The development of a HIV prevention, treatment and care programme in Ukraine by the Government has been spearheaded through support from Alliance Ukraine and its many local NGO partners across the country. A major achievement in this regard is that over the past 3 years, HIV prevalence among PWID under the age of 25 years has decreased. Such a reduction is largely due to the implementation of a comprehensive HIV prevention programme, including harm reduction, led by Alliance Ukraine and its partners, a response that began at the end of 2000 and was accelerated from 2004 to the present day at national scale. It is the national scale of this response by Alliance Ukraine through its partners that is of particular note for possible replication elsewhere.

The International HIV/AIDS Alliance is an international nongovernmental organization with its international secretariat in Brighton, United Kingdom, and currently comprises 40 nationally based, independent, civil society organizations around the world as well as seven Technical Support Hubs, all of which are dedicated to ending AIDS through community action. The Alliance seeks to work with communities through local, national and global action on HIV, health and human rights and is committed to collective action that will lead to a world without AIDS in which the lives of all human beings are of equal value, and everyone has the right to access the HIV information and services that they need for a healthy life.

The purpose of this review is to document the work of Alliance Ukraine and to assess whether such work is a ‘good practice’ that could be replicated in other countries faced with a serious HIV/AIDS epidemic driven largely by unsafe injecting behaviours. The review was undertaken during July 2013 and data was updated were available in April 2014. Criteria have been developed to undertake a comprehensive assessment of the full range of support given by Alliance Ukraine and its local NGO and Government partners relating to the implementation, management and ongoing development of the national HIV prevention programme throughout Ukraine.

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

Good practices in Europe: HIV prevention for people who inject drugs

In 2012, voters in the US states of Washington, Colorado and Oregon were given the opportunity to vote in ballot initiatives for the creation of legally regulated cannabis markets. Washington’s Initiative 502 and Colorado’s Amendment 64 both passed with 55.7% and 55.3% of the vote respectively. Oregon’s Measure 80 failed with 53.4% of those voting rejecting the measure. As calls for and legal processes towards the initiation of cannabis policy reform become more common within US states, it is a timely and useful exercise to reflect upon the campaigns for reform in Washington (WA), Colorado (CO) and Oregon (OR) and examine why the public supported cannabis policy reform in some instances and not others.

Within the United States of America there is a broad and growing consensus that the policy of prohibiting the use of cannabis for anything other than scientific and medical purposes is failing. Yet, most voters still view recreational cannabis use in a negative light. Moreover, as the policy landscape shifts, there is mounting concern that overly commercial and under regulated cannabis policies, particularly those that could harm youth, are not desirable either. Polling and interviews with experts from WA, CO, and OR indicate that swing voters, crucial to passing ballot initiatives, desire to have cannabis policies that are well thought out and not overly ideological. Strong regulations, dedicating tax revenue to education and public health programmes, and strong protections for youth seem to be particularly important to voters. As will be shown, these policy features also align with political messages that most strongly resonate with voters.

Drawing on and developing further the discussions within the GDPO Policy Report, Legally regulated markets in the US: Implications and possibilities, this policy brief will review and analyse what may lie behind the successes and failures of the ballot measures in Washington, Colorado and Oregon, as well as examine the changing national context for cannabis reform. It concludes by bringing together some of the lessons learned within these states in what has been referred to as the process of ‘selling’ policy ideas to the voting public.

Selling cannabis regulation: Learning from ballot initiatives in the United States in 2012

Patterns of illicit narcotics cultivation are among the understudied topics. Some studies estimate the prevalence of illegal crops using imagery and remote sensing data. These studies rely heavily on the availability and quality of the related images, which is often an issue for many countries known as major drug producers.

Using official drug crop eradication data, this study examines the patterns of illegal drug cultivation in Mexico at the municipality level. Species distribution models of ecology were used to guide the selection of environmental variables. A number of sociodemographic variables were incorporated into the model to describe human factors. Global and local models were compared to discern the determinants of marijuana and opium cultivation.

Geographically weighted regression was proved overall more effective than global ordinary least square regression despite the spatial variation of its explanation power. The models explained the spatial patterns of opium poppy cultivation are better than those of marijuana cultivation, suggesting the possible presence of more complicated local factors for growing illicit marijuana crops. A number of human factors such as law enforcement, gang activities, and transportation accessibility were found significant for illicit cultivation.

Click here to read the full article (restricted access)

Illegal drug cultivation in Mexico: An examination of the environmental and human factors

At its 34th meeting, the UNAIDS Board, called for Member States and the UN Joint Programme to pursue, in line with the UNAIDS vision of the three zeros, a clear commitment in the post-2015 development agenda to ending the AIDS epidemic as a public health threat and an obstacle for overall sustainable development by 2030, provisionally defined as the rapid reduction of new HIV infections, stigma and discrimination experienced by people living with HIV and vulnerable populations and key populations, and AIDS-related deaths by 90% of 2010 levels, through evidence based interventions to include universal access to HIV prevention, treatment, care, and support, such that AIDS no longer represents a major threat to any population or country. A process of establishing new targets for 2020 and 2030 is underway, within which targets and commitments on reducing HIV transmission among people who inject drugs will be considered.

