Funding for HIV-related harm reduction programmes globally is in crisis. There can be no ‘AIDS free generation’ without targeted efforts with and for people who inject drugs. Yet funding for harm reduction falls dangerously short of estimated need. While this has been the case for some time, the situation looks set to deteriorate with changing donor policies and national government neglect.

This failure to invest will bring an exponential rise in HIV transmission which in turn will cause additional costs to government health sectors.

This report investigates international donor commitments, both multilateral and bilateral, as well as national investments in harm reduction. It calls on international donors, national governments and UN agencies to take concrete actions to address the funding crisis.

Watch this video presenting the main findings of the report at the International AIDS Conference, July 2014:

Read this infographic for key data on harm reduction across the world:

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The funding crisis for harm reduction

‘Residential treatment’ comprises the provision of a range of treatment delivery models or programmes of therapeutic (and other) activities for drug users, within the context of residential accommodation, in either the community or a hospital setting. The main therapeutic approaches used include the 12-step/Minnesota model, therapeutic community and cognitive–behavioural (or other) therapy-based interventions.

Today, in most European countries, residential treatment programmes form an important element of the range of treatment and rehabilitation options for drug users. Countries differ, however, in the level of residential treatment provision.

Latest estimates suggest that, while almost three-quarters of a million problem opioid users are receiving opioid substitution treatment in Europe, at least a quarter of a million drug users are receiving other forms of treatment, including a range of approaches in residential settings.

Most people receiving specialist treatment for drug problems may not need to access residential treatment. Their needs can be met appropriately by community drug treatment services, which have increased in availability and effectiveness over the past decade.However, outpatient treatment and rehabilitation may not always be the most appropriate option, particularly for a select group of drug-dependent clients who need the safety and structure that residential treatment can provide. Hence, residential drug treatment is a sizeable and necessary element in the range of treatment options available to drug users.

While measuring and improving drug treatment provision and outcome in opioid substitution treatment have been high on the research agenda in recent years, the extent and nature of residential treatment has received less research attention.

The aim of this publication is to provide a Europe-wide overview of the history and availability of residential drug treatment within wider national drug treatment systems. To facilitate this, this paper develops a categorisation of the broad range of available models applied in residential settings.

Finally, it describes the characteristics of residential treatment clients, as well as presenting and discussing key features of the organisational issues around this type of treatment.

Residential treatment for drug use in Europe

Since the early years of the AIDS epidemic, people living with HIV/AIDS and their allies have organized their communities and met with drug companies, researchers, and government regulators to influence clinical trials design, policy, drug pricing, and access to treatment.

The HIV World Community Advisory Board—formed by the International Treatment Preparedness Coalition—has held national, regional, and global meetings with originator and generic pharmaceutical companies since 2004. It played an instrumental role in the availability of affordable generic drugs, enabling the global scale-up of HIV treatment in developing countries.

The hepatitis C virus (HCV) World Community Advisory Board (CAB) grew from an international AIDS activist movement. The objectives of the meeting were threefold:

To provide a forum for leading activists to learn about developments in HCV treatment and access barriers;

To meet with pharmaceutical companies about their plans for low- and middle-income countries (LMICs).

The HCV World CAB included a broad range of activists, including people with HCV, people who inject drugs, people living with HIV/AIDS, representatives from nongovernmental organizations and regional and global advocacy networks, and clinicians and researchers.

The 1st HCV World CAB met in Bangkok in February 2014. During the meeting, 38 activists from 22 countries held the first global LMIC-focused dialogue with pharmaceutical companies that produce HCV treatment. The meeting was co-organized by Treatment Action Group and the Asia Pacific Network of People Living with HIV/AIDS. The HCV World CAB was supported by AIDS Fonds, the Global Network of People Living with HIV, Médecins du Monde, Open Society Foundations, and the World Health Organization.

Participants spent the initial two days conducting peer-led trainings on:

Clinical developments in HCV treatment and diagnostics;

Intellectual property (IP) barriers to access to essential medicines;

Structural barriers to access in LMICs; and

Issues facing key affected populations, in particular PWID and men who have sex with men (MSM).

