Criminal justice and public health systems can work together to provide comprehensive HIV prevention and treatment inside and outside correctional facilities. Incarceration presents a window of opportunity for primary prevention, screening, treatment and establishing comprehensive, pro-active transitional linkages for persons approaching release and follow-up.

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What is the role of prisons and jails in HIV prevention? 

Why do people start injecting is a key question for harm reduction in Kenya and around the world. Injecting brings with it high risks of HIV, other viral infections, vein and skin damage and increased addiction. Many people start using heroin and other drugs by smoking, chasing or sniffing, and then gradually move on to start injecting. This briefing paper explains the reasons why people are attracted to inject drugs through a study case in Kenya.

Why do people start injecting? - Access to care study in Kenya

, highlights a shift toward multilateral support for hemispheric drug policy reform. This report by the Organization of American States (OAS) reviews failures of the U.S.-led prohibitionist “war on drugs” and urges states to reconsider orthodox “supply-side” strategies (including interdiction and drug crop eradication), and to focus more on demand-side policy experimentation. In Central America, a key zone of drug transit that is being ripped apart by narco-fueled violence and corruption, the push for reform signals hope that the conditions fueling drug traffickers' profits and corrosive political influence may eventually be dismantled.

Read here the full article (restricted access)

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Drug policy as conservation policy: Narco-deforestation

Concerns about the availability and use of methamphetamine in Europe have been growing for some time. Historically, the use of methamphetamine has been confined largely to the Czech Republic and Slovakia; however, recent signs of the spread of methamphetamine linked to different European countries have sparked further investigation of this topic. The methodology used is based on the triangulation of data collected using a number of investigative approaches and from multiple sources. The findings summarised in this paper include insights into the chemistry of methamphetamine and the history of its use in Europe since the 1930s. Signs of increased involvement of organised crime groups in methamphetamine markets and possible scaling-up of production are noted. In some countries, there is evidence to suggest that methamphetamine use is increasing, while new injection trends have been detected among small groups of gay men in large cities (London, Paris).

Worrying reports are emerging from south-east Europe that crystal methamphetamine smoking is a limited, but emerging, problem, with the possibility of spreading among vulnerable populations. Negative consequences for physical and mental health are associated with the use of methamphetamine, which may also involve high levels of sexual risk-taking. Evidence exists for effective health and social responses, based on cognitive behavioural and contingency management approaches. The study notes that the knowledge available in Europe on the use of methamphetamine and the associated problems remains incomplete, and highlights information and research gaps. The report concludes that, although methamphetamine use is not a major phenomenon in Europe, even at a relatively low prevalence, it is a drug that has the potential to cause significant harm.

Exploring methamphetamine trends in Europe

Antiretroviral therapy has transformed the global HIV response, but whether people living with HIV benefit from the life-saving and prevention benefits of treatment depends too often on where they live. Worldwide, HIV treatment coverage is lowest in the WHO Eastern Mediterranean Region and UNAIDS Middle East and North Africa Region (referred to in this report as the “Region”), and does not exceed 15% of the estimated people in need of treatment. The situation in the Region is critical and we are not keeping up with the global pace of treatment access – the rate of growth in treatment coverage is lower in the Region than it is globally and this disparity is increasing over time.

This needs to change. Not only do people living with HIV have the same rights to treatment as their peers in other parts of the world, but antiretroviral treatment prevents new infections. Even as the global community celebrates the decline in new infections worldwide, the Region is one of two in the world where new HIV infections are still on the rise.

The WHO and UNAIDS report outlines what needs to be done to close the gap and move towards universal access to treatment. We need to ensure that policies reflect recent advances in science emphasizing the
importance of earlier testing and treatment, particularly for key populations. Putting the Region on track to reach universal access will require intensified focus on the geographical settings and populations where both HIV prevalence and unmet needs for testing and treatment services are highest.

Accelerating HIV treatment in the WHO Eastern Mediterranean and UNAIDS Middle East and North Africa regions

More than 5.5 billion people (83% of the world’s population) in over 150 countries have low to non-existent access to morphine and other controlled medicines for pain relief, palliative care or opioid dependency.

Although access to morphine has increased exponentially over the last two decades, global inequalities in access to pain relief are stark. Ninety per cent of the global consumption of morphine, fentanyl and oxycodone registered in 2009 occurred in Australia, Canada, New Zealand, the United States and several European countries (See Map below). All these medicines are ‘scheduled’ and controlled under the UN 1961 Single Convention on Narcotic Drugs. Widespread lack of access in lower and middle-income countries (LMICs), however, underlines the serious limitations of the current regulatory regime.

