The global spread of harm reduction services is stalling, a continuation of a trend first observed in 20121.

Women are estimated to account for one third people who use drugs globally yet are consistently reported to have less access to harm reduction services and to be at higher risk of HIV and hepatitis C infection. Tools do exist to enable harm reduction services to increase their relevance and reach for women who use drugs (WUD). These include use of a gender lens and gender mainstreaming in planning and service delivery. Services that have introduced such approaches are thin on the ground and where these do exist, it is often difficult or not possible to document and promote the outcome. As a result, robust data on this subject is scarce. In addition, research on drug use and related health issues rarely produces information about women and harm reduction.

In this context, to leverage greater accountability from governments that have endorsed UN guidelines and resolutions around the provision of services for WUD, it is important to document and promote such services where they do exist. By documenting successful harm reduction services for women, models can be incorporated, replicated, resourced and established.

With this in mind, the Women and Harm Reduction International Network (WHRIN) undertook surveys and desk research to map women friendly harm reduction services around the world. This report provides a summary of regional findings as well as common global trends. Also included is a ‘living’ listing by Regions of services with a brief description and links for more detail where available.

WHRIN invite readers to add to this list - where exiting services are not listed, details of services are incomplete or are incorrect.

Global mapping of harm reduction services for women who use drugs

The report ‘Time to End Prohibition’ marks the 10th anniversary of the Global Commission on Drugs.

Ten years after the establishment of the Global Commission, the taboo on drugs has been well and truly broken. In the last decade, there were impressive reforms around the world at national and sub-national levels. More and more countries are decriminalizing drug use, adopting innovative approaches based on public health, and legalizing formerly banned substances.

Recognition is growing that prohibition has failed to achieve its goals while having a detrimental impact on our societies. At the same time, the international drug control regime, created sixty years ago and built around the idea of a ‘drug-free world’, remains in place.

In this report, the Global Commission urges global leaders to review the international drug control conventions in order to build a serious, modern and responsible drug control framework based on science and evidence and centered on human rights. It also calls for a more prominent role of the World Health Organization in the scheduling of substances and in ensuring access to controlled essential medicines.

Time to end prohibition

By Colleen Daniels, Aggrey Aluso, Naomi Burke‑Shyne, Kojo Koram, Suchitra Rajagopalan, Imani Robinson, Shaun Shelly, Sam Shirley‑Beavan and Tripti Tandon

This paper reviews evidence of how drug control has been used to uphold colonial power structures in select countries. It demonstrates the racist and xenophobic impact of drug control policy and proposes a path to move beyond oppressive systems and structures. The ‘colonization of drug control’ refers to the use of drug control by states in Europe and America to advance and sustain the systematic exploitation of people, land and resources and the racialized hierarchies, which were established under colonial control and continue to dominate today. Globally, Black, Brown and Indigenous peoples are disproportionately targeted for drug law enforcement and face discrimination across the criminal system. These communities face higher arrest, prosecution and incarceration rates for drug offenses than other communities, such as majority populations, despite similar rates of drug use and selling among (and between) different races. Current drug policies have contributed to an increase in drug‑related deaths, overdoses and sustained transnational criminal enterprises at the expense of the lives of people who use drugs, their families and greater society. This review provides further evidence of the need to reform the current system. It outlines a three‑pillared approach to rebuilding drug policy in a way that supports health, dignity and human rights, consisting of: (1) the decriminalization of drugs and their use; (2) an end to the mass incarceration of people who use drugs; (3) the redirection of funding away from ineffective and punitive drug control and toward health and social programs.

Decolonizing drug policy

By Alissa Greer, Marion Selfridge, Tara Marie Watson, Scott Macdonald, Bernie Pauly

Many young people who use drugs are structurally vulnerable to policing powers given the ongoing criminalization of drug possession. Police authority limits and the expression of that authority may play a significant role in police encounters among young people who use drugs. This qualitative study explores the views of young people who use drugs toward police power and authority in their recent encounters with police officers. Interviews were conducted with 38 young people who recently used illegal drugs in British Columbia, Canada. We found five interrelated themes related to perceptions of police authority: (1) skepticism and distrust toward authority; (2) paternalism and authority over drug use; (3) officer use of force; (4) police as power-hungry; and (5) officers above the law. Participants described police authority as limitless, unpredictable, untethered, easily abused, and lacking accountability. Participants feared holding police officers accountable to power abuses in a criminal justice system that they saw as stacked against them. Moving forward, institutional reforms may consider and account for the expression, limits, and use of police authority among young people who use drugs and other structurally vulnerable communities.

