Wrestling with Giants Effects of US Influence on Global Policy on Illicit Drugs

1. Wrestling with Giants Effects of US Influence on Global Policy on Illicit Drugs NPHP Conference May 26, 2005 Istanbul Daniel Wolfe, IHRD Photo: Hans Jürgen Burkard

2. Illicit Drug Policies and the Global HIV Epidemic: Illicit Drug Policies and the Global HIV Epidemic: Effects of US Approaches “Democracy under President Bush is not self-correcting” (Aryeh Neier) • Also true that US increasingly wants to make its approach the global standard • Ban on federal funding of NEP • “Gag” rule on abortion • Prostitution pledge for foreign • HOWEVER, these things not fixed or resolved: • States in US have needle exchange; • methadone supported by US government • UN and foreign development grants particular focus of tension—can programs outside country do what we do inside?

3. IDUs as percentage of all registered HIV cases, 2002 Population in these countries alone is 20% of world total.

4. Case Study: UN Commission on Narcotic Drugs • Internal tension between public health and criminal enforcement • UNAIDS/WHO v. Commission on Narcotic Drugs historically and aggressively critical of HR • UNODC uncomfortably in between • This year, special focus at Commission on Narcotic Drugs on HIV prevention, and UNODC head of UNAIDS • Also year that some Americans increases opposition to harm reduction • Asst. Secretary Bobby Charles and UNODC director Mr. Costa • UNODC staffer warns regional office • Congressional hearings against harm reduction • In some cases, emails demanded and leaked to the press • Mr. Walters, US drug czar, to address CND

5. What did we do? • Community sign on letter—56 countries • Editorials: New York Times and Wash. Post • Opinion pieces for International Herald Tribune (Neier), Guardian, etc. • Outreach to “friendly” governments • Coalition of human rights, HIV, and harm reduction groups to CND in Vienna • Daily reports on what US said and did

6. What did we get? • No explicit attack on NEPs • 17 countries, including EU, Sweden (associating itself with EU), China, Morocco, Iran speak in support of HR or NEP • US supports substitution treatment publicly and strongly • HOWEVER, US systematically removes all references to NEP and human rights of drug users from CND resolutions

7. Battle Still Ongoing • US didn’t criticize NEP directly, but forces its removal from all CND resolutions • UNAIDS Prevention Coordinating Board (PCB) to meet in end of June • Countries increasingly aware that US virtually alone

8. How we move forward • Work together to know details of policy, rather than acting on fear • USAID unapologetic • Lithuanian critics of • Know your instruments • UNGASS declaration • UNODC/UNAIDS/WHO position paper on ST • UN MDG—Recs of HIV/AIDS Task Force • See what other donors/countries can support—DfID, Global Fund, etc. • Keep talking—united we stand, divided we fall

9. Policy Responses: Frameworks for Addressing HIV and Drug Use Human Rights Law Enforcement Security Public Health Development Druguser, like drug, to be controlled or contained (drug control) Focus on risk reduction than on legal status of drug use (HIV and HCV control)

10. Photo: Dan Bigg

11. “Stopping harmful culture and social evils are the responsibility of the whole society”

12. Photo: Hans Jürgen Burkard

13. Thank you for your consideration

14. “A drug-free world— We can do it!” (Pino Arlacchi, Director, UNODCCP, 1998 UNGASS) ”The total and immediate elimination of drug injecting is… unlikely to be an achievable goal.” (WHO, Principles for Preventing HIV Infection among Drug Users, 1997) Harmony on Basic Framework? Drug Control vs. Public Health

15. “The term use or consumption should only be applied when it refers to the use or consumption of drugs for medical or scientific purposes…Drug abusers are … neither consumers nor users.” (INCB Annual Report, 2001) “It is crucial to implement HIV preventive activities on the basis of the peer support principle, involvingpeople from the drug using community.” (UNODC, Lessons Learned, 2001) Harmony on Representation of Drug Users? Drug Control vs. Public Health

16. “UNDCP has yet to adopt an official position on harm reduction.” (UNDCP Legal Affairs, 2002) “The United Nations fully endorses the fundamental principles of harm reduction….” (Catherine Hankins, Associate Director, UNAIDS, 2002) ` Harm Reduction Harmony? Drug Control vs. Public Health