1st Hepatitis C Virus World Community Advisory Board report

“Our mission is to build a better world. To leave no one behind. To stand for the poorest and the most vulnerable in the name of global peace and social justice.”

The AIDS epidemic can be ended in every region, every country, in every location, in every population and every community. There are multiple reasons why there is hope and conviction about this goal:

One step closer to elimating new HIV infections among children

More people living with HIV knoz their status and are receiving HIV treatment

The AIDS epidemic brought the world to its knees before bringing people to their feet. Activism and research led to one of the most effective global movements of this generation. Global commitment and clear goals paved the way for countries at the start of the AIDS response. Then resources, innovation and communities accelerated its progress. So much so that today we can say these words with confidence: ending the AIDS epidemic is possible.

There will be no ending AIDS without putting people first, without ensuring that people living with and affected by the epidemic are part of a new movement. Without a people-centred approach, we will not go far in the post-2015 era.

How do we close the gap between the people moving forward and the people being left behind?

This was the question we set out to answer in the UNAIDS Gap report. Similar to the Global report, the goal of the Gap report is to provide the best possible data, but, in addition, to give information and analysis on the people being left behind.

UNAIDS: The gap report

Latin America is now at the vanguard of international efforts to promote drug policy reform: Bolivia has rewritten its constitution to recognize the right to use the coca leaf for traditional and legal purposes, Uruguay has become the first nation in the world to adopt a legal, regulated Cannabis market, and Colombia, Mexico, Guatemala, and Ecuador are openly critiquing the prevailing international drug control paradigm at the UN. And now with the United States itself relaxing its marijuana laws state by state, the U.S. prohibitionist drug war strategies are losing credibility in the region.

The process is aided by the steady hemispheric erosion of prohibitions against cannabis. As the recognition of both the benefits and the relative lack of harm of cannabis grows, the anti-prohibition community hopes that the moves towards decriminalization will crack open a space for more discussion on international legalization of the Andes’ miraculous herb, the coca leaf. Shifts are being felt in the international framework as well, even if the steps to modify UN conventions are often faltering.

Even as debate widens, consumption and supply patterns are shifting profoundly. Latin America no longer mostly exports drugs; it consumes them too. Not only does problematic drug use now plague parts of Latin America, but the growth of the region’s middle class has fueled an explosion in cannabis consumption. The locus of drugs production in the region has shifted as well. Colombia’s pivotal role has lessened as Peru has become the world’s largest cocaine producer.

In the United States and Canada, which historically have primarily been consumers, domestic production has grown exponentially. Not only is much marijuana grown locally, but in the United States in particular, the scourge of methamphetamines in rural areas has been fueled by local, not foreign, labs. Another switch has happened in regards to gender, as increasing numbers of poor women have become caught up in small-scale trafficking.

Both the promise of change and the continued price that drugs exact are explored in this NACLA Report. The overarching framework presented by the authors here seeks to understand how to manage the harms caused by drugs in a way that minimizes what can be horrendously negative societal and personal impacts—and how to fundamentally uproot the prohibitive, militarized drug-control approach that remains entrenched in the region. But like every other seemingly intractable issue, much problematic drug use and sales are but a symptom of deeper troubles. Until more hope and opportunity emerge than what enduring neoliberalism has put on offer, vulnerable and marginalized people and their families will continue to pay the highest price for the harms that drugs and the prohibition against them bring.

Click here to read the full report [limited access].

Reimagining drug policy in the America 

It is widely acknowledged among European Union policymakers that there is a demand to improve the range and quality of health and social care services for prisoner populations and, most notably, for marginalized and at-risk groups vulnerable to drug-related harms. This includes reducing the high rates of overdose among those who use opioids.

People who inject opioid drugs are at particular risk of overdose following release from prison. However, overdose related deaths are preventable, and continued efforts are needed to improve continuity of care for prisoners, while systematically implementing recommended approaches that are shown to reduce drug-related deaths. This should comprise opioid substitution treatment and overdose prevention programmes which incorporate naloxone distribution as a routine intervention at the point of release from prison for people who inject drugs.

