1 / 29

…at what cost ?

…at what cost ?. Kasia Malinowska-Sempruch Director, IHRD Open Society Institute. Ten year review:. Law enforcement at the expense of public health and human rights Major HIV epidemics among IDU Lack of drug treatment and abuses in the name of drug treatment What about women?.

erna
Télécharger la présentation

…at what cost ?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. …at what cost ? Kasia Malinowska-Sempruch Director, IHRD Open Society Institute

  2. Ten year review: • Law enforcement at the expense of public health and human rights • Major HIV epidemics among IDU • Lack of drug treatment and abuses in the name of drug treatment • What about women?

  3. In Russia and Ukraine, police often harass and arrest drug users who attempt to obtain health information and sterile syringes from drug stores and legal syringe exchange sites. In China, police are known to wait by syringe distribution points to arrest drug users. Outreach workers have been followed and detained. In the U.S., studies have found that drug users who were afraid of being arrested were more than one and a half times more likely to report sharing needles. Law enforcement practices block drug users’ access to public health services

  4. Drug enforcement in China, Kazakhstan, Russia, and Ukraine, has been associated with police extortion and violence against suspected drug users. In Thailand, a federally ordered police crackdown resulted in reports of thousands of extra-judicial killings of suspected drug users. Many of those arrested report that police planted drugs in their pockets, forced them to sign false confessions, or threatened to arrest them simply for not being enrolled in drug treatment. In Kazakhstan, police come to drug-dealing points to conduct body cavity searches, which women IDUs report lead to sex in exchange for the return of seized drugs. Law enforcement approaches associated with police use of excessive force and human rights violations

  5. As many as 1.7 million people are living with HIV in Eastern Europe and Central Asia Injection drug use is the single most significant driving force behind the epidemic in the region IDU accounts for more than 70 percent of cumulative HIV casesin Eastern Europe and Central Asia HIV Epidemics: Mostly or Almost Entirely among Drug Users, FSU

  6. HIV Prevalence In UKRAINE:estimated 1.5% (the highest in all of Europe) Source: UNAIDS Global Epidemic Update, 2006 Photo: Jacqueline Mia Foster

  7. HIV among drug users

  8. Deadly Denial: Barriers to HIV/AIDS Treatment for People Who Use Drugs in Thailand (Thai AIDS Treatment Action Group and Human Rights Watch) • Thai authorities have provided minimal support for harm reduction services for drug users. • The few existing harm reduction programs are seriously undermined by the government’s ongoing, repressive anti-drug campaigns. • Police regularly interfere with drug users’ efforts to seek health care by harassing clients outside of drug treatment centers. • Police also use possession of sterile syringes, or presence at a methadone clinic, as a basis for harrassment or arrest.

  9. Percent of IDUs Reached by Needle/Syringe Exchange ProgramsSelect CIS Countries, December 2005 Note: UNAIDS recommends 60% coverage for effective HIV prevention among IDUs Sources: IDU Estimates: UNODC HIV/AIDS unit, September 2005 (midpoint estimates, data collected 2002-2005); WHO/UNAIDS October 2005 (Ukraine) Coverage Estimates: Open Society Institute/ Soros Foundation network (Armenia, Azerbaijan, Georgia, Kyrgyzstan, Tajikistan); UNAIDS 2006 (Russia); HIV/AIDS Alliance (Ukraine); GFATM and program reports (Uzbekistan).

  10. U.S. in the global debate • Federal ban on funding needle exchange • PEPFAR unable to fund needle exchange. Currently funding some substitution treatment for HIV positive drug users • U.S. very active in drug control arena in its opposition to harm reduction in general and needle exchange specifically – often results in perception that harm reduction doesn’t exist in the U.S.