17. Strategic Fiction #1: Old UN tensions resolved in favor of cooperation • System-wide harmonization--position paper on prevention of HIV among drug abusers (endorsed by UN High-Level Committee on Programmes) and CND resolution 45/1 • UNGASS Declaration of Commitment on HIV, UN theme groups • UNODC now funds needle exchange, chair of UNAIDS, supports substitution treatment (position paper released last month) But • UN has yet to work with bilateral donors or national govts. to bring single HR program to national scale • Methadone remains Schedule I drug • UN still routinely cited as reason why drug users offered only forced abstinence, prison, or worse • Headlines at height of Thai drug war: UN supports • Russia: “Total prohibition of illicit drug use is not our own initiative…but rather a responsibility to implement the UN Drug Conventions” (Interior Minister Boris Gryzlov 2002) • Ukraine blocks plans this week for pilot methadone saying UNODC chief Costa advised against it

18. Strategic Fiction #2: HR turning the corner even in countries famous for harsh policies • Growing numbers of NSPs in Russia, pilot methadone programs in China, HR in Vietnam, anti-stigma efforts and conferences like this one But In five countries with injection-driven mega epidemic, virtually none support NSPs with national funds None have national substitution treatment, and pilot programs are often asked to show what has been proven many places in the globe already All require registration of drug users with authorities All have war on drugs or social evils campaigns All have forced incarceration or institutionalization for very small amounts of drugs Often include forced testing (without treatment) for HIV “Treatment” often impose punitive penalties for relapse

19. Imprisonment and Institutionalization • Russia: any heroin possession large/extra large (1996-2003) • Prisons and pre-trial detention centers so crowded that inmates faint from lack of air by 2000 • Even after amnesties and legal changes, 20% of prisoners drug offenders, and 40% of women prisoners • TV program, Coma, offers weekly “education” • China: “People’s war on drugs” • More than 230,000 drug users arrested in 1998 alone • Suspicion of drug use alone sufficient for placement in compulsory detoxification • “Treatment” includes work without pay making goods for tourists • Vietnam: Social Evils Campaigns, with arrests and roundups to 05/06 camps • more than 2/3 of all tried on drug charges receive terms of 7 to 20 years in 2002 • More than 25,000 users rounded up since late 2001 • “Rehabilitation” (some call forced labor) extended to five years

20. Institutionalization or Incarceration= Engine of HIV Infection “Mixing Bowl” Effect (Beyrer, Johns Hopkins): • bring uninfected and infected together • Force them to remain in places where risk continues but means of protection unavailable • Release them into situation where relapse penalized heavily and drug users stigmatized (e.g, registration) • In effect, penalty for minor drug use becomes HIV infection, and often, death

21. Less fiction, more Action: UN Level • Reschedule methadone and add it to WHO’s essential drugs list—status as most controlled substance dates from 1961, and inappropriate for realities of HIV/AIDS epidemic • Criticize overcriminalization of drug users, recognizing that punitive efforts work against HIV prevention efforts • Create memorandum of understanding for signature by countries implementing successful harm reduction measures • Summarize key legal opinions and precedents • End dynamic where countries singled out by INCB have to respond to criticism alone

22. Less fiction, more action: national level • Stop incarceration and institutionalization for small amounts of drugs • Attend to treatment effectiveness as carefully as INCB does to drug control efforts • What is “treatment”—what standards do we apply? • Set targets for scale-up to avoid perpetual pilot program status • Ensure that HIV treatment and drug treatment integrated

23. Incremental change important, but so is increased urgency • Number of countries reporting HIV among IDUs more than doubled in last decade, from 52 in 1992, 114 in 2002 (Strathdee and Poundstone, 2002) • Outside of Africa, estimated 1 of every 3 new infections now comes from contaminated needle (UNAIDS) • If standards for policy reform seem high, the stakes are just as high • Every year of delay means thousands of infections, and deaths, that could be avoided.

24. Illicit Drug Policies and the Global HIV Epidemic:Effects of UN and National Government Approaches English version of full report available: www.soros.org/initiatives/ihrd

25. 2003 INCB Report Offers Qualified Support of “Harm Reduction” • INCB recognizes needle distribution and substitution therapy in accord with national sound medical practice, as part of comprehensive strategy of DDR, But Rejects safer injection rooms without providing clear legal criteria except para 4 (1961) Issued press release titled “Cautions to governments on harm reduction” and Warns—in widely quoted passage—that harm reduction may carry national and international negative consequences