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In this new consolidated guidelines document on HIV prevention, diagnosis, treatment and care for key populations, the World Health Organization (WHO) brings together all existing guidance relevant to five key populations – men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and transgender people – and updates selected guidance and recommendations.

The risk behaviours and vulnerabilities of key populations result in their being disproportionately affected by HIV in all countries and settings. These disproportionate risks reflect both behaviour common among members of these populations and specific legal and social issues that increase their vulnerability. Yet HIV services for key populations remain largely inadequate. In many settings HIV incidence in key populations continues to increase, even as incidence stabilizes or declines in the general population.

To date, WHO has developed normative guidance separately for each of the five key populations, but, in general, guidance has not adequately addressed overarching issues relating to key populations. Similarly, the WHO global HIV guidance, including the 2013 consolidated ARV guidelines, did not specifically consider issues relating to key populations.

Consequently, these guidelines aim to address these gaps and limitations by:

Providing a comprehensive package of evidence-based HIV-related recommendations for all key populations;

Increasing awareness of the needs of and issues important to key populations;

Improving access, coverage and uptake of effective and acceptable services; and

Catalyzing greater national and global commitment to adequate funding and services.

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Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations

Although the incidence of hepatitis C virus (HCV) in Russia is extremely high, posing one of the biggest threats to the national public health, access to treatment of hepatitis C in the country remains limited.

On the one hand, the government acknowledges hepatitis C as a socially significant disease and commits to providing free treatment for those in need, but on the other hand, treatment programs receive minimal funding at the federal and local levels, and the country does not even attempt to lobby for reduced prices for medications.

In the absence of a special governmental treatment program, patients have to pay for their treatment, although not many people can actually afford a full course that significantly exceeds an average salary.

Despite the urgency of the problem, Russia has yet to conduct a systematic research that would assess hepatitis C prevalence, treatment needs, availability of medications, legal provisions and the level of access to HCV treatment. Such research is needed if the country wants to harmonize its approaches to achieve exponential growth of access to hepatitis C treatment and optimize its advocacy priorities.

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Hepatitis C in Russia: an epidemic of negligence

This policy briefing analyses the results of the partial agreement on drugs reached at the talks being held in Havana between the Revolutionary Armed Forces of Colombia, FARC, and the Colombian government.

The analysis is based on the joint communiqué issued on 16 May 2014,1 the eve of the first round of the presidential election in Colombia. Following a brief introduction to the drugs issue in the broader framework of the peace talks, the briefing looks at how the subject of illicit crops, drug use and trafficking is dealt with in the agreement.

It concludes with an assessment of the progress that the agreement represents in terms of the link between drugs and armed conflict.

The diversity of participants in the war who are involved in drug trafficking has led to a complex scenario in which the guerrilla groups are only one part of the problem. The criminal economy is able to continue operating regardless of who controls security in the producer regions.

The territorial approach that the agreement rhetorically claims to adopt is weak. It is not based on an integrated view of the territory and reduces it to the coca situation. A genuinely territorial approach would open the door to participation by rural settlers, indigenous and African-descent communities and give them a say in their territory’s future.

The agreement is a ratification of the ongoing relevance of the current approach to drugs, which is based on prohibition. In this case, the objective is the total elimination of both coca and drug trafficking. To insist on "eradicating drug trafficking" is to repeat old recipes in new packaging because it leaves intact the very mechanism that makes the drug trade competitive: continued prohibition.

The agreement ignores the significant level of progress made in processes that have become stronger and currently represent a critical mass in favour of a regulation scenario. These processes include the development of harm reduction models. These models are based on the understanding that drugs must be accepted as a reality that must be lived with, while preventing or minimising the harm that drugs may cause to users.

The agreement fails to envisage a strategic approach to the problem, including the seeking of commitments from other countries to rethink the current policy on drugs.

Drugs, armed conflict and peace

The Research Consortium on Drugs and the Law (Colectivo de Estudios Drogas y Derecho, CEDD) has published a new study that assesses state responses to illicitly-used drugs in eight countries in Latin America: Argentina, Brazil, Bolivia, Colombia, Ecuador, Mexico, Peru and Uruguay.

