CND: A Report from NGO Perspective

The main theme of the 48th Session of the Commission on Narcotic Drugs was HIV/AIDS prevention among drug users. However, none of the adopted resolutions mentioned harm reduction or syringe exchange. Two reprepresentatives of HCLU participated as members of the OSI delegation, read their short report on the event.

Opening Speeches

 

Antonio Maria Costa, Executive Director of UNODC refused criticisms coming from civil society (or as he put it the “pro-drug lobby”) concerning the effectiveness of UN measures aiming to eliminate or significantly reduce drug cultivation, trafficking and use until 2008. He said there was a progress since 2003 and the present “balanced approach is most appropriate” to achieve the goals set in the 1998 action plan. He denied that legalization can lead to curb crime and emphasized that there is no choice for governments between health and security. Mr. Costa called UNODC the “counter-narcotic conscience of the world,” and said only political capital is missing behind its efforts. He pointed out that the spread of HIV/AIDS, the lack of road testing and the rise of raves are three major problems challenging the international narcotic control system. Notwithstanding, his speech did not answer the crucial questions about HIV/AIDS prevention among injecting drug users. He countered the issue of harm reduction saying that all UNODC activities are indeed harm reduction activities, for instance to provide alternative crops for farmers in the third world. According to Mr. Costa abstinence is the best form to tackle the HIV/AIDS problem and he claimed drug users cannot think rationally and act responsibly, so the only way to reduce the risks of HIV transmission is to diminish drug phenomena as such. He talked much more about raves, calling them “drug festivals” where young people dance several hours and than drive their cars under the influence of drugs, causing road accidents.

 

The UN building in Vienna (photo: Marek Zygadlo)

 

John Walters, head of ONDCP did not address the issue of syringe exchange directly as several NGOs expected. His speech was rather an optimistic overview of American drug policy with several referrals to increasing funds to treat drug addiction and to decreasing drug use among adolescents. He claimed that addiction is a “fundamental disease of the brain caused by repeated drug use according to best science.” This “deadly disease” is a preventable condition and active drug users should be restored to community. He stated that effective drug treatment services and drug testing in schools are working interventions to curb the disease of addiction and said using the criminal system to provide alternative treatment for drug users instead of imprisonment is “extremely successful intervention” that saves lives. He called delegated of the CND to keep existing unity in the battle against narco-terrorists and implement the three UN conventions, which are accepted by the overwhelming majority of states. He rejected injecting rooms and heroine maintenance programs because they facilitate drug use and emphasized that strict anti-narcotic measures are adequate responses to HIV/AIDS epidemic. The “drug czar” claimed US takes responsibility in fighting the epidemic with paying billions of dollars worldwide to special health programs.

 

Thematic Debate on HIV/AIDS

 

Peter Piot, director of the UNAIDS chaired the thematic debate on HIV/AIDS. He stressed the importance of growing feminization of the HIV/AIDS epidemic (in the occasion of the International Women’s Day). There is a rapid growth of new infections if HIV/AIDS enters an IDU community, he said. It is not easy but possible to stop the epidemic, though only really comprehensive strategies work. Prevention of drug use is the number one priority, but it is important to prevent the transmission of HIV/AIDS among active drug users, with providing them access to treatment, substitution therapy, voluntary testing, counselling, access to clean syringes and ARV. There is a need for a dialogue between the world of drug control and the world of HIV prevention, which is missing in many countries. He expressed his hopes that UNODC will establish this dialogue in the international level as the donor of UNAIDS this year.

 

Luxembourg (in the name of EU Commission) emphasized the effectiveness of European integrated approach and evidence based actions preventing the transmission of HIV/AIDS among IDUs. Effective outreach of IDU communities has a key role in this approach. He mentioned AIDS education, access to clean syringes, confidential testing, counselling and

substitution therapy as effective tools. Even if there is a controversy around providing injecting equipment, there is relatively robust evidence that these measures are effective. As the representative pointed out, WHO and INCB also acknowledged this. The prevalence of HCV is worryingly high in Europe so this is a critically important area where new prevention

measures should be implemented.