Progress has been made in some European countries, although significant gaps between prison and community-based services still exist, in terms of both coverage and quality of health services available to prisoners. Over the last decade, prison healthcare has increasingly been recognized as part of public healthcare, and changes have been made as to who takes responsibility for this, alongside specific drug and health strategies or regulations for the prison setting. While European Prison Rules specify that prisoners should be offered a medical examination as close as possible to the time of release, this type of routine ‘exit’ health examination does not seem to be common in Europe.

This report concentrates on the mapping of existing overdose prevention and management programmes for released prisoners qnd involves the following five European Union (EU) countries: Estonia, Hungary, Lithuania, Poland and Romania.

identification of existing programmes and services available upon release from prison;

opportunities for the introduction of overdose prevention and/or naloxone programmes.

Overdose prevention services upon release from prison - Estonia, Lithuania, Hungary, Poland and Romania

People who inject opioid drugs are at particular risk of overdose following release from prison. However, overdose-related deaths are preventable, and continued efforts are needed to improve continuity of care for prisoners, while systematically implementing recommended approaches that are shown to reduce drug-related deaths.

There is a strong argument to suggest that any successful approach to improving prison health in the future must recognize the importance of including harm reduction and drug treatment services which are integrated with mental healthcare and other relevant services. This requires a significant scale-up of services within prisons, a functioning throughcare mechanism and substantial efforts to improve this liaison and continuity of treatment.

A number of interventions targeting opioid users have been recommended to reduce the risk of a fatal overdose in the period shortly after release from prison. They include prerelease counselling on overdose risks and prevention, along with training in first aid and overdose management – again optimizing referral to maintain solid links between prisons and community-based services.

This ‘Fact Sheet’ reports on good practice models in four European Union (EU) countries – Scotland, Denmark, Italy and Spain (more specifically, the Catalonia region) – on overdose prevention and management programmes upon release from prison. The main findings are concluded with recommendations made regarding their relevance to the five target countries of the project: Estonia, Hungary, Lithuania, Poland and Romania.

Information gathered includes programme descriptions; evidence of effectiveness; functioning; and involvement of people who use drugs. The methodology for collection and documentation of good practices is based on reports and guidance from leading organizations in the field such as the World Health Organization, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) etc. This fact sheet is of particular relevance to prison staff, health care professionals and people who use drugs.

Overdose prevention services upon release from prison - Best practice from Scotland, Denmark, Italy and Spain

Established in 1986, The Sentencing Project works for a fair and effective U.S. criminal justice system by promoting reforms in sentencing policy, addressing unjust racial disparities and practices, and advocating for alternatives to incarceration.

In this report we will address racial disparities in the criminal justice system, juvenile life without parole, the death penalty and its racial implications, and finally, felony disenfranchisement. All of these issues fall under the purview of Article 5 of the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD).

The United States emphasizes in paragraph 17 of its report that “[r]acial discrimination by the government is prohibited at all levels.” Through its laws and policies, the government suggests strides have been made in securing the government’s compliance with the ICERD.

While there has been change in U.S. laws and policies to address racial discrimination, disparities in the justice system remain profound with disturbing consequences for participation in society.

Here are the following suggested recommandations:

Given the injustices and unfairness produced by mandatory sentencing policies, the government should strive to see such policies either repealed or substantially scaled back in scope. In addition, policies such as the Fair Sentencing Act which have corrected injustices in the system should be applied retroactively to persons convicted of relevant sentences prior to adoption of the legislation.

As a result of the 2012 U.S. Supreme Court ruling in Miller v. Alabama persons under the age of 18 may no longer be sentenced to life without parole without judicial consideration of less punitive options. As the states come into compliance with this ruling they should establish a minimum term before parole consideration of no longer than 15 years in prison, based on young people’s capacity to change and to take advantage of rehabilitation opportunities in prison.

Shadow report on racial disparities in the US criminal justice system

For more information on the Guidelines, please read our latest blog!

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.

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.

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