Young people who use drugs views toward the power and authority of police officers in British Columbia, Canada

A person’s health is multifaceted and interconnected. In order for any service to genuinely empower people to improve their health, it needs to recognise the various factors that contribute to it. Integrating health and social services enables these services to be responsive to the needs of their clients.

Where health and social services are disparate and disconnected, they can only address particular symptoms or conditions of a person’s health. On the other hand, integrated services are capable of addressing a person’s health in a broader context.
This ‘biosocial’ approach to health acknowledges that different health and social issues are interconnected and need to be addressed holistically. This can range from biomedical knowledge about the interaction between certain medications, to acknowledging the impacts of discrimination, marginalisation and criminalisation on a person’s ability to access good health. A failure to recognise any one factor in a person’s health can dramatically impact the ability to address other areas.

For harm reduction, this means moving beyond the narrow frame of preventing and treating infections and overdoses through biomedical and biobehavioural interventions.

The services profiled in this report show real world examples which have had excellent results. In some cases, this simply means making it easier for people to access the health services they need by providing them all in one place. In others, it means broadening what we mean by harm, and recognising the full range of what harm reduction can be. They are person centred services: organised around the person as an autonomous whole, not reducible to their drug use or specific medical conditions, but with intersecting needs linked to their personal social determinants of health.

Community leadership has always been central to harm reduction. It is the only way to provide the appropriate range of services in the appropriate way. It is also essential to consider those whose needs are commonly unmet. People who use but do not inject drugs, as well as people who use stimulants, are largely left out of a framing of harm reduction centred on injecting opioid use. Women, people of colour and Indigenous people are poorly served by services created with white men in mind. People from sexual minorities experience stigma and a lack of understanding in services not used to their practices and needs.

Integrated and person centred harm reduction services

We can end AIDS by 2030. Some countries are making remarkable progress, showing us what is possible. But globally, we are simply not bending the curves fast enough to stop the AIDS pandemic.

In this report the Joint United Nations Programme on HIV/AIDS (UNAIDS) issues a stark warning. The red light is flashing. Progress against AIDS, which was already off track, is now under even greater strain as the COVID-19 crisis continues to rage, disrupting HIV prevention and treatment services, schooling, violence-prevention programmes and more.

Analysis in this report shows that millions of lives will be lost from AIDS-related causes if we carry on as we are—if we do not rapidly expand coverage to stop new infections and deaths and bring the pandemic to end.

And make no mistake: AIDS remains a pandemic. To stop it we urgently need a bolder view of pandemic response that is capable of tackling the inequalities prolonging the AIDS pandemic. Many of these missing pieces to fight HIV are also allowing the COVID-19 pandemic to continue and leaving us dangerously unprepared for pandemics of the future.

Leaders took a major step forward this year at the United Nations General Assembly when they agreed to a bold plan to tackle those inequalities. Making that plan a reality depends now on determined and rapid follow-through.

By acting boldly together, leaders are bringing together cutting-edge science, services that meet people’s needs, the protection of human rights, and sustained financing. These actions are making AIDS-related deaths and new HIV infections rare. But this is only the case in some places and for some people.

World leaders must work together urgently to tackle these challenges head-on. We have a very clear sense of the right direction. But right now, in too many cases, we are not heading in it fast enough. Some are even heading in the wrong direction.
Through fighting the AIDS pandemic, we have learned a lot about what is needed to successfully confront AIDS and all pandemics. The world must not choose between ending the AIDS pandemic that is raging today and preparing for the pandemics of tomorrow. The only successful approach will achieve both. As of today, we are not on track to achieve either.

The good news is that inequality-busting approaches have been proven to work, even in the most challenging contexts. Now they need to be rapidly applied at scale everywhere.