 

Peter Sarosi (HCLU) and Raminta Stuikyte (CEEHRN) during break (photo: Marek Zygadlo)

 

 

The delegate of Brazil referred to the new national health system introduced to Brazil in 1997 as a success model. Civil society plays a key role in this system, as a result of effective harm reduction measures HIV prevalence is significantly reduced, and today 76% of Brazilian IDU

population is covered by HR programs. These drug users do not share injection equipment any more and there is a universal access to ARV. In addition, there are prevention campaigns in schools organized in partnership with the Ministry of Education, and harm reduction trainings have been established in primary health care.

 

The representative of the Netherlands pointed out that there is an alarming situation around HIV epidemic among IDUs and he referred to the UNODC report that there is a need for a pragmatic approach to manage these problems. Previously even the INCB acknowledged that needle exchange and substitution therapy are compatible with the UN conventions and research indicates that these programs work successfully. NEPs do not only distribute syringes but spread information and educate drug users about the risks. These programs should be managed effectively and designed properly. There is no evidence that HR programs have negative consequences, such as increase in the number of IDUs, these phenomena did not occur in practice. UNODC should urgently deal with this problem and support harm reduction services, if not, it would reject evidence-based methods.

 

Finland introduced special measures to reduce HIV epidemic among IDUs: education, testing, distribution of clean needles. These practices remarkably reduced the prevalence of HIV. According to the Finish delegate the public health approach should be taken seriously by more countries. It is not sure that measures working effectively in Finland can work in other parts of the world, therefore UNODC has to conduct more studies in this field.

 

The delegate of France explained that his country faced a huge HIV epidemic 15 years ago which is comparable to the one that has risen in Southern- and Eastern Europe recently. Abstinence-only approached were not sufficient to stop the spread of HIV in the early nineties in France so the government accepted a resolute commitment to increase access to clean syringes. The first step was to introduce the free sale of needles in pharmacies, second they started NEPs, substitution therapy and ARV for PLWHA. According to recent data only 2% of HIV incidences are related to drug use. The implemented harm reduction measures are seemed to be appropriate by drug users themselves too, because they are not considered irresponsible criminals any more.

 

HIV/AIDS forced to rethink the drug policy of Germany, said the German delegate. It was one of the first countries to implement special programs like substitution therapy and supervised health facilities to reach IDU population. In 1993 13% of IDU population was affected by HIV/AIDS, today this proportion is only 2-3%. This means that harm reduction programs were successful. HIV is not the major threat anymore, but HCV among IDUs is a major problem. Adequate responses should be developed to address this issue.

 

The delegate of the U.S. acknowledged that HIV/AIDS is a global problem, but he pointed out that abstinence and drug free treatment should remain a priority in preventing the transmission of blood born diseases, together with substitution treatment as an optimum strategy. Voluntary HIV testing should be implemented but programs that „facilitate drug use” should not be supported. Therefore he suggested avoiding the term „harm reduction.”

 

According to its delegate, Croatia has low prevalence of HIV, there are around 200 PLWHA, and ARV is fully covered. 13% of HIV incidences are attributed to IDU. Almost 4000 people are on methadone or buprenorphine. Croatia started its first NEP in 1997, now NEPs operate in 13 locations in the country.

 

The delegate of WHO reported that 4 million IDUs are living with HIV/AIDS today, and this number is increasing. There is an urgent need for effective HIV prevention among IDUs and universal access to ARV. Drug treatment should remain important but it is not enough to stop the epidemic. At least six interventions should be implemented in all affected regions of the world:

 

1, needle exchange

 

2, substitution therapy

 

3, HIV testing/counselling

 

4, peer based outreach work

 

5, services for preventing sexual transmission (condom distribution)

 

6, HBV vaccination

 

 

Balázs Dénes (HCLU) at the CND (photo: Marek Zydaglo) 

 

There is a great diversity among IDUs should be respected, special groups should be targeted (women, sex workers, prisoners, ethnic minorities etc.). Effective harm reduction measures are still not available in many countries despite good evidence. WHO promotes evidence-based prevention, harm reduction and public health response in its global strategy on HIV/AIDS accepted in 2003. Only small proportion of IDUs has access to ARV (10% of people in need), this is unacceptable.

