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How is harm reduction a human rights issue?
What is harm reduction?
A common social response to people who use illegal drugs is to treat them like drugs: as something to be controlled and contained. Drug users are often subject to prolonged incarceration or institutionalization, or offered health care only if they demonstrate that they have stopped their drug use altogether. This is true despite evidence that dependence on certain drugs is chronic and relapsing, that active drug users can benefit from many forms of prevention and treatment, and that refusing services makes people who use drugs more vulnerable to a range of health and social problems.
Harm reduction takes a different and more pragmatic approach, recognizing that not everyone is able or willing to stop illicit drug use, and that those who are still using drugs can make choices to protect their health and the health of others. Also known as “harm minimization,” harm reduction focuses on reducing the adverse consequences of drug use, including risk of HIV and other blood-borne infections, rather than on demanding that people stop drug use altogether. Central to much harm reduction is a belief that services should meet people who use drugs “where they are,” rather than requiring people to fulfill many complicated requirements or behavioural changes before they get help.
Some common harm reduction measures include:
- Access to HIV prevention
Provision of sterile injection equipment and prescription of orally-administered medications such as methadone or buprenorphine to reduce injection of heroin and other illicit opiates have been shown clearly to reduce HIV risk. Yet these services remain out of reach of people who inject drugs in many countries. Programs are either too small to reach all at risk, opposed by politicians who insist—without evidence—that they encourage drug use, or limited by police actions such as harassment of needle exchange workers and arrest of clients.
- Access to HIV and drug treatment
Evidence shows that people who inject drugs can, with proper supports, enjoy the same benefits from antiretroviral treatment (ART) as other people with HIV. However ART remains limited or ineffective for drug users, if it is available at all. While effective treatment for drug addiction can enhance ART adherence, many drug treatment programs offer little more than forced labor and long-term detention, making these programs more like prison than like treatment. Even humane and effective drug treatment programs are of limited use if fear of harassment, arrest, or incarceration makes drug users reluctant to use them.
- Access to sexual health services
Provision of sexual health services enables people who use drugs to protect themselves and their sexual partners from HIV, preventing further sexual transmission of an epidemic initially spread by drug use. UNAIDS urges that sexual health services be made available to all drug users and their partners. Source: UNAIDS, Intensifying HIV prevention: UNAIDS policy position paper. Geneva, 2005.
How is harm reduction related to human rights?
Drug users are vulnerable people. They suffer from inadequate medical assistance. They experience discrimination, invasion of privacy, police harassment, and social marginalization. They have to endure the arbitrary deprivation of rights, such as mandatory medical treatment. Their capacity to defend their interests is impaired by social stigmatization. One would assume that society’s majority would oppose such violations. After all, arbitrary searches, disco raids, compulsory urine tests, and wrongful appropriation of confidential medical files are injustices suffered by nonusers as well. But the majority accepts the invasion of privacy in an attempt to have a drug-free environment. Support for the human rights of drug users is virtually nonexistent.
Judit Fridli, “Harm Reduction and Human Rights” Harm Reduction News, 2003
Harm reduction goes hand in hand with advocacy to ensure a range of human rights for people who use drugs. Such advocacy includes work to ensure:
- Access to information and measures to protect against disease and overdose
- Protection against cruel or inhumane treatment
- Protection against violations of privacy such as forced testing and registration
- Freedom of association and political participation.
Some harm reduction and human rights efforts include:
- Protection against abuses by police and health care providers
Mistreatment of people who use drugs by police and healthcare providers is widespread. Police use the threat of incarceration or painful withdrawal symptoms to coerce testimony and extort money of people who use drugs. In many countries, police or health care providers release confidential information regarding HIV or drug using status, register drug users’ names on government lists, and deny them employment or services. It is common for governments to impose lengthy prison sentences for minor drug offences. This not only constitutes cruel and unusual punishment, but also catalyzes HIV transmission, since hundreds of thousands incarcerated in environments where drug injection and unprotected sex continue, and where HIV treatment and prevention measures are often unavailable.
- Support for political participation
More than two decades of experience with HIV have shown that “hard-to-reach” populations are their own best advocates. Despite the importance of involving those who are directly affected in the formation of AIDS policy, drug users have often been excluded, even from those mechanisms that are intended to increase participation of people living with HIV.
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Did you know?
- Some 30% of new HIV infections outside of sub-Saharan Africa are due to contaminated injection equipment.
- In Eastern Europe and Central Asia injecting drug use accounts for more than 80% of HIV cases, but less than 24% of people receiving HIV treatment. In South and South-East Asia, injecting drug users are from 4 to 75 percent of those infected, but only 1% of the people receiving HIV treatment.
- Thailand’s “War on Drugs” initiated in 2003 included:
- Arrest of tens of thousands of suspects on government “blacklists” or “watchlists ”
- Arrest quotas, arbitrary arrest, and other breaches of due process
- Coerced or mandatory drug treatment
- Intimidation of human rights defenders
- More than 2,300 extrajudicial executions.
- Drug users or even those in neighborhoods where drug use is common are rounded up in advance of national or international events such as the Olympics or the UN’s International Day against Drug Trafficking and Drug Abuse. Drug users are often forcibly tested and sent to prolonged mandatory treatment without evaluation by a medical professional or right of appeal.
- Some countries, such as Malaysia and Georgia, criminalize the status of drug users. In Malaysia, law permits those suspected of drug use to be detained and forcibly tested. Those who test positive are subject to mandatory detention in treatment centers, and those caught in possession of drugs are subjected to mandatory flogging and incarceration.
- Other countries, including several in the Commonwealth of Independent States, do not criminalize drug use, but punish possession of “large” or “extra large” amounts of illicit drugs with prolonged imprisonment. “Large” amounts of drugs can be defined as the residue in a used syringe or half a cigarette of cannabis.
- In parts of Russia, prisoners are tested for HIV and those who are positive are segregated—by a wire fence. Since injection is common but clean needles and syringes are not, injection equipment can be shared as many as forty times.
- Across Asia, drug users are confined to treatment centers that are more like prisons than health care facilities, and that offer little or no psychosocial or medical support. In China, IDUs are arrested and forced into compulsory detoxification facilities, and those who return to drug use are sent to forced labor camps. In one study, as many as ten percent of drug users swallowed nails or glass to avoid such detention.
The good news
- In Brazil, needle exchange services contributed to a remarkable 20 percent drop in HIV incidence among injecting drug users between 1998 and 2000.
- Countries such Spain have successfully targeted injecting drug users in prison with HIV prevention interventions including needle exchange and opiate substitution treatment, achieving huge reductions in HIV prevalence among prisoners.
- Human rights advocacy has led to tangible victories on behalf of people who use drugs:
- In 2007, the European Court of Human Rights found in favor of a Russian drug user who had been entrapped by police and placed in prolonged detention without a trial or medical care
- In Vancouver, Canada, documentation of police abuse against people who use drugs led to an independent investigation of the Police Department
- In Hungary, a public campaign against drug raids of discos led to a dramatic decline in raids and parliamentary proposals to reform anti-drug laws.
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