  11. Photo: Dan Bigg

  12. Photo: Jacqueline Mia Foster

  13. Methadone • Categorization as Schedule 1 (1961 Convention) not suited to data and realities of 2005 • No comment by INCB on countries that ban the treatment • Methadone proven to reduce injecting & demand for illegal opiates, and increase adherence to ARV treatment

  14. Perpetual Pilot • Poland has over 40,000 opiate users but only about 1000 methadone treatment slots • Compare neighboring Germany- 120,000 to 150,000 heroin users and roughly 65,000 people in substitution therapy • Kyrgyzstan, Azerbaijan, Georgia, similarly slow to scale up

  15. No substitution treatment at all • Russia—1/2 million+ opiate users, no substitution treatment. Russian policies often influence neighboring countries. • Tajikistan still considering, but not treatment • Methadone written into the Kazakh Global Fund proposal but no medication for patients

  16. Methadone Maintenance Clinic (China)

  17. FEWER THAN 1% of IDUs IN NEED RECEIVE SUBSTITUTION TREATMENT(Low/middle income countries with majority of registered HIV infections among IDUs, Oct. 2006)

  18. Over-Control Makes Treatment Inaccessible • Treatment philosophy organized around often unrealistic goal of complete abstinence • Waiting lists, age limits, requirement of documented attempts at abstinence, review by commission • Prohibitive fees passed to patients; corrupt staff demand bribes • Police interference • Lack of take-home doses disrupts lives • Punitive urine testing and body searches • HIV-positive status preference—creates “perverse incentive”, denies HIV-negative IDUs crucial prevention tool

  19. Other drug treatment? Patients’ views in Russia A recent survey of 988 injection drug users in 10 Russian regions by the Penza Anti-AIDS Foundation found that a majority of patients have tried to stop drug use at least once using detox and/or residential rehabilitation services.

  20. Other findings • Half the people surveyed reported abuses while undergoing treatment, including beatings, limitation of freedom of movement, prohibitions on visits by relatives, and doctors’ refusal to provide painkillers. • Breaches of confidentiality and registration as drug user serious obstacles to seeking drug treatment. • Drug treatment clinics charge substantial fees for their service and shift the responsibility for failure of treatment on patients and their families. Vicious cyle of detox - brief remission – relapse—detox again. • Disappointment in spectrum of services lowers patient expectations.

  21. Abuses in the name of “treatment” No international standards for evidence-based drug treatment Any intervention, no matter how inappropriate and ineffective can be considered “drug treatment” Photos courtesy Jimmy Dorabjee

  22. Photo courtesy Jimmy Dorabjee CAGES AS TREATMENT

  23. Locked wards as treatmentMoscow Substance Abuse Hospital #17, 46 dead, December 2006 http://news.ntv.ru/99430/

  24. Women and drug use Global inattention to women drug users: UNODC 2006 World Drug Report, which relies in large part on national self-reporting, makes more references to the female cannabis plant (14) than to women drug users (5) This despite assertions in 2005 report that number of women drug users was increasing and injection-driven HIV epidemics were feminizing.

  25. Preliminary results of assessments in Russia, Ukraine, and Georgia Stigma and lack of integrated services are key obstacles to care • In Georgia, women IDU so stigmatized that they are afraid to speak about drug use even with other drug users • Vertical transmission rates in Ukraine in 2000-2004 compare with those in Western Europe before the introduction of perinatal antiretroviral treatment. Here and in Russia, many avoid prenatal care due to stigma and only seek care once in labor • Stigmatization from reproductive health and drug treatment providers lead to minimal access to methadone treatment, the “gold standard” for pregnant opiate users, women often forcefully counseled into abortion • Lack of supportive services such as child care

  26. Sex work and drugs The link between sex work and drug use is strong • Some use drugs to cope with harsh conditions of being sex workers; others turn to sex work to support their drug use. • 44% of sex workers in Moscow inject drugs (Epi of Inf Dis, 1998) • In Tashkent, non-IDU sex workers had HIV prevalence of 10% and IDU sex workers had HIV prevalence of 28% (UNAIDS/WHO, 2005).

  27. HOW ARE WE DOING? • Governmentstreat drug users like drugs: as something to be controlled and contained • Mass incarceration, forced institutionalization and registration are a norm • Harm reduction not anywhere near required scale • None of the most affected counties have national scale, effective substitution treatment, and most do not have pilot programs • Instead, punitive, abusive interventions are considered “drug treatment”

  28. Thank you kmalinowska@sorosny.org

More Related