 

Sweden emphasized that harm reduction is not the sole way to prevent HIV/AIDS transmission but there is a need for more sexual education. Drug use has itself many negative effects so the main aim should be to reduce drug use. Countries have to develop a combination of drug abuse treatment and HIV prevention.

 

The delegate of Spain explained that harm reduction strategies came late to his country but they had good results. Spain had the highest prevalence of HIV/AIDS in Europe, 60% of its 70.000 AIDS patients has already passed away. There was a rapid growth in development of harm reduction strategies (NEPs and STs). NEPs have different forms in Spain: pharmacies, health care centres, mobile units, NGOs, prisons. At the present inmates in 37 prisons have wide access to sterile syringes and condoms. Today HIV prevalence is around 40%.

 

Japan attacked countries distributing syringes and drugs (i.e. methadone) to drug users. They called for a strict regulation of NEPs. The delegate said intensive public awareness campaigns should be implemented to stop drug use and raise awareness on the negative consequences of drug use. Japan is deeply concerned about some countries sending the wrong

message.

 

Iran has 2.1 million problem drug users, 60% of them are IDUs. The main group of newly infected people is IDU community, 15% of them are HIV positive. HIV situation is the worst in prisons, 22% of all prisoners are HIV positive. Harm reduction strategies were implemented in Iran (outreach work, NEP, ST, condoms). According to a study conducted in partnership with a Japanese university the distribution of 7 needles per week would stop sharing injecting equipment.

 

The Council of Europe emphasized a need for pro-active and timely prevention of HIV/AIDS and effective risk reduction, which should be 1) comprehensive 2) adapted to real circumstances and 3) evaluated, monitored, effective and cost-effective. The Pompidou Group accepted a draft resolution on ST accepted by CND as well. Outreach work and early detection of problems is very important.

 

NGO speeches

 

The distinguished delegate of the International Red Cross mentioned that his organization released a document on reducing risk behaviour among IDUs in December 2003. According to this document, harm reduction measures should be implemented and CND should accept concrete measures with timelines to stop the spread of the epidemic. The Red Cross published a document entitled „Spreading the Light of Science” which is a guideline for states how to implement effective harm reduction strategies. Red Cross recommends countries to take this guideline into consideration while introducing new measures against HIV/AIDS.

 

Mauro Guarinieri (chair of the European AIDS Treatment Group) is the first HIV positive activist speaking at the plenary meeting of the Commission on Narcotic Drugs. He called CND for widening the access to life-saving medical treatment for people living with HIV/AIDS. Only 1 percent of injecting drug users has access to antiretroviral treatment in Eastern-Europe, said Mr. Guarinieri. He urged delegates to increase the coverage of methadone substitution treatment (which is still illegal in several states including Russian Federation) because it would lead to significant reduction in HIV/AIDS transmission in the region.

 

Marco Perduca, the delegate of the Transnational Radical Party (TRP) had two speeches. At the thematic debate on HIV/AIDS he criticized harsh drug laws sentencing drug users to long imprisonment for a victimless crime and called for the implementation of harm reduction measures in prisons. In his second speech Mr. Perduca recommended the Commission to legalize and industrialize coca production in Latin-America for non-narcotic purposes.     

 

Resolutions

 

