But there is notable criticism on the progress and policies surrounding injecting drug users, which I’ll try to collect here:
From the foreword:
Stigma and discrimination remain rife in many parts of the world, and punitive laws continue to deter those most at risk from seeking essential HIV services.
On the 2011 target to ‘Halve the transmission of HIV among people who inject drugs by 2015’ (from the Introduction):
The world is not on track to reduce HIV transmission among people who inject drugs by 50%, as recent evidence suggests little change in the HIV burden in this population. HIV prevalence among people who inject drugs remains high – up to 28% in Asia. HIV prevention coverage for people who inject drugs remains low, with only two of 32 reporting countries providing the recommended minimum of at least 200 sterile syringes per year for each person who injects drugs. Among 35 countries providing data in 2013, all but four reached less than 10% of opiate users with substitution therapy. In addition to exceptionally low coverage, an effective AIDS response among people who inject drugs is undermined by punitive policy frameworks and law enforcement practices, which discourage individuals from seeking the health and social services they need.
More on that in these snippets from Chapter 2:
Recent data suggest little change has occurred in the HIV burden among people who inject drugs. HIV incidence among this population remains high, with people who inject drugs accounting for more than 40% of new infections in some countries.
A package of HIV prevention, care and treatment services is recommended for the prevention of new HIV infections among people who inject drugs.
Recommended services include access to HIV testing and counselling, sterile injecting equipment (through needle and syringe programmes), opioid substitution therapy, antiretroviral therapy and other health and social services. People who inject drugs and their sexual partners also need counselling, education, behavioural interventions and access to condoms to prevent sexual transmission.
Uptake of voluntary HIV testing and counselling is extremely low among people who inject drugs, and criminalization, stigma and discrimination deter individuals from seeking services.
…draconian policy and legislative obstacles, and low service coverage, prevent meaningful HIV prevention for many people who inject drugs in many countries in [Central Asia].
Chapter 8, on eliminating HIV-related stigma, discrimination, punitive laws and practices, says:
Punitive policies pertaining to drug use – including harsh penalties for possession of small amounts of drugs for personal use, criminalization of drug dependence, compulsory drug detention and bans on drug substitution therapy or needle and syringe programmes – prevent or deter many people who inject drugs from receiving the services they urgently need. Compulsory drug detention regimes in some countries are so severe that a United Nations Special Rapporteur on torture or other cruel, inhuman or degrading treatment or punishment singled them out for denunciation in 2013. In 2012, 12 UN system agencies jointly called for the closure of compulsory drug detention and rehabilitation centres.
I wrote in 2010 on how “the UN says bad laws and discrimination, particularly in respect to drug users and homosexuals, continue to hamper the fight against Aids.” Russia is a particularly bad offender but seems to get away with it in this year’s UNAIDS report by having failed (along with the USA) to report statistics about HIV amongst injecting drug users.
PS It was this blog’s 3rd birthday yesterday! I’ve rarely posted recently due to work - and the option of other outlets for writing - but it’s still here and I’ll continue to post when it’s useful…