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Tuesday 21 April 2009 – DAY TWO –
Daily Update
– 3
Ethics, rights and drug use: why is it so hard?
Those of us working in civil society often readily invoke vague notions of ‘rights’ and ‘abuse’ in our
conversations and presentations, but are frequently less clear about the specific principles
underpinning our activity, writes
Ian Hodgson
of Health and Development Networks, Thailand.
'WE HAVE HAD SIGNIFICANT PROGRESS ON HARM
REDUCTION IN ASIA
, so what has been the regional experience of
scaling up?' asked Mukta Sharma, chairing Monday's plenary
session reviewing drug use and HIV in Asia.
In 2005 coverage of harm reduction in Asia was less than 5 per
cent. Three years on there had been progress, said Anindya
Chatterjee, programme director at the HIV/Aids Asia Regional
Programme. Injecting drug users (IDUs) in 21 countries had been
reached with HIV prevention programmes and one in ten were on oral
stabilisation treatment in nine countries, although needle exchange
programme were still failing to reach more than 20 per cent of IDUs.
Harm reduction was typically part of HIV and Aids plans these
days and national strategies were being joined up: 'There has been
large scale change in the way we do things,' he said.
However there were vital missing pieces that needed to be found.
Services needed better coverage and attendance and quality had to
be improved, from understanding dosages to extending opening
hours. 'Sustainability depends on money, people and the social policy
environment,' commented Mr Chatterjee, adding that it was 'time to
systematically develop the workforce on harm reduction'.
Although Asian harm reduction had come a long way, there was
'quite some way to go', he said. ‘The building blocks are in place but
we need to find ways of scaling up activism – activism has broken
new ground for us', he said.
Tim Brown, senior fellow at the East-West Centre, said a slowing
trend in HIV epidemics in recent years was now showing signs of
reversing, and highlighted countries' 'ongoing failure' to contain
epidemics. Efforts needed to be focused on all members of the
population, he said, as all modes of transmission were active.
'We can reverse Asian epidemics by just doing what works,' he
told delegates, pointing to basic measures like using substitution
programmes to reduce injecting, introducing condom use in sex
work and reducing needle sharing. 'We're making progress but we
have a long way to go.' Targeting at-risk populations had most
impact and was cost-effective, so countries must prioritise their
budgets, he said.
Sujan Jirel from Youth Rise, a network to reduce drug-related
harm, said skilling up on harm reduction was critical not just for drug
users but also for families and communities. 'Reporting systems are
not in place to track effectiveness,' he said, pointing out that young
people were particularly vulnerable and needed school programmes
and peer support.
Services for drug users in Asia were too few, but 'won't improve
unless we are involved,' he stressed. 'Nothing about us without us.'
Harm reduction 'must be scaled up'
Anand Grover, Director of the Lawyers
Collective HIV/AIDS India, speaking at
Monday's opening plenary session about
'the right to health in Asia', reminded
delegates that harm reduction is founded
on strong ethical principles, and advocacy
for drug users to give them the same civil
rights as other citizens must be scaled up to
make sure that harm reduction – in its
broadest sense – reaches all who need it.
The effectiveness of harm reduction is
now undeniable, but for many drug users
across the Asia region, access to services
as low as 2 per cent in some areas. This, for
Grover, is a clear and undeniable contra-
vention of human rights. Examples of the
systematic abuse of many drug users
confirm that legislation in many countries is
based less on individual rights and more on
command and control.
Grover described the imprisonment,
torture, and compulsory treatment meted
out to drug users in India, and may readers
will know of other regions where the
criminalisation of drug use creates a context
where harm reduction is eschewed in favour
of disproportionate punishment. Citing the
principle of proportionality – the notion that
responses should match an action – how
could capital punishment be a response to
simply for possessing a drug?, he asked.
Other examples were shared, and many
working in the field of harm reduction have
their own case studies of people who use
drugs suffering extreme privations from the
state. The value of this presentation is the
reminder that the rights for which we
advocate in civil society – autonomy,
confidentiality, non-disclosure, health,
consensual treatment – are all sound
ethical principles, enshrined in the
Universal Declaration of Human Rights,
which codifies rights for all to physical and
mental health. That drug users are denied
this is simply flawed, and by using a rights-
based approach, can be argued rigorously
and robustly.
Grover closed by reminding us of another
ethical concern – affected people being
simply objects in harm reduction and
advocacy interventions. To prevent this, we
must ensure that 'drug users should not be
the objects, but the subjects of the process'.
As we develop our programmes, policy
interventions and advocacy initiatives, using
a narrative that includes key ethical
principles could add a level of sophistication
that helps prevent glib reiteration of tired
responses to the ongoing threat to human
rights and denial of harm reduction.