Despite the fact that this year the main theme of the CND was HIV/AIDS prevention, only three resolutions were submitted by different member states addressing this issue and only two of them were accepted in a revised form by the Committee. The most progressive draft resolution was submitted by the government of Brazil (E/CN.7/2005/L.14, Download the Brazilian draft resolution here!) with the title “HIV/AIDS and the right to health.” The text considers that “HIV/AIDS epidemic has had a major impact on injecting drug users, thus contributing to the spread of hepatitis, tuberculosis and other diseases.” It keeps in mind that “in its resolution 46/2, the Commission on Narcotic Drugs stressed the need for the United Nations Office on Drugs and Crime to continue developing and strengthening its role and strategies at the international and regional levels, regarding prevention of drug related HIV/AIDS transmissions.” It recommends “the adoption of health policies that facilitate access by drug users to different types of treatment for drug addiction and HIV/AIDS, hepatitis and other blood born diseases” and stresses the need “to provide drug users wide access to condoms, needles, disposable syringes, medication and vaccines for the treatment of HIV/AIDS and hepatitis.” Even if all GRULAC countries and most member states of the European Union stand behind this resolution, the delegates of the United States and some of their allies torpedoed this initiative. A working group was set to reach a consensus about the resolution but the negotiations failed because of the inflexible American refusal of any terms or expression which can be referred to as harm reduction. The US representatives even questioned the right of NGOs to participate at the plenary discussion of the draft resolutions, therefore NGO delegates were not permitted to enter the room. However, this exclusion was abolished by favour of a Dutch intervention at the Secretariat.  The last day of the session the Commission suspended the discussion of this resolution and postponed it to next year. The resolution of the Nigerian government (E/CN.7/2005/L. 30) aimed to build capacity for civil society to fight the HIV/AIDS problem “in the context of drug abuse treatment.” The US negotiators rejected again to accept any terms or referrals which could be interpreted in a slightest way as UN support for harm reduction services and revised a text of the resolution in a form which tackles the problem of HIV prevention only in the context of demand reduction. The same happened with the joint resolution of the Bolivian and Luxembourgian governments (the latter represented the EU this year). Finally, no resolution was accepted on preventing the spread of HIV/AIDS among active drug users.

 

Discussion of the resolutions at the CND (photo: Marek Zygadlo)

 

OSI luncheon

 

The largest side event of the 48^th Session of the Commission on Narcotic drugs was the luncheon organized by the Brazilian National AIDS Program, the Human Rights Watch and the Open Society Institute on Thursday afternoon. More than 50 country delegates from various countries accepted our invitation and came to listen to our spkeakers (even if the US held a luncheon in the next room at the same time). After a short welcome speech by Daniel Wolfe, Deputy Director of the International Harm Reduction Development Program and Jonathan Cohen (Human Rights Watch), Joanne Csete (Canadian HIV/AIDS Alliance) introduced the advantages of a public health and human rights oriented approach in drug policy. Cristina Pimenta, Chif of the Bazilian National AIDS Program emphasized the effectiveness of needle exchange and substitution services introduced to her country in the past decade. Alexandr Zelichenko, former Deputy Director of the State Commission on Drug Control in Kyrgiztan, explained his personal experiences leading him from harsh prohibitionism to harm reduction, from operative police actions to human rights advocacy. Mauro Guarinieri (EATG) spoke on behalf of those people living with HIV/AIDS and hepatitis C, urging political decision makers to provide access to health care and prevention services for injecting drug users. Copies of the sing-on letter were widely distributed in English, French, Spanish and Russian language to the country delegates.    

 

The OSI luncheon (photo: Marek Zygadlo)

 

The last battle

 

On the last day of the CND the Commission discussed the adoption of resolutions and draft reports. Bolivia and Brazil expressed their disappointment and concern on the suspension of the L. 14 resolution and asked the Commission to reflect their initiative in the report. Malaysia questioned the 6. paragraph of the draft report on the thematic debate on HIV/AIDS claiming that the text does not mirror the real situation that is many countries who did participate in the debate were against the implementation of harm reduction measures. They immediately got support from the Japanese, the Swedish and the US delegates. However, the negotiator of the Netherlands called the CND to keep insist on the original text, saying that the report should record the speeches and not the silence. Several European countries formed into line behind the Netherlands and the plenary discussion was suspended for at least half an hour, while negotiators reached consensus in informal debates. Russia also expressed its concerns about some sentences of the report on the thematic debate on HIV/AIDS. In the end consensus was reached and the chairman dissolved the 48^th session of the Commission. 

    

"The OSI team" (photo: Marek Zygadlo) 

Line above: Raminta Stuikite (Executive Director, CEEHRN), Daniel Wolfe (Deputy Director, OSI/IHRD), Balázs Dénes (Executive Director, HCLU), Mauro Guarinieri (Chief, EATG), Péter Sárosi (Drug Policy Project Coordinator, HCLU) Below: Marek Zygadlo (head of the Krakow Monar), Alexander Zelichenko (former Chief of Kyrgiz Special Drug Control Service), Jonathan Cohen (HIV/AIDS Researcher, Human Rights Watch)