Unequal, unprepared, under threat: why bold action against inequalities is needed to end AIDS, stop COVID-19 and prepare for future pandemics

Synthetic drugs present a unique challenge to the international drug control aim to preserve the health of the global community. Unlike the production of plant-derived drugs such as cocaine and heroin, which is geographically constrained, synthetic drug manufacture can occur anywhere depending on human creativity and a few key chemicals. This versatility makes the manufacture of synthetic drugs extremely mobile and any country can be a potential source. Yet this is not a totally new phenomenon. For over a century, international drug control has had to contend with waves of emergence of synthetic drugs: derivatives of morphine in the 1920s, fentanyl analogues in the 1980s and amphetamine-type stimulants in the 1990s. The 2010s marked a defining period for synthetic drugs with the unprecedented emergence of hundreds of substances which mimic the effects of drugs hazardous to human health and therefore under international control. Known as ‘new psychoactive substances’ (NPS), by December 2020 over 1,000 of these had been reported in 120 countries and territories worldwide. For unprepared societies, the effects of these cyclical surges in synthetic drugs have had severe consequences, but none has been as distressing as the ongoing synthetic opioids crisis affecting mainly North America with fentanyl and its analogues, and parts of Africa, Asia, and the Middle East with tramadol.

The dynamic nature of synthetic drug markets has by necessity required equally adaptable solutions and continuous refinements of strategies. The establishment of the Global SMART Programme in 2009 as a strategic response to the amphetamine-type stimulants problem identified in the 2009 Political Declaration and Plan of Action; the development of the first global forensic Early Warning Advisory on New Psychoactive Substances to operationalize the 2016 UN General Assembly Special Session ideal of prioritizing the most harmful, persistent and prevalent substances for international action; and the establishment of the UNODC Opioid Strategy in 2018 to support countries in addressing the synthetic opioids crisis are all clear examples of the nimbleness with which UNODC has responded to the ever-changing and complex synthetic drugs market.

Launched on World Drug Day in June 2018, the fivepillar UNODC Opioid Strategy integrates through strong inter-agency cooperation the unique expertise housed within the Office with complementary specialized knowledge across the United Nations system. Its operational theme of Predict, Protect and Prevent leverages a robust scientific culture to generate the evidence-base for multilateral decision-making, such as the international scheduling of substances, through use of the best available scientific data and timely early warning analyses. Several science-driven multilateral actions over the past few years related to some of the most harmful substances ever known to humankind, including several fentanyl-analogues, illustrate some of the many successes of the Strategy. Within the framework of the Opioid Strategy, UNODC continues to deploy its vast law-enforcement programming assets to offer a coordinated response to air, land and sea container and parcel trafficking in priority regions and countries as well as the online sale of these harmful substances.

UNODC Synthetic Drug Strategy 

Produced in the context of the Partnership to Inspire Transform and Connect the HIV response (PITCH)

This paper highlights specific and inspiring examples of positive shifts in policy, programme and service delivery as well as rights protections for people living with and at greatest risk of HIV, in response to the COVID-19 pandemic. It draws on powerful examples from the Partnership to Inspire Transform and Connect the HIV response (PITCH) – a strategic partnership between Aidsfonds, Frontline AIDS and the Dutch Ministry of Foreign Affairs that ran between 2016 and 2020. PITCH enabled people most affected by HIV to gain full and equal access to HIV and sexual and reproductive health and rights services.

Chapter 1: People who use drugs: the response from harm reduction services

Chapter 2: Men who have sex with men in their diversity

Chapter 5: Adolescent girls and young women

Chapter 6: Intersections across marginalised populations

Conclusion: Learning from the COVID-19 experience can transform HIV community-led responses and feed into future pandemic planning

Accelerating community-led HIV responses: Adapting positive practice beyond the COVID-19 crisis

Human rights violations against people who use drugs, committed in the context of enforcing the failed 'war on drugs', have been widely documented by the community and civil society. These include but are not limited to:

Extrajudicial killings & capital punishment for drug offenses

Torture and other cruel, inhuman or degrading treatment

Discrimination in schools, employers and healthcare settings

Loss of access to justice & defendant's rights

A growing number of United Nations experts, agencies and even some member states have acknowledged these harms, with consensus often beginning with reports and resolutions from UN human rights mechanisms. Engagement with the mechanisms, however, can be highly specialised and time-consuming, requiring knowledge of legal norms, bureaucracies, procedures and even personal connections. For national, regional and global networks of people who use drugs, the question is how can we effectively bring our expertise and lived experience to advocacy within UN human rights mechanisms given our limited resources?

