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colour, from ethnic minority communities, people who are young – almost
stigmatised from every perspective. And so the response gets even further impeded
by that. It’s a disappointment, given the work that so many people have been doing
– not just people like myself who have done research and policy, but people who
have actually done the hard work of implementing and defending the programmes.’
On the subject of the criminal justice system, one of the biggest campaigning
issues for HRI has been around the death penalty for drug offences. Although
countries like Iran and Saudi Arabia have increased the number of executions,
fewer countries with the death penalty for drugs on their statute books are
actually using it. Is the tide turning?
‘Well, the title of our last report on the death penalty was
The tipping point
,
because we really feel that there is a growing global movement and change of
attitude around the death penalty for drugs. The countries that actually use the
death penalty for drugs are an incredible minority. Some of them are major, huge
countries, obviously, like China and Iran, but the countries that are executing
people for drug offences really are out of step – not only with the international
community as a whole but even with other death penalty states.’
There is also a growing movement against capital punishment for drugs – and
capital punishment generally – even within many of these retentionist countries, he
points out. ‘One of the things we heard when we first started up the death penalty
project – primarily from harm reductionists from the west – was that this was a
Eurocentric approach and “you can’t talk about these issues in countries in Asia”. But
in fact we’re seeing growing and robust debates in countries like Vietnam, China
and Indonesia – not only constitutional court challenges being taken against the
death penalty for drugs, but bills being introduced and debates in parliament. It
certainly shows that it’s a live issue, and that’s obviously an important part of trying
to move political and public opinion against the death penalty.’
*****
Another increasingly important area of work for HRI, with support from UNICEF, is
around injecting drug use and people under the age of 18. Although the numbers
of children injecting worldwide may not be huge they do represent a ‘particularly
vulnerable population and very much an invisible population’, he says. ‘They’re not
only at increased vulnerability because of their age and their injecting behaviours,
but they’re also typically denied access to harm reduction services because of age
restrictions. And what we’re finding is that those young people don’t actually get
recorded anywhere – they even fall between different categories in epidemiology
studies, so you can’t actually quantify them.’
Although harm reduction is now widely recognised as a cost-effective,
evidence-based response, there remains a major funding gap between what’s
needed and what’s available, he states, with many governments still reluctant to
invest in programmes aimed at people who inject drugs.
‘The focus for us on the one hand is on international donors, obviously, but at
the same time they can’t be expected to carry the entire can,’ he says. ‘The other
problem we’re seeing – and it’s a particular problem in the Eurasian region – is that
a lot of countries, as they progress economically and move into middle income
status in terms of their GDP, all of a sudden become ineligible for Global Fund aid
or some of the international aid that they might have been relying on before, not
just in terms of harm reduction programmes but their HIV programmes generally.
So we’re left with a situation where the international donors are pulling out but
the national donors aren’t stepping in, so you have services under threat. There is
that responsibility of national governments to step up as well.’
As well as focusing on the economic case for harm reduction as a cost-effective
public health intervention, one of the aims of this year’s HRI conference was to
provide a platform to reclaim its ‘moral, ethical and philosophical basis’ in the face
of efforts to portray it as a ‘morally suspect, clinical’ response that fails to fulfill
people’s aspirations and potential, he says.
‘We wanted to say that harm reduction obviously works but at the same time
it’s fundamentally based in recognising and respecting the dignity of people who
use drugs, and to try to claim otherwise is just fundamentally wrong. So for us it’s
almost trying to rebrand harm reduction a bit and not surrender that kind of
moral and ethical and value-based ground to the conservative elements of the
recovery agenda.’
There is also often an attempt to suggest that harm reduction likes to propose
itself as ‘the sole approach to providing services for people who use drugs’, he
believes. ‘Clearly none of us argue that. We do a specific and important piece of
the health responses related to drug use, but it’s only a particular specialised
piece that speaks to particular needs. It’s not the entirety of drug services, let
alone the entirety of health and social services, so it’s important that we don’t
allow ourselves to be painted into that.
‘But at the same we need to say very clearly that our services are critical and
essential and life-saving.’
DDN
July 2013 |
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Rick Lines
‘We’re left with a
situation where
the international
donors are pulling
out but the
national donors
aren’t stepping in,
so you have
services under
threat.’
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