The study found that Latin American governments’ approach to drug use continues to be predominantly through the criminal justice system, not health institutions. Even in countries where consumption is not a crime, persistent criminalization of drug users is common. In all of the countries studied, CEDD found that drug users are criminally persecuted, even in countries where consumption is not a crime.

The study also finds that the penal response contributes to a climate of stigmatization and discrimination against users, which negatively affects their ability to be considered impartially by police and judicial system. This discrimination also prevents drug users who need medical attention from seeking assistance.

Finally, this way of addressing the issue through the criminal justice system violates several fundamental rights of users such as the right to health, information, personal autonomy, and self-determination, among others. All of these transgressions violate various national and international human rights standards that states arestates are obliged to protect.

In Search of Rights: Drug Users and State Responses in Latin America

Unlike most other counties, it has long been legal to possess an undefined “reasonable quantity” of any drug for personal consumption in Uruguay. However, production, transportation and sale remained illegal.This meant that illicit drug traffickers supplied the marijuana that was then legally possessed by Uruguayans, creating profit for organized crime.

On December 23, 2013, Uruguay became the first country in the world to fully legalize the production, sale and consumption of marijuana for personal use when President José Mujica signed law 19.172.

To improve public health and reduce the risks and harms associated with the use of marijuana.

To promote the dissemination of information, education, and prevention for the consumption and negative consequences of problematic drug use.

To protect the population from the risks associated with illegal drug trafficking, and specifically to “attack the devastating social, health, and economic consequences of psychoactive substance abuse,” thereby reducing illegal drug trafficking and organized crime.

Marijuana legalisation in Uruguay

The International AIDS Society (IAS) is the world’s leading independent association of HIV professionals Last year they celebrated twenty-five years of IAS commitment to overcoming HIV. In this quarter of a century the organization and the global response to the epidemic has gone a very long way by constantly evolving to best address the issues presented
by HI V and AIDS .

Nowadays thanks to antiretroviral treatments being HIV positive is no longer a death sentence in most countries. Globally, more and more people every year have access to these life-saving drugs. Also, science has recently delivered new prevention tools that have the potential to reverse the course of the epidemic.

Yet, more than three decades on from the discovery of the virus, too many people still do not have access to prevention and treatment and too many government policies continue to be based on discriminatory ideology rather than scientific evidence.

In 2013 the IAS went through an in-depth analysis aimed at understanding better in which areas the organization can make a stronger impact and how it can improve the way it carries out its activities. As a result, it was decided to focus on three key priorities in 2014: Key Affected Populations (KAPs) HIV Cure; and Paediatric HIV.

The IAS also decided to create a working group on co-infections that will in particular focus on hepatitis, tuberculosis and human papillomavirus. Finally, in June 2013, more than 5,000 participants gathered in Kuala Lumpur, Malaysia, to attend the 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013).

IAS Annual Report 2013

Drug courts arose in the 1980s as a laudable attempt to ameliorate the devastating effects of the nation’s misguided drug laws. Today there are more than 2,800 drug courts operating in the 50 states and U.S. Territories, up from 1 in 1989 and 665 in 2000. Half of all U.S. counties have at least one operating drug court.

Available evidence shows, however, that most drug courts are costly; are no more effective than voluntary treatment; do not demonstrate cost savings, reduced criminal justice involvement, or improved public safety; leave many participants worse off for trying; and often deny proven treatment modalities, such as methadone and buprenorphine.

Consequently, the Drug Policy Alliance supports eliminating criminal penalties for personal drug possession and use.

There may be a role for drug courts as well, but only if they undergo a change of course. Specifically, drug courts should not receive public funding unless they:

Target people arrested for more serious offenses who would otherwise face lengthy incarceration terms;

Eliminate jail sanctions for simple drug relapse;

Allow the use of opioid substitution treatments, such as methadone and buprenorphine, to treat opioid-using participants

Provide opioid-using participants with overdose prevention education, training and naloxone; and

Adopt pre-plea rather than post-plea or post-conviction procedures for participant eligibility.

Moving away from drug courts: Toward a health-centered approach to drug use

Approximately two-thirds of those deported in 2013 were guilty of minor, nonviolent offenses – including thousands deported for nothing more than possessing small quantities of drugs, typically marijuana.