There is now three decades of available scientific research data assessing the evidence regarding the effectiveness and cost effectiveness of harm reduction services and the right to health for people who inject drugs. This data shows that evidence-based harm reduction interventions such as Needle and Syringe Programmes (NSP) and Opioid Substitution Therapy (OST) are effective, pragmatic and cost effective—provided they are delivered in a way which is accessible and acceptable to people who inject drugs, for example at sufficient scale. Nevertheless, in many countries this evidence has not been translated into programmes of sufficient size or reach.

Halving HIV transmission among people who inject drugs

It is almost two decades since life-saving treatment for human immunodeficiency virus (HIV) became available. Life expectancy among people living with HIV, for whom optimal therapy is initiated timely, is now close to that of the general population. Despite this, an estimated 1.6 million people died from acquired immunodeficiency syndrome (AIDS)-related illnesses globally in 2012, and the number who died within the World Health Organization (WHO) European Region reached almost 100,000. A large proportion of these deaths occur in the eastern part of the Region, and without changes in the HIV response, the death toll in this region is likely to continue to increase in the coming years. Conversely, in the west, the risk of AIDS-related death continues to decline, reflecting some positive progress.

The majority of AIDS-related deaths would be preventable if available evidence were to be fully implemented. Research findings reported in this issue of 

 exemplify the challenges we face as we enter the fourth decade of the epidemic. Better and more comprehensive testing strategies aimed at persons most at risk of contracting HIV are needed, linked to HIV care and treatment programs. Implementation research needs to be at the core of the HIV response.

Diagnosis at a late stage of HIV infection and subsequent delays in starting treatment with antiviral agents are the important factors for the high death toll in parts of Europe and certain subgroups. Pharris et al. in this issue present the latest trends in HIV diagnoses in the European Union/ European Economic Area [4] and show that, based on countries where information is available, about half of the 300,000 people diagnosed with HIV over the past decade had a CD4 cell count of 350 copies/mL or less at the time of diagnosis (defined as ‘late diagnosis’). Consequently, their risk of death within the year of their diagnosis was more than 10 times higher than that of individuals diagnosed early and entering care promptly; those diagnosed late aged 50 years and over carried an even greater risk. This is of particular concern given the increase in the number of persons diagnosed at an older age in Europe with almost two thirds diagnosed at a late stage of infection (personal communication Anastacia Pharris, November, 2014).

Death from AIDS is preventable, so why are people still dying of AIDS in Europe?

The main objective of the report is to examine alternatives to incarceration that have been used in different countries of the world for drug-related offenses. It is intended to offer Member States a wide range of options to move forward in the design and implementation of policies that are both effective and uphold human rights.

Drafted for the 56th Meeting of the CICAD in November 2014 in Guatemala City, this four-part document provides a four-part synopsis of the major findings and alternatives identified by the TSG.

The first part of the document explains the rationale behind the project, laying out why it is important to design and implement alternatives to incarceration for drug-related offenses. The second part outlines the legal, conceptual and methodological approaches guiding the TSG’s work. The third part provides essential information about the alternatives identified in this exercise, arranging these experiences by their most salient components and proposing a system of categorization thereof, as well as a few specific examples. Lastly, in the fourth part, conclusions are drawn and a list of guiding principles is provided for the adoption and development of alternatives, recognizing the importance of taking into account the context and particular needs of each country.

Alternatives to incarceration for drug-related crimes

本文总结了2016年联合国大会关于毒品的特别会议的目前的谈判准备情况。英语版本拥有更多信息，请阅读下文。

随时掌握与药物政策发展相关的最新信息。

The UNGASS on drugs in 2016 will be an important moment in the international drug policy debate. The preparations for this crucial meeting have been much discussed by UN member states, starting with the negotiations of CND resolution 57/5 in March 2014.

The negotiations of the ‘omnibus resolution’ in the Third Committee of the General Assembly over the past few weeks have been the latest forum for agreeing the ‘modalities’ of the UNGASS and as these negotiations draw to a close, two of the most contentious procedural issues have now been provisionally agreed. Ahead of the Special CND Segment on preparations for UNGASS, scheduled for 3rd December 2014, the current state of play on these two issues are summarised in this document.

