‘Zero new infections, zero discrimination, and zero AIDS related deaths’.
As objectives go this one is difficult to find fault with. Unless your concern is the protection of punitive drug policies.
Today world leaders arrive in New York for a UN summit on AIDS where a new Political Declaration will be adopted, an international agreement intended to guide the response to HIV/AIDS until 2020. The negotiations are, in fact, already over for the Political Declaration that will emerge from this meeting. These have been taking place in the last few days with lengthy, heated debates on many issues from men who have sex with men to intellectual property and access to anti-retroviral drugs to human rights. Last night the final round of negotiations ended. All that remains is tidying up the document. Unfortunately, one message of the document is clear - many states are willing and ready sacrifice lives and HIV responses in order to protect punitive drug control systems.
As the post-negotiation dust settles in New York (swirling invisibly around the world leaders in attendance) we are left with the following in relation to injecting drug use and HIV:
An HIV/AIDS declaration with strong ‘war on drugs’ language inserted for the first time ever. According to the document ‘the drug problem continues to constitute a serious threat to, among others, public health and safety and the well-being of humanity, in particular children and young people and their families’. This is the very basis of the justification for so many human rights abuses in the war on drugs around the world – and for the denial of HIV prevention measures for people who inject drugs. Two of the most severe costs of the war on drugs. It goes on to say that ‘much more needs to be done to effectively combat the world drug problem’. It is a paragraph about cracking down on drugs, rather than effective responses to HIV.
A document that backtracks on earlier commitments on HIV prevention for injecting drug users. Sure there were victories for those States committed to tackling HIV, such as the listing of at risk groups, and the commitment to ‘work towards’ reducing HIV among people who inject by 80% by 2020, and the newly included mention of UN guidelines on HIV prevention for injecting drug users. But they are pyrrhic victories. Mentioning injecting drug users means little unless backed up with commitments, and the language is such that all States have to do is ‘consider’ the programmes alluded to - just have a think about them. And only if their national laws allow it. An 80% reduction simply will not be reached with these limitations. In the previous landmark political declarations on AIDS from 2001 and 2006 UN member states agreed together to ‘intensify efforts’. Not this time.
At the risk of playing a broken record, I must reiterate the statistics. There are an estimated 15.9 million people who inject drugs worldwide. 30% of new HIV infections outside of sub-Saharan Africa are related top unsafe injecting practices. In Eastern Europe and East Asia this is far higher. Less than three cents per day per injecting drug user is spent on HIV prevention. This is a major component of global HIV epidemics and a major gap in the response.
There is no point at this stage in diplomacy as to the States responsible for this shameful outcome. Italy, Russia, the Vatican, Singapore and Iran (on behalf of the Arab Group) led the charge against HIV prevention related to drug use (I would urge interested readers to ask their MPs to find out what their Government’s position was).
Singapore suggested the language of ‘harm elimination’ at one stage (a scary choice of words from such a prolific executor of drug offenders). Italy sought ‘risk reduction’, a different concept to harm reduction which deflects attention from HIV prevention goals.
The negative contribution of Iran and the Arab Group is saddening following the first ever International Harm Reduction conference in the Middle East having taken place this year in Lebanon. There we saw academics, service providers, activists and people who use drugs from the region speaking openly about the need for harm reduction scale up. At these negotiations, to ensure a tough stance on drugs and to protect State interests in punitive drug control systems, these governments have betrayed their people’s commitment to health and human rights.
But perhaps the most egregious behaviour was that of Russia given the scale of the injecting driven HIV epidemic within its own borders (There are an estimated 1.6 million opiate users in Russia with unsafe injecting accounting for 80% of new infections. HIV prevalence is 37% among people who inject). Nationally, in response, Russia has banned opioid substitution therapy until 2020, one of the core HIV prevention interventions for opiate injectors; it has branded needle and syringe programmes ‘drug propaganda’ and refuses to fund them, and has promised to clamp down on the promotion of harm reduction. At these negotiations Russia has sought to legitimise that neglect, and has succeeded. It can now point to its national laws as justification for allowing its citizens to get sick and die. In October, Russia will host the MDG 6 Forum on halting and reversing the spread of HIV. Based on its behaviour at home and at the UN, it has no legitimacy whatsoever to do so. Russia has shown that it has no desire to reach MDG 6.
Against so many opponents, the many issues under attack and the UN desire for consensus there was little the numerous supportive states and civil society organisations could do except to limit the damage. Their efforts are clear to those who have followed the process and the developing wording of the declaration.
All of this comes after a year of significant events in drug policy and HIV/AIDS campaigns. Let’s go back a year to the 18th International AIDS Conference in Vienna. There the Vienna Declaration was launched. It was the official conference declaration, calling for reform of the international drug control system in order to meet the challenge posed by HIV/AIDS and endorsed by cities, Nobel laureates, former heads of state, scientists, lawyers, academics, researchers and activists from around the world. There are over 20,000 of them to date.
In April 2011, Harm Reduction International launched the Beirut Declaration on HIV and Injecting Drug Use. Targeted specifically at the UN meeting on AIDS the declaration reminded UN member states of their commitments on HIV prevention and injecting drug use made in the declarations of 2001 and 2006. The Beirut Declaration has been endorsed by hundreds of HIV/AIDS, development, drugs, human rights, children’s and humanitarian organisations.
At the end of May, the online campaign organisation Avaaz launched a petition to call for an end to the war on drugs. It has now amassed over 600,000 signatures. A massive achievement.
The Avaaz campaign coincided with the launch of the report of the Global Commission on Drug Policy, by far and away the most prestigious and high level group of people ever to call for global drug policy reform. It included former heads of state, a sitting Prime Minster and the former UN Secretary General, Kofi Annan. The report was launched on 2nd June.
So here we are, less than a week later, the first opportunity for progress. Not a dent. Not even on the basics of harm reduction. What this means is that even while a prestigious group of former world leaders (and one active) showed how much the ‘drug war’ of the past has failed, sitting governments cannot collectively agree to progress, even on the most basic of needs.
At the UN meeting on AIDS over the next two days expect lofty speeches and strong words. Some, let’s be fair, will be sincere and many states will act upon these words. But the speeches will be soon forgotten while the Political Declaration will remain and will affect international negotiations on HIV/AIDS for years to come. As usual AIDS has managed to expose prejudice and the ugly face of politics in a way that few issues can. Harm reduction, for its part, has again shown to be a threat to the punitive status quo of drug control such that some states are willing to sacrifice lives and scuttle international negotiations on global health concerns to protect it.
The Global Commission on Drug Policy has said, clearly and insightfully, what needs to be done. The UN High Level Meeting on AIDS will show just how far from that reality we really are. Indeed, the negotiations have shown how far we are from even a reasonable discussion about it.