Roughly 40,000 people have been deported for drug law violations every year since 2008. That means that nearly 250,000 – one-quarter of a million – people were deported for nonviolent drug offenses in just the past six years.

No one should be arrested, incarcerated or deported for merely using or possessing drugs – which necessarily entails two major drug law reforms:

Stop arresting and criminalizing people for using or possessing everything else.

The PDF below includes the publication in both English and Spanish.

The drug war and mass deportation

In 2012, Colorado and Washington State became the first two jurisdictions to legally regulate marijuana, followed by Uruguay becoming the first country to do so in 2013. This table provides a comparison of the main elements of each jurisdiction’s system.

A comparison of the world’s first three jurisdictions to legally regulate marijuana: Colorado, Washington and Uruguay

The Department of Veterans Affairs (VA) should remove barriers to ensure access to evidence-based drug dependency treatment and make overdose prevention programs available to veterans in the community, Human Rights Watch said in a report released today.

An estimated more than one million US veterans take prescription opioids for pain, and nearly half of them use the drugs chronically, yet drugs to treat dependence on pain medicines fail to reach tens of thousands of veterans in need.

The report compiles and analyzes findings from a wide range of sources about problems of drug dependency among veterans and the implications for treatment and assistance.

Human Rights Watch found that alcohol and drug dependence are strongly associated with homelessness as well as with mental health conditions – including post-traumatic stress syndrome and depression – that affect 40 percent of Iraq and Afghanistan veterans in VA care. Drugs or alcohol are involved in one of three Army suicides, and the VA estimates that 22 veterans commit suicide each day.

The report is based on interviews with dozens of veterans and their advocates, VA officials, and community service providers, as well as extensive review of government, academic, and other research. Human Rights Watch also reviewed and assessed the availability of a wide range of evidence-based programs – that is, programs that have been proven effective – to treat dependency and address veterans’ drug-related problems.

One of the report’s findings is the need to expand the availability of naloxone, an inexpensive prescription medication, used in emergency rooms for decades, that can reverse overdose from opioids such as heroin. Evidence-based drug dependency treatment programs also should be expanded.

No time to waste - Evidence-based treatment for drug dependence at the United States Veterans Administration

Most American high schools do not offer effective drug education, nor do they provide interventions to assist students struggling with abuse of alcohol and other drugs. Instead, they rely primarily on deterrent punishment for students who are caught violating the rules. Proponents of the “big four” consequences – exclusion from extracurricular activities, transfer to another school, suspension, and expulsion – believe that harsh consequences for those who are caught will
deter other students from committing similar offenses, and too often constitute the whole of prevention.

But research has shown that these punishments are not likely to change students’ behavior. Ironically, rather than serving as an effective deterrent, drug education that lacks credibility and is backed by punitive measures often fosters resentment and oppositional behavior.

Beyond Zero Tolerance is a comprehensive, cost-effective approach to secondary school drug education and school discipline that is all about helping teenagers by bolstering the student community and educational environment.

This innovative model combines honest, reality-based information with interactive learning, compassionate assistance, and restorative practices in lieu of exclusionary punishment.

A reality-based model incorporates three mutually reinforcing elements: education, intervention/assistance, and restorative consequences. The basic tenets are as follows:

Drug education should be honest,balanced, interactive, and delivered in a way that involves full participationof students.

Intervention for students who need assistance should be an integral part of drug education.

A restorative process, in which offenders identify harms they have caused and then make amends, should replace most suspensions and expulsions.

Beyond zero tolerance - A reality-based approach to drug education and school discipline

es the national surveys (ENA) that are the main policy instrument used to measure illegal drug consumption in Mexico.

On different occasions, the government has used increased drug consumption rates to partially justify the “War on Drugs.” The paper reviews the 2008 and 2011 surveys, and highlights the methodological and conceptual flaws of the national surveys, such as faults in the sample and methodology; definitions of the categories “use,” “abuse,” and “dependence”; and the relationship established between consumption and prevention.

It concludes that the ENAs are not clear regarding whether they want to measure consumption or dependence, and also unclear on their objective. The survey results do not allow precise measurement of the phenomenon of illegal drug consumption, which is of fundamental importance in creating and proposing effective public policies.

It is hoped that this analysis contributes to the formulation of more appropriate surveys in the future.

Click here to read the full article [restricted access].

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