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

2014年12月IDPC宣传备忘录：审查CND闭会期间和特别CND段的问题为2016年UNGASS做准备

这报告提供了欧洲毒品消费室的组织和工作方法的概述。英语版本拥有更多信息，请阅读下文。

This report provides an overview of the organisation and working methods of drug consumption rooms (DCRs) in Europe. It offers information about the functioning of DCRs as well as on the organisation and structure of such facilities and aims to benefit various groups of stakeholders. Chapter 1 will commence with the definition, background and a brief history of DCRs in Europe, followed by the methodology of this study in chapter 2. In the third chapter of this report, some general aims and objectives and a breakdown into a number of specific objectives (Hedrich et al, 2011), the text continues with an elaboration on how the DCRs work on an environment for safer drug use (chapter 4) and improving the health status of drug users (chapter 5).

Moreover, in line with the survey tool employed in a previous survey among Dutch DCRs (Havinga & Van der Poel, 2011), which was adapted for use in the present study, this report elaborates on several other crucial aspects of the organisation and working methods of DCRs. The general services on offer at DCRs (chapter 6) will be discussed, particularly those addressing non-health related issues, and focusing more on the social status or well-being of drug users. Details on the differences in staff functions and the trainings offered to the staff (chapter 7) and the way facilities involve peers in various organisational elements of the DCR (chapter 8) are also examined.

After this European overview with insights into the way DCRs organise and structure their facilities and services, the final chapter pays some attention to the future of DCRs, and elaborates briefly on what those currently involved in the running of DCRs consider to be important when setting up a new facility (chapter 9). Our overview study concludes with some relevant remarks when considering the foundation of a new DCR service.

All in all this report, in its discussion of aims, objectives, services, organisational structure and points of importance, is primarily directed at all who are involved in DCRs in Europe and beyond, or those who wish to set up a DCR in a new location. However, it may also be of interest to anyone concerned with the provision of basic services to drug users in Europe.

在欧洲的毒品消费房间

Although there is evidence of the effectiveness of needle and syringe programme (NSP), opioid substitution therapy (OST) and antiretroviral therapy (ART) in reducing HIV prevalence, most Central and Eastern European sub-regions still have low or no coverage of most or all of these interventions.

For St. Petersburg, when OST, NSP and ART are combined, only 14% coverage of each intervention is required to achieve a 30% reduction in HIV incidence over 10 years. Similar findings are obtained for Tallinn and Dushanbe. In order to achieve the same reductions in HIV prevalence over 10 years, over double the coverage level is required relative to what was needed to achieve the same reduction in HIV incidence in that setting. To either reduce HIV incidence to less than 1% or HIV prevalence to less than 10% over 20 years, with all interventions combined, projections suggest that very high coverage levels of 74–85% are generally required for the higher prevalence settings of Tallinn and St. Petersburg, whereas lower coverage levels (23–34%) are needed in Dushanbe. Coverage requirements are robust to increased sexual HIV transmission, risk heterogeneity and like-with-like mixing, as well as to assuming a lower HIV acute phase cofactor or different injecting cessation rate.

The projections suggest that high but achievable coverage levels of NSP can result in large decreases (30%) in HIV incidence in settings with high HIV prevalence among PWID. Required coverage levels are much lower when interventions are combined or in lower prevalence settings. However, even when all three interventions are combined, the targets of reducing HIV incidence to less than 1% or prevalence to less than 10% in 20 years may be hard to achieve except in lower prevalence settings.

Controlling HIV among people who inject drugs in Eastern Europe and Central Asia: Insights from modelling

With regard to all the drugs, the reality is that Brazil, like other countries, is losing the fight against drug addiction. Current policies created in the context of the idea of the drug war have been insufficient to reduce consumption and dependence. And have exacerbated other problems. The prohibition as has been practiced is not giving the required effect on the problem size and creating two other problems: the drug war, with their victims; and the sentencing of young users, treated as criminals, whom after prisoners are socially condemned many times definitively. As the drug war policy has focused primarily on strengthening police repression mechanisms, the whole society ends up being affected.

Mounting a heavily armed police state and a major consumer of weapons and their components ends just putting pressure on the government machinery and the way in which the state relates to the application of repressive laws and society. The testimony of Colonel Jorge da Silva, former chief of the Military Police of Rio de Janeiro, in the hearing held on last August 11, was very clear in this respect, showing that the logic of war causes imbalance in democracy and has a strong correlation with mortality of black and poor young people on the outskirts of cities.

Other consequences of this are known. On one hand, the drugs are used in small doses for reducing stress, fun, filling existential voids. But in large doses, the overwhelming cost of violence, directly or by accidents, cause human degradation, lack of social and economic integration, focus on depression, and relate to different forms of suicide and serious diseases, both physical and mental. Added to this drug-trafficking violence, police violence, corruption and the consequences of imprisonment of young users. Nevertheless, the social problem of drug and the individual right to its use have not been discussed at the level they should.

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