions.

According to United Nations estimates, one in five people currently in prison around the world are there because of a drug offence, 83 per cent of whom are imprisoned for possession offences. The criminalisation of people who use drugs has had little effect on the overall prevalence of drug use worldwide, while it has driven people away from health‑based interventions in the community.

The mass incarceration of low‑level drug offenders has led to an overloading of the criminal justice system in many countries – rendering courts unable to tackle serious crime cases. This ten‑point plan details how states can effectively and appropriately deal with the issue of drugs through a health and human rights‑based approach rather than solely a criminal justice response.

The publications below initially stated that, according to the UN Commission on Crime Prevention and Criminal Justice (CCPJ), 83% of all people convicted for a drug offence had been sentenced for drug possession. In May 2020, this was amended to reflect the accurate interpretation of the CCPJ’s findings, which is that 83% of all recorded drug offences are offences related to possession, with no reference to sentencing. According to more recent UN data from 2019, one in five people incarcerated worldwide are detained for a drug offence, of which 21.65% (or 470,000 people) were detained for drug use and drug possession only.

Ten-point plan on reforming criminal justice responses to drugs

The Council of Europe’s Co-operation Group to Combat Drug Abuse and Illicit Trafficking in Drugs (“Pompidou Group”) promotes public health and the implementation of a drug policy which respects human rights and supports gender mainstreaming.

By holding a first symposium in 1988 on women and drugs, the Pompidou Group was a pioneer in Europe regarding the gender aspect of drug policies.

Within the framework of its 2014-2018 mandate, the Pompidou Group resumed its activities in this field with the introduction of a gender dimension in drug policies.

This would not have been possible without the political and financial support of the Department for Anti-Drug Policies of the Presidency of the Council of Ministers of Italy.

The activities cover three different fields consistent with the Pompidou Group’s mission of promoting the link between research, policy and practice;

Research on the gender dimension in the Non-Medical Use of Prescription Drugs in Europe and in the Mediterranean Region (NMUPD)

 which resulted in an ISBN 2015 publication covering data from 17 countries: The study reveals that women are a high-risk category for NMUPD and that no standardised monitoring system for NMUPD exists in Europe and in the Mediterranean Region. It addresses recommendations to national authorities and calls for a better understanding of the link between drug use among women and violence.

Improving the management of violence experienced by women who use psychoactive substances

As jurisdictions enact reforms creating legal access to cannabis for purposes other than exclusively “medical and scientific,” tensions surrounding the existing UN drug treaties and evolving law and practice in Member States continue to grow. How might governments and the UN system address these growing tensions in ways that acknowledge the policy shifts underway and help to modernize the drug treaty regime itself, and thereby reinforce the UN pillars of human rights, development, peace and security, and the rule of law?

Cannabis regulation and the UN drug treaties: Strategies for reform

This document presents a number of results and recommendations collected from “Austerity and the Portuguese Drug Policy Model: an exploratory study”, a research study undertaken by Agência Piaget para o Desenvolvimento (APDES) and co-financed by Open Society Foundations.

The main aim of this project was to monitor what is happening in the Drug phenomenon, in the lives of people who use drugs and in related public care services, while austerity measures are being applied in Portugal. The Portuguese Drug Policy Model has been under international attention and scrutiny and is frequently pointed out as a possible example to follow because of promising related indicators. Nevertheless, its complex and integrated nature of care services and programmes might be at risk because of the currently restrictive public policy framework. In that case, the Portuguese Model itself is also at risk. By losing its inner and idiosyncratic traits, it might become inadequate and inoperative. This project took place at a very critical and decisive moment, in which it was possible to understand in real time how comprehensive policies react to the undermining process of the resources to which they are anchored.

Austerity and the Portuguese drug policy model

Evidence supports the need for a shift in the global approach to drug use. In this report, Do no harm: health, human rights and people who use drugs, UNAIDS shows what works to reduce the impact of HIV and other harms related to drug use.

Countries that have moved away from laws and policies that are harmful to people who use drugs and that have increased investment in harm reduction have reduced new HIV infections and improved health outcomes. These policies also deliver broader social benefits, such as lower levels of drug-related crime and reduced pressure on health-care and criminal justice systems.

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