Untreated pain in the lower and middle-income countries

In spite of a decades-long 'war on drugs', the global drug trade persists as a significant problem for international security given its scale, the number of deaths related to trafficking and consumption it creates, and the organized crime and corruption it fuels. The international drug control system has been ineffective in reducing the size of the market and in preventing the emergence of new drugs and drug routes that cause and shift instability around the world.

Current drug policies have been counter-productive, often causing more harm than the drugs themselves through capital punishment for offences, widespread incarceration, discrimination in law enforcement, violation of basic human rights in forced 'treatment' centres, and opportunity costs.

In the last three years, the drug policy debate has evolved more than in the previous three decades. There remain a number of political obstacles to making recent developments sustainable ahead of the UN General Assembly Special Session (UNGASS) on drugs in 2016, but these should not be used as excuses for continuing with a failed status quo.

Illicit drugs and international security: Towards UNGASS 2016

Long perceived as an offense or a deviant behaviour, drug addiction is now widely acknowledged as a medical condition. As such, access to appropriate treatment for those who suffer from addictive behaviour is no privilege, it is a right. The right to equitable access to health care services derives from the fundamental right to health which is enshrined in international law, and especially in the International Covenant on Economic, Social and Cultural Rights.

This policy paper provides a practical and widely applicable definition of risk and harm reduction.

Policy paper on preventing risks and reducing harm linked to the use of psychoactive substances

Almost two years have passed since the Center for Disease Control and Prevention found that the number of people who live with HIV has in-creased among injecting drug users (IDUs). In the meantime, a coordinated and effective response mechanism to deal with the phenomenon should have been introduced, although we are well aware that the effects of interventions in such epidemics are not easily visible right away. What happened and no satisfactory progress was made in the plans and strategies that were com-prehensively described in detailed reports and findings of competent bodies in Greece, as well as of experts from the European Union and the international community?

The current briefing paper aims to address this issue; it draws up a brief history of the course of a serious problem for public health and human rights, together with the efforts to tackle the problem; it cites the views of competent state bodies and institutions actively involved in offering services to injecting drug users; finally, it openly calls towards all directions, so as for slop-piness, exploitation of the phenomenon for petty political reasons and stigmatisation of people who live in difficult conditions, to stop. What is needed is thorough analysis of the facts, ac-countability, consultation, collaboration, short-, medium- and long-term objectives and frequent assessments.

The HIV epidemic among injecting drug users in Greece during the economic crisis

Britain is to criminalise the distribution and consumption of the chewable leaf khat – a mild stimulant imported from Kenya and Ethiopia. This follows the Home Secretary Teresa May’s decision in July 2013 to introduce legislation classifying khat as a class C drug, with possession resulting in a maximum two year prison sentence (or fine) and up to 14 years for supply related offences under the 1971 Misuse of Drugs Act.

The pending legislation will bring the UK into line with European and North American countries, and is being introduced on the basis that: a) use of khat among the Somali migrant community has detrimental impacts on health and family life; b) the UK has become an international distribution point for khat; c) khat use and the proceeds from the sale of khat contribute to criminal and terrorist activity.

Adverse consequences should be anticipated from the criminalisation of the shrub.

The UK khat ban: Likely adverse consequences

The much trumpeted closure in October 2013 of the Tor-accessible illicit market known as Silk Road and arrest of its founder Robert Ulbricht struck a blow to consumer trust in the market for illicit goods and specifically narcotic drugs that are hosted on the Tor network. However, this success for the US multi-agency task force (involving the Federal Bureau of Investigation, Drug Enforcement Administration, Department of Homeland Security, Internal Revenue Service, US Postal Inspection, Secret Service and Bureau of Alcohol, Tobacco, Firearms and Explosives) does not mark the end of black markets hosted on the Tor network, or the availability of drugs anonymously bought online. Rather it spurred innovations in online illicit trading, underlining the hydra headed nature of ‘successful’ interdiction effort.

Silk road and bitcoin

In 2010 the international HIV/AIDS community called on countries to take action to prevent HIV transmission among people who inject drugs (PWID). To set a baseline we proposed an “accountability matrix”, focusing upon six countries accounting for half of the global population of PWID: China, Malaysia, Russia, Ukraine, Vietnam and the USA. Two years on, we review progress.

Prevention of HIV infection and access to HIV treatment for PWID is possible. Whether countries with concentrated epidemics among PWID will meet goals of achieving universal access and eliminating new HIV infections remains unknown. As long as law enforcement responses counter public health responses, health-seeking behaviour and health service delivery will be limited.

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