Africa: To Help Ensure the End of Aids, Leaders Need to Move Away From Punitive Approaches to People Who Use Drugs

6 June 2024
UNAids (New York)

Geneva — UNAIDS welcomes the recent report by Dr Tlaleng Mofokeng, Special Rapporteur on the Highest Attainable Standard of Physical and Mental Health, which was presented to the 56th session of the UN Human Rights Council. The report, on Drug Use, Harm Reduction and the Right to Health, demonstrates the public health necessity of moving away from punitive approaches to people who use drugs.

Notable, in particular, are three recommendations of the Special Rapporteur's report that are critical to ending AIDS as a public health threat:

Decriminalization of the possession of drugs for personal use.

Ensuring the availability, accessibility, acceptability and quality of harm reduction services for people who use drugs.

Ensuring that peer-led initiatives have the necessary political and policy support and sufficient and stable resourcing.

Currently, many people who inject drugs continue to be left behind by the global HIV response. The risk of acquiring HIV is 14 times higher than it is for the adult population generally. In contrast, countries which have successfully scaled up harm reduction services have seen significant declines in HIV infections among people who use drugs.

Harm reduction services need to be accessible and acceptable to all who use them. Currently, whilst women who use drugs have a higher prevalence of HIV than men who use drugs, harm reduction services are still often not designed with women's particular requirements in mind. As the Special Rapporteur on the Right to Health's report recommends to states: "Design harm reduction services so that they provide suitable environments for women who use drugs, including by providing integrated sexual and reproductive health care, information and services, and childcare".

Law reform is essential because the evidence shows that even when services are available and appropriate, punitive laws obstruct their use. Criminalization of drug use is associated with needle sharing and avoidance of harm reduction programmes, and increased risk of HIV.

Community leadership in programme design is vital for programme effectiveness. As UNAIDS Executive Director Winnie Byanyima noted today at the special side event with Dr Tlaleng Mofokeng: "Barriers to accessing services can only be overcome if the communities living with, affected by and vulnerable to HIV are supported to lead. This includes communities of people who use drugs, sex workers, gay men and other men who have sex with men, transgender people and people living with HIV. We will continue to leave people behind if we do not support communities in the lead in both service delivery and law reform."

Global and national approaches to drug policies are starting to change, and this excellent report by the UN Special Rapporteur on the Right to Health will help accelerate this small but important and growing wave of changes. As this report notes, the FRESH project, for example, is engaging transgender women in harm reduction programming, with UNAIDS support. Kenya is one of the countries which has scaled up services, and currently has more than 10 public opioid agonist therapy programmes and 35 drop-in centres with needle-syringe programmes, as well as take-home naloxone, pre-exposure prophylaxis and HIV self-testing services. This year, the Commission on Narcotic Drugs adopted, for the first time, a resolution recognizing the need for harm reduction.

Punitive approaches have hurt public health, including the HIV response. Evidence-based approaches will help enable the world to end AIDS as a public health threat by 2030. UNAIDS pays tribute to Dr Tlaleng Mofokeng, and stands with communities as they issue a call to leaders worldwide: "Support, don't punish".

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations--UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank--and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

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