Benjamin Phillips of the Harm Reduction Coalition made the following intervention on behalf of a global working group of harm reduction organisations, including Harm Reduction International, at the Civil Society Hearing for the UN High Level Meeting on HIV/AIDS in New York:
The 2011 target of halving HIV among people who use drugs has been missed. It was missed by a staggering 80%! The world has failed people who use drugs and we must refocus our efforts. To do this, we need leadership on harm reduction. Harm reduction leadership means increasing political support and funding for harm reduction. Harm reduction leadership also means ending the criminalization of people who use drugs.
Harm reduction aims to reduce the health, social and economic harms associated with drug use, without requiring people to stop using drugs. When scaled up sufficiently harm reduction interventions, such as needle and syringe programs and opioid substitution therapy, have a significant impact on reducing new HIV infections, overdose, drug related deaths and rates of crime.
Last year, world leaders adopted the Sustainable Development Goals (SDGs), which included a target to end AIDS by 2030. Yet, if the implementation of harm reduction continues at its current levels only a minimal reduction in new HIV infections will be seen.
Prisoners have also been left behind in global responses to HIV. Between 33% and 50% of the world’s prison population is made up of people who use drugs, while global HIV prevalence is up to 50 times higher among prison populations than the community. Despite these alarming figures, key harm reduction services are severely lacking in prison and other closed settings. Behind this failure is the chronic underfunding of harm reduction. At last count, investment in harm reduction in low-and middle-income countries totaled $160 million, only 7% of the estimated $ 2.3 billion required. By contrast, $100 billion is spent annually on drug enforcement and control.
New projections by the Burnet Institute and Harm Reduction International show how just a tiny shift in funding could virtually end injecting-related HIV infections by 2030. By moving as little as 7.5% of current spending on drug enforcement into harm reduction programs, we could achieve a 94% reduction in new HIV infections among people who inject drugs by 2030, and reduce HIV-related deaths by similar proportions.
We urge member states to champion harm reduction at the High Level Meeting on HIV by pushing for inclusion of the following elements:
- Acknowledge that the provision of harm reduction and evidence-based drug treatment (including in prisons and other closed settings) cannot be seen as a policy option at the discretion of states, but must be recognized as a legally binding human rights obligation;
- Recognize that the 2011 target of halving new HIV infections among people who inject drugs by 2015 has been missed; and commit to a new HIV prevention target for people who inject drugs of a 75% reduction in new HIV infections by 2030;
- Acknowledge the global deficit for sustainable funding of harm reduction programs and support a shift of resources away from punitive responses towards proven harm reduction interventions;
- Recognize the importance of the removal of legal barriers to ensure equitable access to harm reduction services;
- Recognize the need for appropriate, voluntary, evidence based services for people who use stimulant drugs, as the WHO/UNODC/UNAIDS ‘comprehensive package’ of interventions does not address this;
Pledge to intensify meaningful participation of, and provide support, training and funding to, community-based organizations and civil society organizations (including drug user organizations) in designing and implementing services and advocacy programs for people who use drugs/people who inject drugs;
In order to achieve “90-90-90” for prisoners we urge member states to champion the following specific targets:
- 90% reduction in new HIV, viral hepatitis and TB infections among prisoners by 2030;
- 90% of prisoners have access to HIV prevention, treatment, care and support, including NSP, OST, naloxone and other harm reduction services by 2030;
- 90% of prisoners benefit from continuity of health care, including HIV treatment and harm reduction services, between the prison and the broader community by 2030;
In closing, slogans and simple answers will not end the AIDS epidemic. Given the explicit endorsement of harm reduction within the UN human rights system, provision of harm reduction services cannot be seen as a policy option at the discretion of States, but must instead be understood as a core obligation of States to meet their international legal obligations.
We cannot be serious about human rights and ending AIDS if we are not serious about harm reduction.