Transcript Nicolas Ritter 19 août 2014

Harm reduction for people who use drugs
Nudhar Bundhoo
Advocacy officer
[email protected]
16 April 2015
What is Harm
Reduction?
•Harm reduction refers to the range of services and
policies to reduce the adverse effects of drug use
•Instead of insisting that people should stop using
drugs, harm reduction acknowledge that many are
not able or unwilling to abstain from illicit drugs
•Harm reduction strategies recognise that many
people will continue to use drugs, despite the
strongest efforts to prevent initiation and continued
use
What is wrong with
punitive laws?
•Laws which puts people who use illicit drugs in
prison have failed to produce positive outcomes
•Laws have been unable to reduce supply/demand
•Laws have not improved public health, including
overdose, HIV and HCV prevalence
•Laws have not been able to reduce criminality,
human rights abuses
•Laws have been unable to reduce environmental
degradation
Harm reduction for
people who use drugs
•The approach extends to the use of proper language
when working with people who use drugs
•No ‘junkies’, ‘addicts’, ‘social evils’..
•Compassionate approach which extends to families
of people who used drugs
•Respect human rights of people who use drugsrights to the highest attainable standard of health, to
social services, to work, to benefit from scientific
progress, to freedom from arbitrary detention and
freedom from cruel inhuman and degrading treatment
Harm reduction and
HIV prevalence
Injecting drug use in
Sub-Saharan Africa
•Reliable information on injecting drug use in SubSaharan Africa is limited
•Estimates suggest 1,020,000 people who inject drugs
•Kampala: 16.7% HIV prevalence among people who
inject drugs
• In 2014, Ghana is set to undertake a study to ascertain
an accurate picture of trends of injecting drug use
•Tanzania: 42% reported HIV prevalence among people
who inject drugs
•Tanzania Network of People who use drugs (TANPUD).
2014 ReAct peer-led network of people who use drugs
Injecting drug use in
Sub-Saharan Africa
•Research also scheduled in Somalia and Senegal
•South Africa: CDC contracted CSOs to work on
increasing services, awareness and education on
harm reduction in Cape Town, Durban and Pretoria
•Kenya Network of People who use drugs (KeNPUD)
•Eastern African Harm Reduction
•Uganda: countrywide harm reduction network
•Zambia: no verified data on injecting drug use and
HIV. No research planned
•Rwanda: claim no injecting drug use, do not target
people who used drugs in their HIV strategy
•Nigeria: 9% new HIV infection due to unsafe injecting
drug use
Harm reduction in
Sub-Saharan Africa
Harm reduction in
Sub-Saharan Africa
Needle exchange programs:
•Mauritius first country started NSP
•2012 Kenya initiated NSP-10 sites, in Nairobi, Kilifi,
Mombassa and Kwale
•Tanzania: 2014 seven sites, one mobile NSP
•South Africa: one NSP focused on men who have
sex with men who inject drugs
•Senegal: small scale NSP provision
•Seychelles: high percentage of people who inject
drugs report practising unsafe injecting-no NSP
Harm reduction in
Sub-Saharan Africa
Opioid substitution therapy:
•Mauritius reaches over 6000 people on methadone
substitution therapy
•Tanzania: newly initiated programmes (three sites in
Dar es Salaam, 1,200 receiving methadone)
•Kenya: Methadone program in development (funded
by US government and UNODC)
•Senegal: OST site built in Dakar
•South Africa: restricted to one government-funded
site, private OST available in clinics
•Nigeria: no OST
•Uganda: no OST
Policy development for
Harm Reduction
•Since 2012, seven sub-Saharan countries adopted reference to
harm reduction in their national HIV policy documents
•Tanzanian National Strategy for Non-communicable Diseases
2009-2015, Tanzania Third National Multi-sectoral Strategic
Framework for HIV and AIDS
•HIV policy framework in Mauritius, Seychelles and Kenya
•Senegal 2011-2015 National AIDS Programme
•Nigeria: harm reduction included in National Policy on HIV/AIDS in
2009
•UNDP invited Uganda Harm Reduction Network to develop a
model for a regional framework among key pops
•Department of Health in South Africa drafting operational
guidelines advocate for strategies for opiate dependence
Funding for Harm
Reduction programmes
•Tanzania: MdM received grant from Elton John AIDS
Foundation and French Development Agency to scale up
HR programmes in Dar es Salaam. OSF supported
capacity building and advocacy, CDC supported OST
•Kenya: Dutch funded CAHR implemented by
International HIV/AIDS Alliance. Global Fund, UNODC
and USAID
•Mauritius: Global Fund
•Uganda: ITPC
•South Africa: UNODC, UNAIDS, WHO, PEPFAR
Population : 1,2 M
inhabitants
Surface area about
2000km
HIV Prevalence 1.02%
2
A bit of history on
Harm Reduction in
Mauritius
•1996 : Civil society starts raising the alarm about HIV among PWIDs
•Early 2000’s: Exponential growth of HIV Infection within PWID
•2004: Platform created by Civil society to advocate for Harm Reduction Strategies in
Mauritius. This platform will later be CUT (Collectif Urgence Toxida)
•2006 : Launching of illegal Needle Exchange Program by CUT
•2006 : Launching of Methadone Substitution Therapy by the Ministry of Health &
Quality of Life (MOHQL)
•2007 : Legal Framework for NEP through the HIV/Aids Act
•2007 : Creation of National NEP Committee by MOHQL where CUT is invited to sit.
•2009 : CUT launches premises and follow-up on NEP and advocacy on Harm
Reduction
•2010 : GFTAM allows upscaling of Harm Reduction Services
•2011 : Methadone in Prisons
Existing Harm
Reduction services in
Mauritius
Needle
Exchange
Program
Methadone
Substitution
Therapy
HR Community services
Mobile
Caravan for
MARPS
Impact of Harm reduction
in Mauritius
1000
900
New HIV Cases
800
PWID Incidence Rate
700
600
500
400
300
200
100
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Impact of Harm reduction
in Mauritius
Reduction in crime rates
for drug-related offences
Reported cases
3000
2500
2650
2466
2046
2000
1641
1500
1295
1000
1085
500
0
2007
2008
2009
2010
2011
2012
Comprehensive Harm
Reduction package
Laws, policies and practices should be reviewed
and revised where necessary, and countries
should work towards decriminalization of
behaviours such as drug use/injecting, (…)
and toward elimination of the unjust application of
civil law and regulations against people who use/
inject drugs (WHO, 2014)
References and important
publications
•2009: After the War on Drugs: Blueprint for Regulation
•2011: A Quiet Revolution: Drug Decriminalisation Policies in Practice Across
the Globe
•2011: A Quiet Revolution: Drug Decriminalisation Policies in Practice
Accross the Globe
•2012: The Alternative World Drug Report : Counting the Costs of the War on
Drugs
•2014: HIV and young people who inject drugs
•IDPC
•Global Commission on Drug Policy
•Drug Policy Alliance
•INPUD
•Harm Reduction International: Global state of Harm Reduction
•Transform drug policy foundation
•Release
•TNI (Transnational Institute)- Drugs and Democracy Programme
Crisis in Mauritius!
•Law Reform Commission: voluntary HIV transmission to be
criminalised
•Reduction of syringes/needles distributed, despite increasing needs
from people who inject drugs
•Decentralisation of methadone distributing sites to police stations
•No HCV treatment for people who inject drugs
•Immigration Act discriminates against HIV positive foreigners coming to
Mauritius
•Mass and arbitrary arrests of sex workers: condoms possession used
to arrest