To explore this and related questions, INPUD has published this report to introduce the different human rights mechanisms and processes and how they have weighed in on human rights issues relevant to people who use drugs. The mechanisms discussed include:

UN Human Rights Council: Universal Periodic Reviews (UPR) and Special Procedures

This report was written for INPUD and all other networks of people who use drugs interested in increasing or beginning their engagement with UN human rights advocacy, particularly in the 10 countries supported through the Love Alliance project. It begins with an overview of the UN Human Rights Council and relaed bodies and procedures, as well as some critiques of the human rights system, and a brief history of the recent engagement of drug policy activists with the system. It then turns to consider each mechanism involved, and some resources available to support INPUD and its members in future engagement. Recommendations are included in each section and summarised at the end. The annexes include additional resources.

Overall, networks of people who use drugs have a specific and important opportunity to use the "show in Geneva" to catalyse meaningful change at national levels, and to ensure that 'nothing about us without us' is applied to human rights mechanisms.

INPUD would like to thank Sara (Meg) Davis for writing this report, with guidance and input from Judy Chang, Jake Agliata and Gayane Arustamyan. The report also benefited greatly from the insights of: Inez Feria, Ann Fordham, Bishnu Fueal-Sharma, Giada Girelli, Svitlana Moroz, Johann Nadela, Anya Sarang, and Rebecca Schleifer.

The fight for accountability: Opportunities to engage in human rights advocacy for INPUD

Perhaps it is unsurprising that the most marginalised women experience the sharpest end of discrimination against women, but we at AKSI Keadilan and the Women and Harm Reduction International Network, the authors of the report, are surprised. We are surprised that more attention is not therefore paid to intersectionality including drug use status and associated structural drivers of gendered discrimination.

The report brings focus on institutionalized discrimination and violations of the rights of women who use drugs including GBV, access to health, parental custody rights, sexual and reproductive health rights and the violence of law enforcement – including disproportionate sentencing, extortion and incarceration.

Urgent steps must be taken to address the risks of violence faced by women who use drugs. Systemic barriers to human rights must be removed and access to essential health services and safety vastly improved.

The situation of women who use drugs in indonesia - CEDAW shadow report

“CHECK” is a magazine for people who use drugs, experts and advocates working in the EECA region, and those who want to learn more about the drug policy and harm reduction in the region. It is published by the Eurasian Harm Reduction Association (EHRA) and the Eurasian Network of People Who Use Drugs (ENPUD).

The first issue of the magazine “Check” is dedicated to exploring the topic of new psychoactive substances, existing responses to the emergence of these substances and thoughts of peers from the EECA region.

CHECK the first issue of the magazine here ↓↓↓

CHECK - First issue - (IL)legal highs

You can help challenge wrongs, advance rights, and transform lives.

In countries of the Eastern Europe and Central Asia (EECA) region, people who use drugs are routinely denied basic healthcare and harm reduction services. They are unfairly targeted by police and subjected to torture. Parents face losing custody of their children. There are currently more than a million people living with HIV in the region — and without access to harm reduction services, the number of cases linked to injection drug use continues to grow. This is the reality we are working to change.

The HIV Legal Network has challenged injustice in the EECA since 2003, using scientific evidence and legal advocacy to defend rights and advocate for policies that will help us overcome the HIV epidemic. From our early efforts to implement harm reduction in EECA prisons to our more recent work on removing legal barriers to medical and social support for people most at risk of HIV, we have always centred human rights for all.

People who use drugs need support to prevent their human rights from being stripped away — and alongside our EECA partners, the HIV Legal Network is at the forefront of this work.

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