Failure of the War on Drugs pushed back harm reduction programmes

In June of this year, world leaders including the former Secretary-General of the United Nations, Kofi Annan, the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) Dr Michel Kazatchkine and 5 former presidents and prime ministers, formed the Global Commission on Drug Policy, and released a report after reviewing the global body of evidence. The report’s very first sentence succinctly describes their findings: “The Global War on Drugs has failed, with devastating consequences for individuals and societies around the world.

Unfortunately, human rights abuses rather than treatment are characteristic of the dominant approaches used by governments to control drugs in this region. Documentation reveals police harassment and interference at health services accessed by drug users; arrest and forced detention at compulsory drug detention centres; a lack of due legal process, unreasonably long pre-trial detention, and other breaches of fair trial standards including false or forced confessions such as forced labour and torture in the name of healthcare is meted out through beatings, chaining, and electric shock; denial of information, prevention tools, antiretroviral therapy (ART) and also food are also reported.

Not only are massive human rights violations taking place under the aegis of public security and drug control, but these methods are also failing to achieve their own goals of reducing and deterring drug use. There are more people using different drugs than ever; however we have less capacity to effectively address their harms.

Antonio Maria Costa himself, the former Executive Director of United Nations Office for Drugs and Crime (UNODC), said that governments have a legal obligation to put human rights at the centre of their drug policies, and that, “too often, law enforcement and criminal justice systems themselves perpetrate human rights abuses and exclude and marginalize from society those who most need treatment and rehabilitation.” This may sound ironic, given the fact that the UNODC is part of a global drug control system that promotes confusion and misunderstanding about the drug conventions, and actively fights against humane approaches to drug control, bullying countries and creating barriers to change.

“The absence of people who use drugs at 10th International Congress on AIDS in Asia and the Pacific (10th ICAAP), which aspires to bring “diverse voices” together for “united action” on HIV/AIDS, only further compromises our ability to truly achieve universal access to HIV prevention and treatment; for without the rich contributions of people most affected by HIV, namely people who inject drugs, people in prison, undocumented citizens and migrants and ethnic minorities, men who have sex with men, sex workers, transgender people, and women, by not actively promoting their involvement in the response, we are denying them a right and we are perpetuating the bad practices of discrimination and denial that we deplore in others” said Karyn Kaplan, Director, Policy and Development, Thai AIDS Treatment Action Group (TTAG).

Rightly said Karyn: “I do hope that from the outset, the next conference will take concrete steps such as ensuring on-site access to medical care including opiate substitution therapy for people who use drugs as a matter of course and that a conference that does not provide this is not allowed to happen.”

Asia is home to more than half of the world’s opiate users, over 16 million drug users and at least 6.5 million injecting drug users (IDUs). HIV prevalence among IDUs is among the highest in the world in Asia and Asian HIV epidemic is largely driven by unsafe injecting practices, where less than 10% of heroin injectors are on methadone, and where injectors can access an average of just 2 sterile syringes per month. “We also lack 90% of the resources necessary to provide the essential harm reduction services necessary for realizing the right to health. But while resources are a significant challenge, I would argue that even when we have the resources, it does not ensure access” said Karyn.

Without legal reforms for supportive AIDS policies, harm reduction programmes will not have the desired and optimal impact. “Unless and until we address and remove the legal and policy barriers to accessing services for people who use drugs, investing in harm reduction is tantamount to flushing your money down the toilet. No smart investor in harm reduction would ignore the repressive legal and policy environments in which harm reduction services in Asia take place” said Karyn.

The constant threat of police arrest, violence, and incarceration at harm reduction drop-in centres, methadone clinics and other places where people who use drugs receive services minimizes the impact of these services. Failing to provide comprehensive harm reduction services in prisons, which are largely filled with drug offenders, ensures the perpetuation of unsafe injection and sex practices and disease transmission among prisoners and their sex and injecting partners.

Added Karyn: “We would never expect someone having sex to reuse a condom, but every day we force injectors to do the equivalent with dirty needles. We would never require a diabetic to visit a clinic daily in order to obtain their insulin, nor deny them insulin for eating a piece of cake; however, we do the equivalent with people who use drugs when we demand directly-observed methadone and denial of antiretroviral therapy (ART) or even methadone if they do not quit drugs.”

Agrees Dr JVR Prasada Rao, Senior Adviser to Executive Director UNAIDS: “Harm reduction programmes started rather late, initially the [HIV] response was mostly restricted to sex workers and harm reduction programmes for injecting drug users came much later. And [harm reduction] coverage is also very low. Because of very high level of stigma associated with drug use and serious punishment due to criminal laws associated with drug use, it is very difficult for drug users to access services. Unless we do something about the law and its enforcement, the drug users on their own will not come forward to avail the services. This is one of the reasons for the limited coverage of harm reduction. Even if the harm reduction programmes are standard, the law is the biggest impediment as far as injecting drug use is concerned.”

Added Dr Rao: “Injecting drug use is a big problem in this region. The country that has highest number of IDUs is China which has 70% IDUs in this region. Indonesia, Vietnam, Cambodia, Thailand, and many other South East Asian countries have a huge problem of injecting drug use. In South Asia too, India and Pakistan have an increasing problem of injecting drug use. Earlier in India, it used to be mostly concentrated in North-East but now in states of Punjab, Haryana, Delhi, we find a growing injecting drug use problem. In Pakistan, Punjab and Sindh are regions with big problem of injecting drug use. I think China has started well on scaling up harm reduction services. They have a large number of harm reduction programmes both methadone substitution services and needle syringe exchange programmes. India has started too but coverage is very low, and we still have not yet introduced methadone programme because we haven’t been able to get clearance from ministry concerned and methadone is still a banned drug in India.”

There is a Chinese proverb: “The best time to plant a tree was 20 years ago. The next best time is now.” Despite massive efforts to push for decriminalization and legal reforms for supportive AIDS policies for injecting drug users, a lot more remains to be done to save lives, reduce human suffering, prevent HIV and hepatitis C infections and protect human rights. Let’s hope Karyn’s appeal to next ICAAP marks a benchmark where Asian countries report desired progress outcomes for IDUs.

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and recently reported on-site from 10th ICAAP, Busan, South Korea for CNS. She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. Email:, website:

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